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EMT > Ch 12 Shock > Flashcards

Ch 12 Shock Flashcards

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1
Q

Cyanosis

A

Blue skin discoloration that is caused by a reduced level of oxygen in the blood

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2
Q

Decompensated Shock

A

The late stage of shock when blood pressure is falling

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3
Q

Dehydration

A

Loss of water from the tissues of the body, may cause or aggravate shock

Very young or old patients are particularly susceptible

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4
Q

Distributive Shock

A

A condition that occurs when there is widespread dilation of the small arterioles, small veins, or both

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5
Q

Edema

A

The presence of abnormally large amounts of fluid between cells in the body tissues, causing swelling of the affected area

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6
Q

Homeostasis

A

A balance of all systems of the body

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7
Q

Hypothermia

A

A condition in which the internal body temperature falls below 95 degrees F (35 C)

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8
Q

Hypovolemic Shock

A

Shock caused by fluid or blood loss

Injuries involving bleeding may result in hemorrhagic shock, while vomiting and diarrhea may result in non-hemorrhagic shock

Also occurs with severe thermal burns (loss of intravascular plasma), and crushing injuries

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9
Q

Myocardial Contractility

A

The ability of the heart muscle to contract

As volume of blood increases, precontraction pressure builds and muscles stretch, as the muscles stretch, contractility increases

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10
Q

Neurogenic Shock

A

Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation; seen in patients with spinal cord (especially upper cervical levels) injuries

The muscles of the walls of blood vessels are cut off from the sympathetic nervous system, allowing them to dilate widely and causing blood to pool

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11
Q

Obstructive Shock

A

Shock that occurs when there is a block to blood flow in the heart or great vessels causing an insufficient blood supply to the body’s tissues

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12
Q

Perfusion

A

The flow of blood through body tissues and vessels

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13
Q

Pericardial Effusion

A

A collection of fluid between the pericardial sac and the myocardium; may lead to cardiac tamponade

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14
Q

Preload

A

The precontraction pressure in the heart as the volume of blood builds up

As preload increases, the volume of blood coming into the heart increases, which causes the muscles to stretch

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15
Q

Psychogenic Shock

A

Shock caused by a sudden, temporary reduction in blood supply to the brain that causes fainting (syncope)

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16
Q

Pulmonary Embolism

A

A blood clot that breaks off from a large vein and travels to the blood vessels of the lung, causing obstruction of blood flow

Backup of blood in the left ventricle leads to catastrophic obstructive shock and complete pump failure

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17
Q

Pulse pressure

A

the difference between the systolic and the diastolic pressures

Signifies the amount of force the hear generates with each contraction; a pulse pressure of < 25 mm Hg may be seen in patients with shock

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18
Q

Sensitization

A

Developing a sensitivity to a substance that initially caused no allergic reaction

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19
Q

Septic Shock

A

A complex type of shock caused by severe infection, usually a bacterial infection

Vessel walls leak and are unable to contract well; widespread dilation and plasma loss result in shock

Insufficient volume + leaked fluid often collects in the respiratory system + vasodilation

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20
Q

Shock

A

A condition in which the circulatory system fails to provide sufficient circulation to enable every body part to perform its function; also called hypoperfusion

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21
Q

Sphincters

A

Circular muscles that encircle and, by contacting, constrict a duct, tube or opening

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22
Q

Syncope

A

Fainting or transient loss of consciousness that occurs when blood pools in dilated vessels, reducing the blood supply to the brain, resulting in the brain ceasing to function normally and the patient faints

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23
Q

In the early stages of shock the body will

A

Attempt to compensate by maintaining homeostasis

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24
Q

Systemic circulation

A

Carries oxygen-rich blood from the left ventricle through the body and back to the right atrium

Blood passes through the tissues and organs, delivering oxygen and nutrients

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25
Q

Oxygen diffuses through ______ into the bloodstream

A

The walls of the alveoli

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26
Q

If Oxygenated blood is not properly circulated

A

Cell death may occur

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27
Q

Diffusion

A

A passive process in which molecules move from an area of higher concentration to an area with a lower concentration

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28
Q

Carbon Dioxide can be transported in the blood from tissues back to the lungs in three ways

A
  1. dissolved in the plasma
  2. combined with water in the form of bicarbonate
  3. attached to hemoglobin
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29
Q

Bicarbonate

A

Concentrations become higher as as more carbon dioxide is produced and blood moves toward the lungs

Breaks back down to carbon dioxide and water and carbon dioxide is exhaled

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30
Q

The transportation of carbon dioxide out of the tissues will become impaired in cases of

A

Shock

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31
Q

To compensate for shock

A

The body directs blood flow away from organs that are more tolerant to low flow (ex: Skin and intestines) to organs that cannot tolerate low flow (ex: heart, brain, lungs)

