Exm 5 - Shock Flashcards
Shock Overview
Decreased blood flow to vital organs
Decreased MAP
Decrease blood pressure
pathophysiology of all shock
HYPOperfusion
HYPERcoagulability
activation of the inflammatory process
Classes of shock
Class 1:
drop in MAP is detected
SNS activated to increase CO and increase BP:
tachycardia
increased contractility
peripheral vasoconstriction
Class 2:
tachycardia, vasoconstriction, increased contractility
eventually tissue hypoxia leads to lactic acid build up - acidosis and depressed cardiac function
R-A-A-S
Class 3:
cannot be compensated by compensation mechanisms, fluid in interstitial space, BP drops
Class 4:
usually don’t recover
Normal MAP
70-100
How does shock effect the body systems?
CNS: restlessness, agitiation, anxiety, lethargy
cardiovascular: BP decreases, HR increases, decrease in cardiac perfusion, weak & thready pulse, decreased CO
respiratory: increased respirations, hypoxia (ARDS)
Renal: R-A-A-S, decreased GFR, decreased output, AKI
GI/hepatic: slows activity, decreased bowel sounds, GI bleed, shock liver, hypoglycemia
integumentary: sweaty, clammy, cool skin, pallor, mottled, cyanotic, edema
hematolytic: DIC
DIC treatment
treat type of shock
low dose heparin to prevent clotting becuae clots cause microthrombi
platelet transfusion
PRBC
avoid invasive procedures
hypovolemic shock
decrease in circulating blood volume related to: hemorrhage, burns, severe dehydration, renal fluid loss, severe vomiting/diarrhea, fluid shifts
BP, SV, CO decrease
HR increases
CVP decreases
effects preload
hypovolemic shock treatment
stop hemmorhage
if d/t hemorrhage give PRBC
if d/t dehydration give IV fluids
position patient to optimize venous return: head flat, feet up
Distributive shock (Vasogenic)
3 types: neurogenic, anaphylactic, septic
blood volume is normal
blood vessels dilate and there is not enough volume to maintain normal pressures in the big vessels
neurogenic shock
imbalance between sympathetic and parasympathetic nervous systems
caused d/t spinal cord injury, head trauma, severe hypoglycemia, CNS depression, anesthesia, severe pain, prolonged heat exposure
neurogenic shock S&S
ONLY shock with decreased BP and DECREASED HR
CVP drops
skin WARM and DRY d/t vasodilation
LOC: anxious, restless, lethargic, progressing to comotose
oliguria
low body temperature
neurogenic shock treatment
treat underlying cause
remember abcs
vasoconstrictors (noreepinephrine)
treat bradycardia (+ ionotropes)
IV fluids
anaphylactic shock
allergic/hypersensitivity reaction
anaphylaxis - major dilate of BV
anaphylactic shock S&S
flushed, warm skin, headache, dizziness, anxiety, disorinetation, LOC
hypotension
tachycardia
largyngeal edema - horse, dyspnea, stridor
bronchospasm and wheezing
decreased O2
anaphylactic shock S&S
flushed, warm skin, headache, dizziness, anxiety, disorinetation, LOC
hypotension
tachycardia
largyngeal edema - horse, dyspnea, stridor
bronchospasm and wheezing
decreased O2 sat
angioedema
hives
low urine output
anaphylactic shock treatment
remove offending agents
restore adequate tissue perfusion
MILD:
oxygen, antihistimines (benydryl), corticosteroids, epinephrine
Severe:
NS rapid infusion
corticosteroids and bronchodilators
+ ionotropes and vasoconstrictors (Vasopressin, noreepinephrine)
intubation, cricothyrotomy
educate on epi-pen, triggers
SIRS
core body temperature >38 or <36 C
HR > or equal to 90 bpm
respirations greater than 20 or PaCO2 <32 mmHG
WBC >12,000 or <4,000 or 10% immature forms
septic shock
SEPSIS: at least 2 SIRS criteria caused by known or suspected infection
severe vasodilation and capillary permeability
septic shock S&S early
release of histamines/bradykins
“warm shock” or “pink shock”
hypotenson
tachycardia
decreased CVP
respirations rapid & deep
mental status alert/disoreinted/anxious/restless
normal urine output
increased body temperature, chills, weakness
N/V, diarrhea
septic shock S&S late
“cold shock” - may be hypothermic
skin pale, cold, clammy, mottled
hypotension, tachycardia, arrythmia
rapid, shallow respirations
lethargic to comatose
oliguria to anuria
decreased CVP
what can be used to asses risk for SIRS/sepsis?
procalcitonin
septic shock interventions
maintain oxygenation
decrease metabolic demands (sedation, neuromusuclar block, therpeutic hypothermia)
identify organism - broad spectrum antibiotics first then organism specific
fluid resuscitation
vasopressors
corticosteroids
electrolytes and glycemic control
assess for DIC - highest risk
cardiogenci shock
hearts pumping action is compromised
severe decrease of CO and decrease in tissue perfusion
cause:
MI
cardiac surgery
large PE
pericardial temponade
tensionpneumothorax
cardiogenic shock S&S
decrease co leads to decreased MAP
tachycardia
decrease coronary perfusion
back of of blood:
JVD
rales
tachycardia
decreased CO
decreased perfusion - cyanosis
chest pain
