Chapter 12 Flashcards
shock (…) describes a state of collapse and failure of the … system–> in the early stages, the body attempts to maintain homeostasis
shock can occur because of medical/traumatic events
hypoperfusion; cardiovascular
adequate … is required to provide cells with oxygen and nutrients and remove waste products. Any compromise can lead to cellular injury/death
… is a passive process in which molecules move from an area with a higher concentration of molecules to an area of lower concentration –> this is how ox and CO2 cross the walls of the alveoli; the majority of oxygen is carried to the tissues attached to hemoglobin
perfusion; diffusion
CO2 can be transported in the blood from tissues back to the lungs in three ways:
- dissolved in the ..
- combined with water in the form of …
- attached to …
carbon dioxide waste products released from cells can combine with water in the bloodstream to form bicarbonate. once it reaches the lungs, it breaks back down into CO2 and water and CO2 is exhaled
plasma; bicarbonate; hemoglobin
in cases of poor perfusion (shock), transportation of … out of tissues is impaired, resulting in a dangerous buildup of … that may cause cellular damage
CO2; waste products
shock refers to a state of collapse and failure of the cardiovascular system that leads to inadequate … –> to protect vital organs, the body directs blood flow from organs that are more tolerant of low flow (such as the … and …) to organs that cannot tolerate low blood flow (such as the .., …, and …)
circulation; skin; intestines; heart; brain; lungs
cardiovascular system consists of three parts:
… (..)
set of … (… or …)
.. (the …)
pump; heart
pipes; blood vessels; arteries
contents; blood
the pump, container, and content functions can be referred to as the …–> when a patient is in shock, one or more of the three parts is not working properly
perfusion triangle
blood pressure is the pressure of blood within the vessels at any moment in time:
…: peak arterial pressure
…: pressure in the arteries while the heart rests between heartbeats
…. is the difference between the systolic and diastolic pressures
systolic
diastolic
pulse pressure
blood flow through the capillary beds is regulated by the ..., circular muscular walls that constrict and dilate --> under the control of the ... nervous system these respond to other stimuli such as: ... ... the need for ... the need for ...
capillary sphincters; autonomic; heat cold oxygen waste removal
perfusion requires more than just having a working cardiovascular system:
adequate … in the lungs
adequate … in the form of glucose in the blood
adequate .., primarily through the lungs
oxygen exchange
nutrients
waste removal
mechanisms are in place to help support the respiratory and cardiovascular systems when the need for perfusion of vital organs is increased –> these mechanisms include the … and …
the sympathetic side of the autonomic nervous system, responsible for the fight-or-flight response, will assume more control of the body’s functions during a state of …
autonomic nervous system; hormones; shock
the response by the autonomic nervous system causes the release of hormones such as … and … Hormones are triggered when the body senses its … falling, causing an increase in:
..
strength of …
… (in the skin and gastrointestinal tract)
epinephrine; norepinephrine; blood pressure; heart rate; cardiac contractions; peripheral vasoconstriction
the three basic causes of shock are
… failure (cardiogenic/obstructive shock)
poor … function (distributive shock)
low … (hypovolemic shock)
pump; vessel; fluid volume
(cardiogenic shock) caused by inadequate function of the … (pump failure)
a major effect is the backup of … into the …
the resulting buildup of pulmonary fluid is called …
cardiogenic shock develops when the heart cannot maintain sufficient … to meet the demands of the body
heart;
blood; lungs
pulmonary edema
output
(cardiogenic shock) … is the volume of blood that the heart can pump per minute and is dependent on several factors:
heart must have adequate … for the cardiac muscle to contract (myocardial contractility)
the heart must receive adequate … to pump
the resistance to flow in the peripheral circulation must be appropriate
cardiac output
strength;
blood
(obstructive shock) caused by a ... that prevents an adequate volume of blood from filling the ... three of the most common examples: ... .. ...