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32
Q

Perfusion triangle

A 
Heart (pump)
Blood vessels (container function)
Blood (content function) - vehicle for oxygen, fight infection, clotting,
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33
Q

Clotting

A

Clots forms for retention of blood due to blockage in circulation (blood stasis), changes in the vessel walls (such as a wound) and the bloods ability to clot (as a result of disease process or medication)

Important to control blood loss, HOWEVER, clots are unstable and prone to rupture because blood keeps moving as a result of pressure generated by the contractions of the heart and actions of vessels

34
Q

Blood pressure

A

Is a rough measure of perfusion; carefully controlled by the body so that there is always sufficient circulation or perfusion

35
Q

Capillary hydrostatic pressure

A

Tents to force fluids through capillary walls

36
Q

Interstitial fluid hydrostatic pressure

A

Pushes fluid back into the cells

37
Q

Blood flow through capillary beds is regulated by

A

Capillary sphincters

38
Q

Capillary sphincters

A

Controlled by the autonomic nervous system and respond to stimuli such as heat, cold, need for oxygen, need for waste removal

39
Q

Regulation of blood flow is determined by

A

Cellular need and is accomplished by vessel constriction/dilation

40
Q

Perfusion requires

A

A working cardiovascular system
Adequate oxygen exchange in the lungs
Adequate nutrients in the form of glucose in the blood
Adequate waste removal

41
Q

Adequate ventilation and oxygenation are primary concerns because

A

Carbon dioxide is one of the primary waste products of cellular metabolism (work) and is removed through the lungs

42
Q

Causes of pump failure

A

Heart attack, trauma to the heart, obstructive causes (large pulmonary embolus)

43
Q

Causes of low fluid volume

A

Trauma to the vessels or tissues, fluid loss from the GI tract (vomiting/diarrhea can also lower the fluid component of blood)

44
Q

Causes of poor vessel function

A

Infection, drug overdose (narcotic), spinal cord injury, anaphylaxis

45
Q

The ____ side of the autonomic nervous system, which is responsible for the fight-or-flight response, will assume more control of bodily functions during shock

A

Sympathetic

46
Q

The response of the autonomic nervous system releases

A

Epinephrine and norepinephrine, which cause changes in certain body functions (increase HR, strength of cardiac contractions), vasoconstriction in nonessential areas (skin and GI tract), which maintains pressure in the system and sustain perfusion of vital organs

47
Q

The parasympathetic nervous system

A

Sends signals to the cardiac, smooth and glandular muscles

48
Q

It is important to understand the underlying processes of shock and its causes because

A

Shock is a complex physiologic process that gives subtle signs of its presence before it becomes severe

49
Q

Cariogenic Shock

A

A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can be a severe complication of a large MI as well as other conditions

A major effect is blood backup into the lungs - pulmonary edema

50
Q

Afterload

A

The force or resistance against which the heart pumps

As afterload increases, cardiac output decreases

Increased afterload may cause the heart to overwork and is often a reason heart failure develops in patients with hypertension

51
Q

Anaphylactic Shock

A

An extreme, life-threatening, systemic allergic reaction that may include shock and respiratory failure; Widespread vascular dilation, increased permeability and bronchoconstriction

May occur quickly or as a second phase reaction 1-8 hours after the initial reaction

52
Q

Aneurysm

A

A swelling or enlargement of a part of an artery, resulting from weakening of the arterial wall

53
Q

Autonomic nervous system

A

The part of the nervous system that regulates involuntary activities of the body, such as heart rate, blood pressure and digestion

54
Q

Cardiac tamponade

A

Compression of the heart as the result of buildup of blood or other fluid in the pericardial sac, leading to decreased cardiac output

May be caused by blunt or penetrative trauma that causes hemorrhage around the heart

May also be seen in patients with cancer and autoimmune diseases

55
Q

Compensated Shock

A

the early stage of shock, in which the body can still compensate for blood loss

56
Q

Cardiac output is dependent on

A

Adequate strength to contract

Adequate blood to pump

57
Q

Three most common examples of obstructive shock

A

Cardiac tamponade
Tension pneumothorax
Pulmonary embolism

58
Q

Signs and symptoms of cardiac tamponade

A

Beck’s triad: the presence of JVD, muffled heart sounds, and narrowing pulse pressure

59
Q

Tension pneumothorax

A

Damage to the lung tissue allows air into the chest cavity and begins to shift the chest organs toward the uninjured side; the lung collapses if left untreated and accumulated air will begin to apply pressure to the structures in the mediastinum (heart and great vessels)

Vena Cava loses its ability to stay fully expanded, leading to reduced blood return to the right side of the heart

60
Q

Signs and symptoms of tension pneumothroax

A

Dropping blood pressure
Patient becomes anxious and short of breath
HR and RR increases and becomes shallow
Difficulty when attempting to ventilate with a BVM
Affected side will have decreased or absent lung sounds
Cyanosis
Tracheal deviation (Late sign)

