Exam #1: Shock, SIRS And MODS Flashcards
What is shock?
- Syndrome characterized by decreased tissue perfusion and impaired cellular metabolism
- Imbalance in supply/demand for O2 and nutrients
Add stuff that was on the board
*Listen to lecture for more clarification
Low dose of dopamine can cause (<2mcg/min)
Vasodilation
If we give dopamine at 5-10mcg/kg/min, what while happen
It will stimulate beta1 adrenergic receptors -> increases contractility of the heart -> increases CO
If you give dopamine at >10 mcg/kg/min, it will cause
Vasoconstriction
Dobutamine
Causes vasoconstriction.
*may need more info
Nitro/Nitroprusside
Vasodilators
Norepinephrine aka Levophed
Drug of choice.
Listen to lecture for more info.
What are the classifications of shock?
- Cardiogenic Shock
- Hypovolemic
- Distributive
- Obstructive
What is Cardiogenic Shock?
- Systolic (hearts inability to pump the blood forward) or diastolic dysfunction
- Compromised cardiac output (CO)
What can cause cardiogenic shock?
- Myocardial infarction
- Cardiomyopathy
- Blunt cardiac injury
- Severe systemic or pulmonary hypertension
- Cardiac tamponade
- Myocardial depression from metabolic problems
What is the pathophysiology of cardiogenic shock caused by systolic dysfunction?
Slide 6
What is the pathophysiology of cardiogenic shock caused by diastolic dysfunction?
Slide 6
What are early manifestations of cardiogenic shock?
- Tachycardia
- Hypotension (<90)
- Narrowed pulse pressure (diastolic and systolic BP come closer together)
- ↑ Myocardial O2 consumption
- ↑ Pulmonary artery wedge pressure
- Decreased renal perfusion and urinary output
What are physical assessment findings that you would find in a patient with cardiogenic shock?
- Tachypnea, pulmonary congestion
- Pallor and cool, clammy skin
- Decreased capillary refill time
- Anxiety, confusion, agitation (Ativan, morphine could be helpful)
Hypovolemic Shock
- Loss of intravascular fluid volume
- Either absolute or relative hypovolemia
What can cause hypovolemic shock?
- Absolute Hypovolemia:
- Hemorrhage
- GI loss (e.g., vomiting, diarrhea)
- Fistula drainage
- Diabetes insipidus
- Hyperglycemia
- Diuresis - Relative hypovolemia
What is relative hypovolemia?
- Results when fluid volume moves out of the vascular space into extravascular space (e.g., intracavitary space)
- Termed third spacing
Describe the pathophysiology of hypovolemic shock.
Slide 11
Hypovolemic Shock: Response to acute volume loss depends on
- Extent of injury
- Age
- General state of health
What are clinical manifestations of hypovolemic shock?
- Anxiety
- Tachypnea
- *Increase in CO, heart rate
- Decrease in stroke volume, Pulmonary Artery Wedge Pressure, urinary output
Hypovolemic Shock: What is done if loss is >30%?
Compensatory mechanisms may fail and immediate replacement of blood products should be started
What is neurogenic shock?
- Hemodynamic phenomenon
- Can occur within 30 minutes of a spinal cord injury at the fifth thoracic (T5) vertebra or above
- Can last up to 6 weeks
Neurogenic Shock can occur in response to
Spinal cord injury or spinal anesthesia