mechanical obstruction; heart chambers;
cardiac tamponade
tension pneumothorax
pulmonary embolism
(distributive shock) results from widespread ... of small arterioles, small venules, or both the circulating blood volume pools in the expanded vascular beds and ... decreases types of distributive shock: ... shock ... shock ... shock ... shock
dilation; tissue perfusion septic neurogenic anaphylactic psychogenic
… shock results from an inadequate amount of fluid/volume in the circulatory system
hypovolemic
(respiratory insufficiency) a patient with a severe chest injury/airway obstruction may be unable to breathe in an adequate amount of …
…. can lead to tissue hypoxia because there are not enough red blood cells to deliver adequate amounts of oxygen to the cells
oxygen; anemia
(respiratory insufficiency) certain types of poisoning may affect the ability of cells to metabolize/carry oxygen:
… poisoning
… poisoning
CO; cyanide
the stages in the progression of shock:
- … shock
- … shock
- when shock has progressed too far, it is … –> no way to assess when a patient has reached this point; it is imperative to recognize and treat shock early–well before the patient transitions into the decompensated phase
compensated
decompensated
irreversible
… may be the last measurable factor to change in shock –> when a drop is evident, shock is well developed. this is particularly true in infants and children, who can maintain their … until they have blood loss that is more than .. their blood volume. by the time it drops in infants and children who are in shock, they are close to death
blood pressure; blood pressure; half;
expect shock if a patient has any one of the following conditions: multiple severe ... ... or ... injury ... injury a severe ... a major ... ...
fractures abdominal; chest spinal infection heart attack anaphylaxis
primary assessment:
a patient with massive hemorrhage may require a … (or direct pressure dressings) before the airway is opened
if the patient has life-threatening external bleeding it should be addressed …, then the … can be assessed and treated, and then treatments for … provided
tourniquet; first; ABCs; shock
primary assessment contd:
a rapid pulse suggests … shock
in shock/compensated shock, the skin may be …, …, or …
trauma patients with shock, or a suspicious MOI, generally should go to a trauma center
compensated; cool; clammy; ashen
secondary assessment:
repeat primary followed by a focused assessment
perform secondary assessment of entire body if patient:
- is a trauma patient with a significant … or …
- gives you a poor initial …
- has problems shown in primary assessment
- has a … problem but is not ..
- has problems that were not noted in primary assessment
MOI; multiple injuries
general impression
medical; responsive
when treating for shock, place blankets … and … the patient
do not give the patient anything by …
under; over; mouth
treating cardiogenic shock:
the patient who is in shock as a result of a … does not have the power to pump blood throughout the circulatory system
… disease will aggravate cardiogenic shock
usually, patients with this shock do not have any injury, but they may be having ….
they should not receive nitro bc by definition they are …
heart attack; chronic lung; chest pain; hypotensive
with cardiogenic shock, place the patient in a position that … as you give high flow oxygen
eases breathing
treating obstructive shock:
for cardiac tamponade–> increasing … is priority
apply high flow oxygen
… is the only definitive treatment
cardiac output
surgery
treating obstructive shock:
for tension pneumothorax–>
apply … to prevent hypoxia
… is required to relieve pressure in the chest: this is an ALS skill
high flow oxygen; chest decompression
treating septic shock
hospital management is required, including administration of …
use standard precautions and transport
administer … and support ventilations
use … to conserve body heat
notify a specialized … if available to meet the patient in the ED
antibiotics
high flow oxygen
blankets
sepsis team
treating neurogenic shock: emergency treatment: obtain and maintain a proper ... provide ... assist inadequate breathing conserve ... ensure most effective ... possible transport patient to facility capable of managing spinal injuries
airway; spinal immobilization ; body heat; circulation
treating anaphylactic shock:
administer …
promptly transport
provide … and ventilatory assistance
a mild rxn may worsen suddenly/over time
try to find out what agent caused the rxn and how it was received
epinephrine; high flow ox
treating psychogenic shock:
in uncomplicated cases of fainting, brain circulation is restored as the patient becomes ..
can worsen other types of shock
if the patient falls, check for injuries
if the patient reports being unable to … after a fall, suspect another problem
all patients with loss of consciousness should be transported to the ED for evaluation even if they appear normal once you arrive on scene
supine; walk
treating hypovolemic shock:
control all obvious …
keep patient warm
recognize … and provide aggressive support
secure and maintain an airway and provide respiratory support
external bleeding; internal bleeding
