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critical care > distributive shocks > Flashcards

distributive shocks Flashcards

1
Q

distributive shocks are characterized by…

A

massive vasodilation

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2
Q

3 types of distributive shocks

A
  • neurogenic
  • anaphylactic
  • septic
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3
Q

describe neurogenic shock

A

Rare and usually transitory
Massive dilation of blood vessels as a result of the loss of sympathetic tone

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4
Q

causes of neurogenic shock

A

Injury to spinal cord
Spinal anesthesia
Emotional stress, severe pain or drug overdose

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5
Q

clinical manifestations of neurogenic shock

A

Hypotension
Bradycardia
Hypothermia

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6
Q

treatment of neurogenic shock

A

Treat or remove cause
Volume replacement
Vasopressors

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7
Q

descrieb anaphylactic shock

A

Characterized by massive dilation and increased capillary permeability
“Antigen-Antibody” reaction
Release of vasoactive substances

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8
Q

what does histamine do in anaphylactic shock

A

Causes vasodilation
Decreased vascular resistance
Decreased BP

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9
Q

what does serotonin do in anaphylactic shock

A

Increased capillary permeability
Decreased circulating blood volume
Decreased BP

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10
Q

what are some causes of anaphylactic shock

A

Drugs
Contrast media
Blood and blood products
Insect bites or stings
Foods

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11
Q

signs and symptoms of anaphylactic shock

A

Pruritis
Erythema
Urticaria
Angioedema
Laryngeal edema
Hypotension

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12
Q

treatment of anaphylactic shock

A

PREVENTION!
Remove antigen
Reverse effects of vasoactive substances
Maintain airway – intubation
Corticosteroids
Fluid resuscitation
May need + inotropes and/or vasopressors

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13
Q

what is sepsis

A

Life-threatening organ dysfunction due to a dysregulated host response to infection

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14
Q

what is septic shock

A

sis plus hypotension not responsive to fluid resuscitation, along with perfusion abnormalities

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15
Q

clinical signs of sepsis

A

Change in mental status (GCS < 15)
Tachypnea (RR > 22)
Hypotension (SBP < 100)
Tachycardia
Fever (or hypothermia)
Fatigue, malaise, chills
Nausea and/or vomiting
Increased WBC with left shift (or decreased)

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16
Q

early recognition of sepsis

A

Vitals
- SIRS criteria v. qSOFA

Labs
- Lactate
- Coags
- Liver function
- Renal function
- Procalcitonin

17
Q

QSOFA utilizes 3 criteria, what are they

Identifies patients with suspected infections

A

1 point low BP (<100 mmHg)
1 point altered mentation (GCS<15)
1 point high respiratory rate (>22 bpm)

18
Q

SIRS criteria

A

Temp > 38 degrees C
Heart rate > 90 beats/min
RR > 20 or PaCO2 < 32
WBC > 12,000 or >10% bands (immature)

2 or more = SIRS

19
Q

describe SIRS

A

Systemic inflammatory response syndrome

Complex system in place throughout the body to localize inflammation
Inflammation, thrombosis & fibrinolysis
Can occur for other reasons (other types of shock, trauma, surgery)

20
Q

whos at risk for sepsis

A

Although everyone is at risk for developing sepsis from minor infections, it is more likely to develop in people who:

are very young or old
have a weakened immune system
have wounds/injuries from burns/trauma
have addictive habits
have IV’s, foleys, wound drainage, etc.

21
Q

name some HAIs

A

Central line associated bloodstream infections (CLABSI)
Catheter-associated UTIs (CAUTI)
Surgical site infections (SSI)
Ventilator-associated pneumonia (VAP)

22
Q

central line bundle

A

Proper hand hygiene
Maximum barrier precautions upon insertion
Chlorhexidine skin antisepsis
Avoidance of the femoral vein
Daily review of line necessity with prompt removal of unnecessary lines

23
Q

describe diagnosing the source of sepsis

A

Appropriate cultures
- Urine, sputum, wound

Blood cultures
- Minimum 2 cultures
- 1 percutaneous
- 1 from each vascular access > 48 hrs.

24
Q

when should blood cultures be obtained?

After administering the antibiotic
After obtaining the urine culture
After giving the patient prn Tylenol
Before administering the antibiotic

A

Before administering the antibiotic

25
Q

1hr resuscitation bundle for sepsis and septic shock

A

Measure lactate level

Obtain blood cultures prior to administration of antibiotics

Administer broad spectrum antibiotics
Begin rapid administration of 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L

Apply vasopressors if hypotensive during or after fluid resuscitation to maintain a mean arterial pressure ≥ 65 mm Hg

Remeasure lactate if initial lactate elevated (>2mmol/L)

26
Q

clinical manifestations of early septic shock

A

Skin is pink, warm and dry
CO is normal or elevated
- Due to catecholamine release (epi and norepi)
Decreased afterload
Increased respiratory rate
Changes in Mental status

As shock progresses, fluid leaks from vascular compartment and patient develops hypovolemia.

27
Q

hemodynamic profile of a patient in early septic shock

A

Preload is decreased
- CVP is low
- PCWP (PAOP) is low

Afterload is decreased
- SVR is low
- BP is decreased

HR is increased
- Contractility appears normal or increased
- CO/CI is normal or increased

28
Q

treatment of early septic shock

A

Continue fluid administration and antimicrobial agents

Corticosteroids

Supportive care
- DVT & Stress ulcer prophylaxis
- Managing hemodynamics
- Mechanical ventilation if needed
- Electrolyte & glycemic control

29
Q

describe progression of septic shock

A

Capillary walls have increased permeability
- Fluid leaves vascular space enters interstitial and intra-cellular space

Decreased circulating blood volume
Increased blood viscosity

Interstitial and intra-cellular edema

Compensatory mechanisms are failing

Tissue perfusion is decreased

Mitochondrial damage – cells can’t use oxygen

SIRS leads to MODS

30
Q

what is MODS

A

Multiple Organ Dysfunction Syndrome

Progressive physiologic failure of 2 or more separate organ systems

Homeostasis cannot be maintained without intervention.

31
Q

clinical manifestations of late septic shock

A

Cold, clammy skin
Edema (total body) – Anasarca
Low cardiac output
Severe hypotension

32
Q

hemodynamic profile of a patient in late septic shock

A

Preload is increased
- CVP is higher than previously
- PCWP (PAOP) is higher than previously

Afterload is increased
- SVR is high

Contractility is decreased
- BP and CO/CI are very low

33
Q

treatment of late septic shock

A

Continue supportive care
Vasopressors
Inotropes
Corticosteroids
Consider limitation of support

34
Q
A

critical care (14 decks)

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