Drugs for Shock Flashcards
Hypovolemia
Preload:
Pump function:
Afterload:
Tissue perfusion:
Wedge pressure: Decreased
CO: Decreased
SVR: Increased
O2 Sat: Decreased
Cardiogenic Shock
Preload:
Pump Function:
Afterload:
Tissue Perfusion:
Wedge Pressure: Increased
CO: Decreased
SVR: INcreased
O2 Sat: Decreased
Distributive Shock
Preload:
Pump Function:
Afterload:
Tissue Perfusion:
Wedge Pressure: Decreased or no change
CO: INcreased
SVR: Decreasde
O2 SAt: INcreased
What is the warm phase of septic shock (distributive)?
fluid shifts into third spaces
This is why crystalloid fluid resuscitation is always required for septic shock and is ALWAYS first line therapy
What is the cold phase of septic shock?
hypotension, petichiae, etc
What is the initial treatment for hypotension?
Crystalloid IV fluid 30ml/kg
(unless cardiogenic shock)
What is the immediate treatment for anaphylactic shock?
Epinephrine IM
+/- antihistamine
+/- inhaled albuterol
What are the main vasopressors for shock?
dopamine
NE
Epinephrine
Dobutamine
phenylephrine
vasopressin
What is the MOA for dopamine?
precursor to NE
stimulates B receptors at low dose
stimulates a receptors at high dose
What is the MOA of NE
stimulates vascular a receptors and B1 receptors of heart and kindey
no B2 action
What is the MOA of epinephrine?
B1 R stimulator as wel as AR and B2R of vasculatur
What is the MOA for dobutamine?
stimulates B1R of heart to increase rate and contractility
vasodilates periphery
What is the MOA of phenylephrine?
stimulates AR, increases BP and decreases HR
What is the MOA of vasopressin?
vasoconstrictor, binds to V1R in vasculature
V2 receptors in kidney to mediate antidiuretic effects
Cardiogenic shock is caused by any form of severe heart failure including
MI
Arrhythmias
Mitral/Aortic valve Regurgitation
Failed valves
Rupture
Large PE
Tamponade
NE and DA can be used to treat cardiogenic shock, but which is superior?
Low dose Da can be used to preserve what?
When is dobutamine used?
NE
renal function
refractory shock/systolic heart failure when low CO despite adequate filling pressure
What are the criteria for Sepsis?
Temp >38.3 or <36
HR >90
RR>20
AMS
Edema
Hyperglycemia without DM
What are some lab values seen in severe sepsis?
Hypotension
Lactate elevation
decreased urine output
elevated CRT, Bili
Decreased PLT
Elevated INR
When is sepsis considered septic shock?
when there is sepsis-induced Hypotension that persists despite adequate fluid resuscitation
Should Broad Spectrum Abx be given ASAP in septic shock?
EBM supports prompt administration of Abx for septic
shock
*Blood Cx will be positive in only 50% of cases of septic shock
What is the vasopressor of choice for septic shock?
NE is first line choice
Epi can be added to NE or substituted
Dopamine only substituted if bradycardic
Phenylephrine NOT recommended unless NE causes arrhythmias or continue to have high CO and low TPR
Dobutamine sued if inotropic agent needed
Should corticosteroids be used in septic shock?
low dose corticosteroid use improve shock reversal
(no benefit in sepsis in the absence of shock)
