[Exam 4] Stages of Shock Chart Flashcards
What are the three stages?
Compensatory, Progressive, Irreversible (MODS)
What is shock?
A type of life-threatening condition or injury that has caused inadequate tissue perfusion , with organs not being perfused with adequate oxygen.
Compensatory: what is occuring here?
Body is compensating here
Compensatory: What are the main things that happen here?
BP remains WNL
Vasoconstriction
Increased HR/Contractility
Shunting of Blood to vital organs
Compensatory: Why does blood pressure remain the same?
Catecholamines get released. Epi/Norepi get released causing increased HR and contracility. That is why BP remains WNL
Compensatory: What happens since Epi and Norepi is getting released?
vasoconstriction of the whole body
Compensatory - CMs: What respiratory changes occur?
RR > 20
PaCO2 < 32
PaO2 < 80
Compensatory - CMs: Why does respirations go up initially?
Because they are trying to get rid of carbon dioxide and are trying to get more oxygen inside of the body since organs can sense they don’t have enough
Compensatory - CMs: Why would you see a decreased PaCO2?
Because the patient is blowing off all of the CO2, leading to respiratory alkalosis
Compensatory - CMs: What cardiovascular changes occur?
BP: WNL
Hr: SNS stimulation leads to increase
HR and Contracility of heart increased bc of epi and norepi
MAP > 65
Compensatory - CMs: Why do you want MAP greater than 65?
That shows that there is adequate tissue perfusion
Compensatory - CMs: What neurologic changes occur?
Restlessness, agitation, anxiety, confusion
Compensatory - CMs: Why do the neurologic changes occur?
BEcause they are hypoxic and not receiving enough oxygem
Compensatory - CMs: What changes occur with renal?
Urine output decreasing because they aren’t vital organ and are not being perfused.
Compensatory - CMs: What hepatic changes occur?
Hyperglycemia, because the body is stressed and due to catacholimines being released. During stress, glucose levels increase
Compensatory - CMs: What GI changes occur?
Bowel sounds are decreased because they arent getting perfused
Compensatory - CMs: What changes occur with s kin?
Skin is cold and clammy is blood is pulled from skin, causing sweat glands to release.
Compensatory - CMs: What type of shock do you see warm skin?
Sepsis, because this is caused by an infection. Patients will have a fever and will be warm.
Compensatory - Medical Mx: Biggest thing we can do?
Identify the cause, because this is how we reverse it
Compensatory - Medical Mx: What can we do to help treat?
Fluid replacement
O2
Meds to maintain BP and adequate perfusion
Compensatory - Medical Mx: What type of fluid is used for replacement?
Isotonic fluids such as NS or LR.
Compensatory - Medical Mx: Why is LR used?
It helps buffer some of the acidosis as medications are given
Progressive: Why has it progressed?
Because the normal compensatory mechanisms can no longer keep up , a long iwht blood pressure
Progressive: What happens to MAP and blood pressure?
MAP falls and SBP < 90 (or drop of 40 from baseline)
Progressive: What happens first in progressive?
Overworked heart cannot pump effectively, becoems dysfunctional
Progressive: What occurs next with progressive?
Increased capillary permeability and inflammatory response and coagulation cascade is activated
Progressive - CMs: What changes occur with Respiratory?
RR increasing and becoming shallow because they cannot get enough oxygen.
Crackles
Decreased O2 because decreased blood flow
Progressive - CMs: Why does pulmonary vasoconstriction occur with respiratory?
Due to infalmmatory response that leads to decreased pulmonary perfusion leaidng to hypoperfusion of alveoli
Progressive - CMs , Respiratory: Why are crackles heard?
Because of nondirect injury to lungs. inflammatory response kicked in and ARDS has developed.
Progressive - CMs , Cardio: What happens to MAP , and BP?
MAP < 65 , SBP < 90 or drop > 40 from baseline
HR> 150
Increased capillary permeability
Narrowing pulse pressure
Progressive - CMs , Cardio: What is a narrowing pulse pressure?
Normal pressure if 120/80. This is the gap between systolic and diastolic. It means that they are coming closer together
Progressive - CMs: What neurologic changes occur?
Lethargy and loss of consciousnes may occur because the brain continues to not be perfused.
Progressive - CMs: Why may HR increased?
Because the heart is stressed and trying to keep up with demand. Stressed heart can lead to what? Dysrhythmias and accelerated heart rate.
Progressive - CMs: Patients prone to go into AFIb may be put on what?
Beta blocker to leave HR down so that they dont go tachycardic. `
Progressive - CMs: What renal changes occur?
Increased BUN, Creatinine
Decreased GFR
Output < 30
Metabolic Acidosis
Progressive - CMs: What hepatic change occurs?
Decreased blood flwo to liver decrease ability to metabolize meds and waste products like ammonia and lactic acid.
Progressive - CMs: What changes occur in liver specifically?
Can’t filter bacteria leading to infection, impaired glucose production, increased LFTs and BIli and decreased clotting factors.
Progressive - CMs: What changes occur with GI?
Decreased bowel sounds, impaired nutrient absorption, stress ulcers, bloody diarrhea due to necrosis , and translocation of bacteria leading ot increased inflammatory response
Progressive - CMs: What hematolic changes occur?
Inflammatory mediators released activating coagulation system to establish hemeostasis leading to DIC
Progressive - CMs: What is DIC? (Dissementiated Vascular Coagulation)
Patient has an injury. Coagulation gets set off. All clotting factors can sent ot that injury making patient prone to bleeding elsewhere. Basically all clotting factors used
Progressive - CMs: What are some signs of DIC?
Bruises, petechiae, increased PT and PTT, and decreased platelets.
Progressive - CMs: What changes occur with the skin?
It becomes mottled, petechiae, bruises,
Central cyanosis
Progressive - CMs: Medical management deends on what
type of shock and decompensation
Progressive - CMs: What will be given to treat this?
IV fluids, meds, support the respiratory and cario system
Progressive - CMs: What kind of meds will be given to support blood system?
Vasopressors - Epinephrine, Norepinephrine, Dopamine,
Inotropes - Dobutamine , Dopamine at low doses (help with contracility)
Progressive - CMs: Difference between inotrope and vasopressor?
Inotropes help with contracility of the heart
Vasopressors help with clamping down on the vessel to constrict it
Progressive - CMs: What are vasoactive meds?
They can either clamp down on the vessels but also vasodilate. Nitro can decrease afterload to the heart by vasodilating
Progressive - CMs: Aside from from meds and support respiratory and cardio, what else can be done?
Hyperglycemia control, enteral nutrition, PPI or H2 blockers or heparin.
Progressive - CMs: Why is enteral nutrition improtant?
They need more calories because of increased metabolic rate. This can also help decrease peptic ulcer formation.
Progressive - CMs: Why would a PPI or H2 Antagonist be used?
This helps with ulcers and helps decrease gastric secretion. This helps decrease the eating away of GI tissue
Progressive - CMs: Why would heparin be given?
This is given if clotting cascade has been activated, this is given to help break up the clot.
Irreversible (MODS): Why is this difficult to identify?
Sometimes we don’t know when they have entered this tage
Irreversible (MODS): How will they respond to vasopressors?
Will become unresponsive because body can no longer compensate and blood pressure will continue to drop
Irreversible (MODS): What is this?
Organ ddamage is so severe, patient does not respond to treatment and cannot survive
Irreversible (MODS): What happens to organs in the body?
They all begin to die and shut down.
