Adult Shock Flashcards
Adult Shock - Shock differentials:
Anaphylaxis Pneumothorax Sepsis Traumatic hemorrhage Pulmonary edema
Adult Shock - 1st line treatment
NS 500 mL IV/IO bolus prn, total max 2 L
titrate to systolic BP > 90 mmHg or a MAP >65 mmHg
Adult Shock - 2nd line treatment
Mandatory OLMC
Norepinephrine 0.1 mcg/kg/min to 0.3 mcg/kg/min
titrate to systolic BP > 90 mmHg or a MAP >65 mmHg
Consider additional fluid boluses
Adult Shock - Types of shock
Cardiogenic
Obstructive
Hypovolemic
Distributive
Adult Shock - Define cardiogenic shock
Failure of the heart to pump effectively
Adult Shock - Define obstructive shock
Physical obstruction of the heart or great vessels
Adult Shock - Define hypovolemic shock
Blood and fluid loss diminish the circulating blood volume
Adult Shock - Define distributive shock
Decrease in peripheral vascular resistance (anaphylaxis, neurogenic or sepsis)
Adult Shock - Sepsis criteria
Suspected infection and 2 of the following: Temperature > 38° C Temperature < 36° C Heart rate > 90 bpm Tachypnea > 22 bpm
Adult Shock - Norepinephrine indications
Shock with hypotension refractory to fluid resuscitation
Adult Shock - Norepinephrine dose
Start at 0.1 mcg/kg/min to a maximum 0.3 mcg/kg/min
Titrate to effect, increasing dose as per infusion chart q 3 minutes until improved perfusion
Adult Shock - Norepinephrine EMS contraindications
Mesenteric or peripheral vascular thrombosis
Pregnancy
Profound hypoxia
Hypovolemia
Adult Shock - Norepinephrine administration
Draw 4 mL off and discard from a 250 mL bag of D5W or Normal Saline
Add 4 mg (1mg/mL) norepinephrine to D5W or NS = 16 mcg/mL
Adult Shock - Norepinephrine precautions
Pt taking MAOI or TCA may induce hypertension
Administer into a large vein