61
Q

Four most common types of distributive shock

A

Septic shock
Neurogenic shock
Anaphylactic shock
Psychogenic shock

62
Q

Signs and symptoms of neurogenic shock

A

Absence of sweating below the level of injury
Normal and low heart rate in the presence of hypotension
Normal warm skin

63
Q

Microcirculation

A

True capillaries branch off the arterioles and allow for exchange between cells and circulation

Main function is the regulation of blood flow and tissue perfusion, blood pressure, tissue fluid, delivery of oxygen, removal of carbon dioxide and the regulation of body temperature

64
Q

Signs and symptoms of anaphylactic shock

A 
Upper airway constriction
Tightness in chest, persistent dry cough
Wheezing, dyspnea, cessation of breathing
Weak pulse
Drop in blood pressure
Cyanosis (late sign)
Edema (especially face, tongue, neck)
Hives
Abdominal cramping
Altered mental status
Nausea
And more...
65
Q

Anemia

A

Abnormally low Red blood cell numbers

May be the result of chronic or acute bleeding, deficiency in vitamins/minerals, or part of an underlying disease process

Tissues may become hypoxic because blood is unable to deliver adequate amounts of oxygen to tissues even if the hemoglobin is fully saturated

66
Q

When shock has progressed too far

A

It is irreversible and there is no way to assess if a patient has reached that point

67
Q

Blood pressure and shock:

A

The last measurable change in shock and at this point, shock may be well developed, particularly for infants

68
Q

Expect shock in patines with any one of the following conditions

A 
Multiple severe fractures
Abdominal or chest injury
Spinal injury
A severe infection
A major heart attack
Anaphylaxis
69
Q

_____ will alert you to the presence of evolving shock and allow you to expedite transport and begin immediate treatment

A

Monitoring vital signs evert 5 minutes

70
Q

Signs and symptoms of compensated shock

A 
Agitation
Anxiety
Restlessness
Feeling of impending doom
Altered mental status
Weak, rapid (thready), absent pulse
Clammy skin
Pallor, with cyanosis about the lips
Shallow, rapid breathing
Air hunger
Nausea/vomiting
Capillary refill > 2 seconds in infants/children
Marked thirst
Narrowing pulse pressure
71
Q

Signs and symptoms of decompensated shock

A 
Falling blood pressure (systolic 90 mm Hg or lower in adults)
Labored or irregular breathing
Ashen, mottled or cyanotic skin
Thready or absent peripheral pulses
Dull eyes, dilated pupils
Poor urinary output
72
Q

Treatment for cardiogenic shock

A

Position of comfort (typically semi-sitting)
High-flow oxygen
Assist ventilations
Transport promptly and consider ALS
Patients should NOT receive nitroglycerin because by definition they are hypotensive

73
Q

Treatment for obstructive shock

A

ALS to assist and/or rapidly transport
High-flow oxygen

Dependent on cause:
Cardiac tamponade - the only definitive care is surgery
Tension pneumothorax - non-rebreather mask, cautious application of positive pressure ventilation, Chest decompression (ALS)

74
Q

Treatment for septic shock

A 
Prompt transport
High-flow oxygen
Assist ventilations to maintain tidal volume 
Keep patient warn
Consider ALS
75
Q

Treatment for neurogenic shock

A 
Patients will often require a long hospitalization 
Secure/maintain airway
Spinal immobilization
Assist ventilations
High-flow oxygen 
Preserve body heat
Prompt transport
Consider ALS
76
Q

Treatment for anaphylactic shock

A 
Manage the airway
Assist ventilations
High-flow oxygen
Determine cause
Assist administration of Epi
Prompt transport
Consider ALS
77
Q

Treatment for psychogenic shock

A 
Determine duration of unconsciousness 
Position patient supine
Record initial vital signs/mental status
Suspect head injury if the patient is confused, slow to regain consciousness, or unable to walk
Prompt transport
78
Q

Treatment for hypovolemic shock

A 
Secure airway
Assist ventilations
High-flow oxygen
Control external bleeding 
Recognize internal bleeding and provide aggressive general support
Keep warm
Prompt Transport
Consider ALS
79
Q

Treatment for respiratory insufficiency

A 
Secure/maintain airway
Clear mouth and throat of any obstructions, including mucus, vomit, FB
Assist ventilations
High-flow oxygen
Prompt Transport
80
Q

Treatment for shock in older patients

A

May have more serious complications than younger patients; Medications may mask or mimic signs of shock

Be alert for higher resting HR and irregular pulse
Be alert for higher RR, lower tidal volume, decreased gag reflex
Remember dentures may cause airway obstruction
Remember thinner, drier, less elastic, fragile skin – need for thermal regulation
Renal system decreased function
Slower gastric emptying

EMT (25 decks)

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