Cardiac Flashcards
Early signs of shock
Normal BP Increased HR Normal skin color Cool/moist skin Anxious Increased rate and depth of respirations
Late signs of shock
Systolic BP below 90 Pulse increased rate and weak Pale/cold skin Coma Increase respiration rate and shallow
What happens to the BP throughout the stages of shock?
Normal
Systolic less than 90 (requires fluids to support BP)
Required mechanical or pharmacological support
What happens to HR throughout the stages of shock?
> 100
> 150
Erratic
What happens to the respiratory system throughout the stages of shock?
> 20
Rapid, shallow respirations, crackles. Pa02 <80. PaCO2> 45
Requires intubation and vent
what happens to urinary output throughout the stages of shock?
Decreased
Less than 0.5ml/kg/h
Anuric; requires dialysis
What happens to mental status throughout the stages of shock?
Confusion and or agitation
Lethargy
Unconscious
Acid-base balance throughout the stages of shock
Respiratory Alkalosis
Metabolic Acidosis
Profound Acidosis
The first step to treating shock
Apply Oxygen
Hypovolemic shock
Oxgen Stop bleeding with pressure Meds to stop d/v Start 2 large gauge IVs Insert foley Position legs ^^
Cardiogenic Shock
Usually after MI and heart damage Treat oxygen needs Therapeutic hypothermia Arterial Line Limit further damage Labs- BNP, cardiac enzymes, lactate. EKG Meds- Positive inotropics (dobutamine/dopamine) Vasodialtors (nitro) Intra-aortic balloon pump
Distributive Shock
Intravascular volume pools in peripheral blood vessels
Massive arterial and venous dilation promotes the pooling
Pooling of blood, decreased venous return, SV, CO, BP and tissue perfusion
Sepsis
Whole body response Treat Strep! HR above 90 RR above 20 WBC abouve 12 or below 4 Temp above 101 Change in mental status elevated glucose
Can lead to a life threatening emergency
Neurogenic Shock
Any damage above T5 Decreased CO and HR Decreased BP Edema Loss of temp control Warm, dry skin Keep HOB 30 degrees if given anesthesia
Anaphylactic Shock
Insect stings Medication reaction Food allergy Rapid onset Decreased BP EPI IM injection Benadryl Nebulized meds
Multiple Organ Dysfunction Syndrome
MODS
Progression from SIRS to sepsis to severe sepsis to septic shock to MODS
Mortality rate increases with severity of sepsis
Dyspnea and resp failure
IV fluids and vaseoactive to support BP and CO
Hyperglycemia
Increased BUN
Myocardial Perfusion
Coronary artery blood flow to the myocardium occurs primarily during diastole
Mean Arterial Pressure (MAP)
Has to be at least 60 in order to maintain adequate blood flow and tissue perfusion through coronary arteries
Cardiac Output (CO)
4-7
Amount of blood pumped from the left ventricle each min
CO=HRxSV
Elevated Preload
Crackles in lungs Jugular vein distension Hepatomagaly Peripheral edema Taut skin tugor
Decreased Preload
Poor skin turgor
dry mucous membranes
Elevated Afterload
Cool extremities
Weak peripheral pulses
Decreased Afterload
Warm extremities
Bounding peripheral pulses
What is preload
Volume of blood in ventricles at end of diastole
Increased in hypervolemia, HF, regurgitation of cardiac valves
