Exam 2 SHOCK Flashcards
Shock is?
Inadequate tissue perfusion:
Not enough O2 delivered to tissues to meet demand
Shock results in?
Acidosis from anaerobic metabolism ->
hypoTN
Direct determinants of Shock are?
CO
O2 saturation
Hgb levels
What is NOT a direct determinant of Shock?
BP
O2 delivery (DO2) is a direct fxn of what?
DO2 = CO x CaO2
CaO2 = arterial gas content
Direct determinants of BP are?
CO
Preload
Peripheral vascular resistance
What is NOT a direct determinant of BP?
O2 sat
Shock presentation? (4)
1) Tachycard
2) Tachypnea
3) +/- hypoTN
4) Sxs of ↓ end organ perfusion:
∆ mental status
↓ urine
Lactic acidosis
Cool/mottled extremities
Thready pulse
Methods of ↑ DO2 (supply)? (2)
Maximize CO:
Pre/After loads
Contractility
HR
Maximize CaO2:
Hct
Supplement O2
Methods of ↓ VO2 (demand)? (3)
Treat fever
Support respiratory effort
Sedation/Pain control
Causes of Shock: Cardiogenic? (3)
↓ cardio fxn
Arrhy
Obstruction
Causes of Shock: Hypovolemic? (6)
Hemorrhage Over-diuresis (DM, DI) D/V Dehydration DKA Burns
Causes of Shock: Septic?
Exaggerated response to Infection
Hypovol Shock: Compensation mechanisms?
GOAL is to maintain CO
Barorecept-mediated vasoconstriction:
↑ Epi/Renin/ADH -> Tachycard Tachypnea Narrowed pulse pressure ↓ urine output
Hypovol Shock from Hemorrage: Compensated/Non-Progressive is?
Body’s response?
< 20% loss
BP maintained w/ vasoconstriction, ↑ flow to vital organs
CO maintained w/ ↑ stroke vol, slight ↑HR
Hypovol Shock from Hemorrage: Non-Compensated/Progressive is?
Body’s response?
20 - 40% loss
↓ vol = inadequate preload, too low to overcome w/ ↑ contractility and CO
SNS/Neurohormonal response inadequate to overcome w/ ↑ vasoconstriction
= acidosis, mental ∆s, ↓↓ urine output
Hypovol Shock from Hemorrage: Profound/Irreversible is?
Body’s response?
> 40% loss
↓↓ or no BP
↑↑ tachy
Lethargic
Cardiogenic Shock hypoTN BP?
< 90/60
Septic Shock results in? (3)
Circulatory collapse
Multi organ fail
Death (>35% w/ hypoTN, 45% w/ sustained)
Septic Shock: Body’s response
Preload?
CO?
Afterload?
BP?
Organ Perfusion?
Preload: ↓
CO: ↑ (opp of vol/card shock)
Afterload: ↓ (opp of vol/card shock)
BP: ↓
Organ Perfusion: ↓
Systemic Inflamm Response Synd (SIRS) is? (4)
response to severe clinical insults:
1) ↑ or ↓ temp
2) HR > 90 bpm
3) Resp > 20 bpm or PaCO2 < 32 mmHg
4) WBC > 12k or < 4k or >10% band
Sepsis definition?
Severe Sepsis definition?
Septic Shock definition?
Systemic response to infection PLUS ≥ 2 SIRS
Sepsis w/ organ dysfxn, hypoTN or hypoperfusion
Sepsis-induced hypoTN despite adequate resuscitation
Sepsis General Variables? (7)
Fever > 100.1 Hypothermia < 96.8 HR > 90 Tachypnea ∆ mental state Significant edema Hyperglycemia w/o DM
Sepsis Inflamm Variables? (4)
Leukocytosis > 12k
Leukopenia < 4k
N count w/ > 10% band cells
Plasma C-react Protein or Procalcitionin
Sepsis Hemodynamic Variables? (3)
Arterial hypoTN w/
SBP < 90
MAP < 70
or SBP ↓ > 40
Sepsis Organ Dysfxn Variables? (7)
Arterial hypoxemia Acute oliguria Cr ↑ Coag Ileus Thrombocytopenia Hyperbilirubinemia
Sepsis Tissue Perfusion Variables? (2)
Lactic acidosis/Metabolic acidosis
↓ cap refill
Multi System Organ Failure includes:
Hepatic?
Renal?
Pulmonary?
Cardiac?
Neuro?
Other?
Hepatic: Transaminitis, ↑ bilirubin, ↓ ablumin, coag, NH4
Renal: Acute tubular necrosis, olig/anuria, uremia
Pulmon: ARDS, infection
Card: arrhy, myocard depression
Neuro: mental status -> coma
Other: coag, immune
Hyperdynamic vs Hypodynamic Septic Shock?
Both: hypoTN, tachycard, tachyp
Hyper: bounding pulse, warm and well perfused extremities, flushed and moist skin
Hypo: thready pulse, cold and poor perfused extrem, pale and dry skin
