Exam 1 Flashcards
Shock S/S
~Neuro
Early: anxiety, restlessness, increased thirst
Late: ↓ CNS (lethargy,) AMS, weakness, diminished/absent deep tendon reflexes, sluggish pupils
Shock S/Sx
~Cardiac:
↓ cardiac output,↓ bp
↑ hr
Thready/weak pulses, narrowed pulse pressure, decreased peripheral pulses
↓JVP, flat veins (neck, hand)
Slow cap refill
Shock S/S:
~respiratory
↑ rr
Shallow breathing
↓PaCo2 →↑
Cyanosis (nail beds /lips)
Shock S/S
~ gi
↓ motility
Diminished / absent bowel sounds
N/V/constipation
Shock S/S:
~GU
↓ urine output
↑ specific gravity
Sugar/acetone in urin
Shock S/S:
~skin
Cool → cold
Pale → mottled → cyanotic
Dry mouth
↓ cap refill
How to calculate MAP?
SBP+ 2 (DBP) and divide by 3
What happens to MAP during shock?
↓ due to ↓ total blood volume / cardiac output ( hr x stroke volume) and size/integrity of vascular bed
What level do we want the map to be?
> 65
What 3 things does hemorrhage lead to?
↓ venous return =↓ JVP
↓ bp
Hypovolemic shock → insufficient organ perfusion
What 2 things does trauma cause?
Hemorrhage
Third spacing of fluid
What 2 things happen w/ third spacing of fluid?
Hypovolemic shock
Ruptured vessels leaking into large cavities and ↑ inflammatory mediators
Insufficient organ perfusion
~ Brain
Cerebral hypoxia = progressive ↓ in LOC
Insufficient organ perfusion
~ cardiac
↓ bp =↑ hr
↓ myocardial contractility (from lactic acidosis) = PEA
Insufficient organ perfusion
~ kidneys
A renal perfusion
= renal ischemia = acute tubular necrosis = renal failure
↓ GFR = oliguria
Insufficient organ perfusion
~ skin
Body vasoconstricts - preserves circulation to vital organs
= cold mottled extremities
Insufficient organ perfusion
~ all body tissue
↓ lactate clearance (liver, kidneys, skeletal muscle)
= lactic acidosis
What are the 4 stages of shock?
- Initial stage
- Compensatory stage
- Progressive stage
- Refractory/MODS stage
Describe initial stage of shock
What is the alert?
↓MAP 5-10
↑ hr, mild vasoconstriction
Body compensates well, maintaining bp and perfuse to vital organs
Normal range for cardiac output and MAP
Alert: ↑ hr/rr may be the only sign
Describe the compensatory stage of shock
↓ map: 10-15
Kidney/hormonal mechanisms activated to maintain MAP
• ↑ renin, ADH, aldosterone, epi and norepinephrine
↓ urination, ↑ Na +, ↑ blood vessel constriction
↓ tissue hypoxia to vital organs (no permanent damage)
↓ blood ph= acidosis
↑ K+
S/S shock
~ objective
~ subjective
~ objective: restlessness, ↑ hr/rr, ↑DBP, narrow pulse pressure, cool extremities, decreased Co2
~ subjective: thirst, anxiety
Shock
The younger the pt is…
The longer the body will try to compensate for
S/S of progressive stage of shock
↓ MAP - 20
Compensatory mechanism function but ↓ perfusion/oxygenation to vital organs
Hypoxia (vital organs) and Anoxia /ischemia (less vital organs)
= ↑ metabolites → Cell death occurs
S/S of progressive stage
Subjective
Objective
~subjective: impending doom, confusion, ↑ thirst
~ objective: ↑/ weak pulse, ↓ bp
pallor → cyanosis of mucosa/nailbeds
Labs of progressive stage
↓ blood pH
↑ lactic
↑ K+
↑ PaCo2 / pao2
If caused by dehydration: H&H ↑
Describe refractory/ mods stage
Too much cell death from ↓ perfusion / extensivee vital organ damage
Will not respond to tx
What position do we place patients in to ↑ perfusion
Semi fowlers
Medications for shock, what are the categories?
Vasoconstrictors
Iotropic agents
Drugs that enhance myocardial perfusion