General principles Flashcards

1
Q

Four classifications of shock

A

Hypovolemic, Cardiogenic, Distributive, Obstructive

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2
Q

Types of hypovolemic shock

A

Hemorrhagic, Nonhemorrhagic

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3
Q

Types of cardiogenic shock

A

Myopathic (ischemia), Mechanical (valvular), Arrhythmic

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4
Q

Types of distributive shock

A

Septic, adrenal crisis, neurogenic (spinal shock), anaphylactic

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5
Q

Types of obstructive shock

A

Massive PE, tension pneumothorax, cardiac tamponade, constrictive pericarditis

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6
Q

Hemodynamics of hypovolemic shock

A

Decreased CO, right and left ventricular filling pressures (preload), increased after load (SVR). SVO2 or SCVO2 is decreased because of decreased CO and increased tissue O2 demands. Look for flat, non distended jugular veins.

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7
Q

Hemodynamics of distributive shock

A

Normal or increased CO with low SVR, low to normal ventricular filling pressures, increased pulse pressure, normal or increased SVO2 or SCVO2.

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8
Q

Hemodynamics of cardiogenic shock

A

Decreased CO, elevated ventricular filling pressures, increased after load (SVR) and decreased SvO2 or ScvO2. Look for JVD, pulmonary edema and S3 gallop.

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9
Q

What type of MI is more likely to lead to cardiogenic shock?

A

Anterior MI

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10
Q

Why might you hear an S3 in cardiogenic shock?

A

Rapid ventricular filling or poor LV function

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11
Q

Hemodynamics of obstructive shock

A

Decreased CO, increased after load, variable LV filling pressures, depending on etiology. Look for JVD as a clue.

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12
Q

What is pulsus paradoxus?

A

A drop in >10mm Hg in systolic BP during inspiration.

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13
Q

Three major components of shock management

A

Blood pressure, cardiac output, oxygenation

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14
Q

Blood pressure interventions

A

Fluids, vasopressor or vasodilator agents

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15
Q

Cardiac output interventions

A

Fluids, vasodilator agents, vasopressor agents, inotropes

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16
Q

Oxygenation interventions

A

Blood transfusion, supplemental O2, sedation, analgesia, antipyretics

17
Q

How is MAP calculated?

A

(CO x SVR) + CVP or approximated by MAP = DP + 1/3 (SP-DP)

18
Q

What is normal MAP?

A

65-110