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Phys: Cardio > Circulatory Shock > Flashcards

Circulatory Shock Flashcards

1
Q

Define Circulatory shock

A

Inadequate tissue perfusion due to inadequate cardiac output

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2
Q

What are the types pf shock?

A
  1. Cardiogenic Shock: usually MI or arrythmias
  2. Hypovolemic Shock: hemorrhage
  3. Obstructive Shock: tension pneumo
  4. Distributive Shock
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3
Q

What are the types of distributive shock?

A
  1. Septic shock- (most common)
  2. Neurogenic shock
  3. Anaphylactic shock
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4
Q

What are the characteristics of compensated shock?

A
  1. BP stable
  2. CO less than or equal to nl
  3. inc Sympathetic activity to maintain BP
    - Cerebral and coronary arteries are not constricted yet
    - MAP less than 60-70 mmHg triggers vasoconstriction
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5
Q

What are the characteristics of progressive shock?

A
  1. SBP less than 90 mmHg

2. dec CO faster than dec BP

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6
Q

WHat is the cycle involved in progressive shock?

A
  1. Arterial pressure dec leads to coronary blood flow dec leads to myocardial ischemia leads to poor perfusion, and sludging of blood
  2. Medulla oblongata failure d/t ischemia*
  3. Lactic acid inc and leads to Metabolic acidosis
    A. Release of various toxins by ischemic tissues
    Generalized cellular deterioration leads to Tissue necrosis
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7
Q

What can reverse progressive shock?

A

Medical interventions can reverse this scenario

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8
Q

What are the characteristics of irreversible shock?

A
  1. CO & BP dec despite treatment, leading to DEATH

2. ATP depleted due to hypoxia

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9
Q

What are the sxs of shock?

A 
1. Altered mental status
A. Agitated, confused, lethargic or comatose
2. Hypotensive
3. Tachycardic
4. Palpitations
5. Dyspnea
6. Chills
7. Oliguric
8. +/- diaphoresis
9. Pallor
10. Cool, clammy skin
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10
Q

What are the vital signs asst. with shock?

A
  1. SBP < 90 mmHg or MAP < 60-70 mmHg
  2. Tachycardic (except in neurogenic shock)
  3. Weak, thready pulse
  4. +/- tachypnea
  5. +/- temp changes
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11
Q

What tests can be performed on a pt suspected with shock?

A
  1. EKG
  2. CXR
  3. CBC w/ diff
  4. CMP
  5. Accucheck
  6. ABG
  7. Lactate level
  8. PT, PTT
  9. BC x 2 (if suspect septic)
  10. UC
    11, Culture of suspected foci (sepsis)
  11. Type and crossmatch (if indicated)
  12. Echo/TEE (if indicated)
  13. Trop, CK MB
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12
Q

How is shock managed?

A
  1. ABC’s intubation and mechanical ventilation
  2. Central venous catheter (CVC) placement for FLUID and med infusion
    A. Volume replacement is critical
  3. Arterial line (Swan Ganz)
  4. Foley catheter
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13
Q

What are the indications for placement of a central venous catheter?

A
  1. Administration of noxious medications
    A. Such as vasopressors, chemotherapy, and parenteral nutrition are given by because they can cause vein inflammation (phlebitis) when given through a peripheral intravenous catheter.
  2. Hemodynamic monitoring allows measure of the CVP
  3. Hemodialysis
  4. Poor peripheral venous access
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14
Q

Define cardiogenic shock

A
  1. Low output cardiac failure resulting from inadequate cardiac pumping
  2. Vicious cycle which is difficult to change
  3. In ischemic heart, SBP 80-90 mm Hg can set off vicious cycle cardiac deterioration
    A. Most common cause- MI
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15
Q

What is the most common cause of shock in a hospital setting?

A

Most common cause of shock in hospital setting

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16
Q

What is the prognosis for cardiogenic shock?

A
  1. Often a patient dies of cardiogenic shock before normal compensatory mechanisms begin
  2. Survival rate often less than 15%
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17
Q

What is the tx for cardiogenic shock?

A
  1. Treatment includes inotropic drugs and pressors

2. ECMO: extracorporeal membrane oxygenation machine

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18
Q

What are the causes of hypovolemic shock?

A
  1. Intestinal obstruction
  2. Severe burns
  3. Dehydration
  4. Trauma
  5. Hemorrhage
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19
Q

How does intestinal obstruction cause hypovolemic shock?

A
  1. Intestinal distension partly blocks vascular flow in intestinal wall
  2. Results in inc capillary pressure, which leads to fluid leaks into interstitial spaces and intestinal walls/lumen
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20
Q

What are the causes of neurogenic shock?

A
  1. Traumatic spinal cord injury
  2. Deep general anesthesia
    A. Depresses vasomotor center
  3. Spinal anesthesia
    A. Blocks sympathetic nervous outflow tract
  4. Brain damage involving the medulla
    A. Causes vasomotor dysfunction (SNS is not compensating)
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21
Q

What is neurogenic shock a subtype of?

