CR IV - Shock Block Flashcards
What is the definition of shock?
The cardiovascular system cannot effectively regulate arterial pressue
What are the 4 main classifications of shock?
Hypovolemic
Obstructive
Cardiogenic
Distributive
What are 4 main causes of hypovolemic shock? What specific problems cause each?
Hemorrhagic - trauma, GI, retroperitoneal
Increase vascular capacitance - sepsis, anaphylaxis, toxin/drugs
Fluid depletion - External fluid loss - dehydration, vomiting, diarrhea, polyuria
Interstitial fluid redistribution - thermal injury, trauma, anaphylaxis
If volume loss is 10%, what clinical sign do you typically see? 20-25%? >40%?
10% - tachycardia
20-25% - failure to compensate - hypotension, orthostasis, decreased CO
>40% - overt shock, pass out and cannot waken up
What can cause left heart obstructive shock? Right heart? Another main cause?
LH - aortic disection
RH - PE
Increased intrathoracic - tension pnemothorax
What should be done in all pregnant women presenting with shock symptoms?
Roll onto left side to open up IVC
What is obstructive shock? How does that differ from cardiogenic shock?
Obstructive - impaired filling/preload, low CO
Cardiogenic - cardiac pumping failure due to muscle issue
What are some major causes of cardiogenic shock?
MI (or hibernating) Myocardial contusion Septic myocardial depression Cardiac tamponage Arrythmias Pharmogenic
What is distributive shock? What are 4 majors causes?
Inappropriate peripheral vasodilation Septic Toxic Shock Anaphylaxis Neurogenic toxic shock - injury to spinal cord decreases sympathetic outflow
What do all types of shock lead to?
Decreased CO
Define sepsis
The body’s disregulated response to in infection or superantigen
Are all infections sepsis?
No
What is the most common cause of sepsis?
Bacterial
What do gram negatives have that are considered triggers for sepsis? Gram positives (more than 1)?
Gram negatives - LPS (endotoxin)
Gram positives - exotoxin, superantigen and TSST for S. Aureua, superantigen Spe A for S Pyogenes
What are 5 main pro inflammatory cytokines released during septic shock?
IL 1,2,6, TNFalpha, and IFN gamma
What two factors in the body rapidly decline in sepsis? What does this cause?
Antithrombin and aPC (activated protein C)
Causes hypercoaguable state
What does an increased S1P3:S1P1 ratio indicate?
Fluid is able to leak out of the endothelium between tight junctions - sepsis
What is the definition of Sepsis under the updated SIRS? What are the clinical criteria?
Life-threatening organ dysfunction caused by disregulated host response to infection
Clinical - suspected or documented inffection + acute increase of >=2 SOFA Points
What is the quick SOFA score? What does it tell you at 0, 1, and >= 2 points?
SOFA - RR>22, sBP<100, Altered GCS
0 points - mortality <1%
1 point = mortality 2-3%
>=2 points - mortality >10%
What is the definition of Septic Shock in the 2015 updated SIRS?
Subset of sepsis in which underlying circulatorya nd cellular/metabolic abnormalities are profound enough to substantially increase mortality (aka don’t respond to fluids)
What clinically will be seen in someone with septic shock?
Sepsis + vasopressor therapy needed to evaluate
MAP < 65 + lactate > 2 despite adequate fluid resuscitation
What are 3 places that must be checked for source of infection for sepsis?
Lung, abdomen, urinary tract
What is the most common cause of adult community acquired pneumonia? Neonate? In hospital?
Adult - s. pneumoniae
Neonate - group B strep, E. Coli
Hospital - S. Aureua, gram-, pseudomonas
What are two main causes of abdomen initiated sepsis?
E. COli or bacteroides fragilis