A

Distributive shock

22
Q

What are the sxs of neurogenic shock?

A 
1. Hypotension without compensatory tachycardia
A. Low BP
B. Oliguria
C. Altered mental status
D. Cool and mottled extremities
23
Q

How does anaphylaxis lead to shock?

A 
1. Severe systemic allergic rxn
A. Dec CO & dec SBP
-Results from antigen-antibody reaction
2. Leads to histamine release and vasodilation
A. dec venous return to heart
B. dec arterial pressure
3. Increased capillary permeability
A. Leads to rapid fluid loss & protein in interstitial spaces  and EDEMA
24
Q

Define septic shock

A

Shock secondary to disseminated bacterial infection

25
Q

What is the second most common type of shock in hospital pts?

A

Septic shock

26
Q

What are common causes of septic shock?

A
  1. Disseminated strep or staph skin infection
  2. Peritonitis secondary to uterine/fallopian tube infection
  3. Peritonitis secondary to rupture of organ(s) of gastrointestinal system
  4. Disseminated gangrenous infection
  5. Urosepsis
27
Q

What is the shock position?

A

Trendelenburg with the neck turned to one side if no neck injury suspected

28
Q

How are the ABCs managed in shock?

A
  1. ABC’s
    A. intubation and mechanical ventilation
  2. Oxygen
29
Q

How are fluids replaced in a shock pt?

A
  1. Aggressive fluid resuscitation
    A. CVC for infusion of fluids and hemodynamic measuring
    CVP
    B. 18 mm Hg suggests volume overload, HF, tamponade, pulmonary HTN
    D. Treatment aimed at CVP 8-12 mm Hg
30
Q

What other tx methods are necessary in shock?

A
  1. Foley catheter
  2. Monitor I/O’s
  3. Cardiac monitor/ Telemetry
  4. Replace fluids, if severe thrombocytopenia, give platelets (to prevent DIC)
31
Q

What type of transfusion is indicated after hemorrhage?

A

Whole blood

32
Q

What type of transfusion is indicated after shock secondary to plasma loss?

A

Fresh frozen plasma

33
Q

What type of transfusion is indicated after shock secondary to dehydration?

A

If shock secondary to dehydration, administer appropriate isotonic crystalloid
A. 0.9% Normal saline (IV NS)
B. Lactated Ringer’s (IV LR)

34
Q

When are vasopressors and iontropic agents indicated in shock?

A

Administered only after fluid resuscitation and PCWP = 15-18 mmHg

35
Q

What is the function of vasopressors?

A
  1. Support vasomotor tone

2. If persistent hypotension after volume resuscitation

36
Q

What is the function of inotropic agents?

A
  1. Improve contractility

2. Goal to  MAP  60 mmHg

37
Q

When are abx used in shock tx?

A

Empiric broad spectrum abx after obtaining cultures for pts with septic shock

38
Q

When are corticosteroids used in shock tx?

A

Treatment of choice in pts with shock secondary to adrenal insufficiency and anaphylactic shock for edema

39
Q

What are sympathomimetic drugs?

A

Inotropic agents
Drug that mimics sympathetic stimulation:
-epinephrine & norepinephrine

40
Q

When are sympathomimetics used to treat shock?

A
  1. Used when increased vasoconstriction is required
  2. Beneficial when treating:
    A. Neurogenic shock
    B. Septic shock
    C. Anaphylactic shock
41
Q

What is the sympathomimetic drug of choice used for treating septic shock?

A

Norepi

42
Q

What is the sympathomimetic drug of choice used for treating anaphylactic shock?

A

Epinephrine drug of choice

43
Q

What are the two most commonly used vasopressive agents?

A
  1. Dopamine

2. Dobutamine

44
Q

What is dobutamine’s moa and what is it used for?

A
  1. Predominantly β-adrenergic agonist

2. First line for cardiogenic shock

45
Q

What are the physiological effects of dobutamine?

A

Increases contractility

Decreases afterload

46
Q

What receptors does a low dose of dopamine target? What physiological effects does this low does have?

A
  1. Low dose (2-5 mcg/kg/min) stimulates dopaminergic and β-adrenergic receptors
  2. Increases GFR, HR & contractility
47
Q

What receptors does a medium dose of dopamine target? What physiological effects does this medium dose have?

A
  1. Medium dose (5-10 mcg/kg/min) β1-adrenergic receptors effects predominate
  2. Increases HR & contractility
48
Q

What receptors does a high dose of dopamine target? What physiological effects does this high dose have?

A
  1. High dose (> 10 mcg/kg/min) alpha adrenergic effects predominate
  2. peripheral vasoconstriction
49
Q

What abx is used for suspected pyelo?

A
  1. Gentamicin and

2. Fortaz or Zosyn

50
Q

What abx is used for suspected community acquired pneumonia?

A
  1. Ceftriaxone

2. Zithromax

51
Q

What abx is used for suspected GI source of bacterial infection?

A
  1. Vancomycin

2. Zosyn

Phys: Cardio (6 decks)

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