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urgencias > generalidades del shock > Flashcards

generalidades del shock Flashcards

1
Q

definition of shock

A

an abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation

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2
Q

what is the first and second step in the initial management of shock in trauma patients

A

1st: recognize its presence
2nd: ID probable cause of shock

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3
Q

what is the most common cause of shock in the injured patient

A

hemorrhage

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4
Q

how is stroke volume determined

A

preload
myocardial contractility
afterload

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5
Q

how is cardiac output determined

A

HR (beat/min) x Stroke volume (ml/beat)

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6
Q

what is the earliest measurable circulatory sign of shock in a trauma patient

A

tachycardia

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7
Q

what is the most effective method of restoring adequate cardiac output and end-organ perfusion

A

restore venous return to normal by locating and stopping the source of bleeding, along with appropriate volume repletion

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8
Q

T/F. Vasopressors are contraindicated for the tx of hemorrhagic shock

A

TRUE

they worsen tissue perfusion

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9
Q

T/F. Any injured pt who is cool and has tachycardia is considered to be in shock until proven otherwise

A

TRUE

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10
Q

how is shock in a trauma patient classified

A

hemorrhagic or nonhemorrhagic

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11
Q

what does nonhemmorrhagic shock include

A 
cardiogenic shock
cardiac tamponade
tension pneumothorax
neurogenic shock
septi shock
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12
Q

chacarteristics of cardiogenic shock

A

myocardial dysfx can be caused by blunt cardiac injuty, cardiac tamponade, and air embolus, or, rarely a myocardial infarction

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13
Q

characteristics or cardiac tamponade

A

tachycardia, muffled heart sounds, and dilated, engorged neck veins with hypotension resistant to fluid therapy suggest cardiac tamponade

cardiac tamponade is best managed by thoracotomy

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14
Q

how does a tension pneumothorax develop

A

when air enters the pleural space, but a flap-valve mechanism prevents its escape

intrapleural pressure rises, causing total lung collapse and a shift of the mediastinum to the opposite side with the subsequent impairment of venous return and fall in cardiac output

the presence of acute respiratory distress, subcutaneous emphysema, absent breath sounds, hyperresonance to percussion, and tracheal shift supports the dx and warrants immediate thoracic decompression w/o x-ray confirmation of the dx

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15
Q

do isolated intracranial injuries cause shock

A

NO

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16
Q

What is the classic picture of neurogenic shock

A

hypotension w/o tachycardia or cutaneous vasoconstriction

a narrowed pulse pressure is not seen in neurogenic shock

17
Q

how is the blood volume calculated in an adult and pediatric patient

A

adult - 7% of body weight
obese - 7% of IDEAL body weight
child - 8 - 9% of body weight

18
Q

characteristics of class I hemorrhage

A

its exemplified by the condition of an individual who has donated a unit of blood

blood loss: ≤750ml, ≤15%
HR: <100
resp. rate: 14 -20
urine output: >30ml/hr
CNS/mental status: slightly anxious
initial fluid replacement: crystalloid
19
Q

characteristics of class II hemorrhage

A

in uncomplicated hemorrhage for which crystalloid fluid resuscitation is required

blood loss: 750 - 1500 ml, 15 - 30%
HR: 100 - 120
resp. rate: 20 - 30
urine output: 20 - 30ml/hr
CNS/mental status: mildly anxious
initial fluid replacement: crystalloid
20
Q

characteristics of class III hemorrhage

A

is a complicated hemorrhagic state in which at least crystalloid infusion is required and perhaps also blood replacement

blood loss: 1500 - 2000 ml, 30 - 40%
HR: 120 - 140
BP: decreased
resp. rate: 30 - 40
urine output: 5 - 15ml/hr
CNS/mental status: anxious, confused
initial fluid replacement: crystalloid and blood
21
Q

characteristics of class IV hemorrhage

A

is considered a terminal event; unless very aggressive measures are taken, the pt will die within minutes

blood loss: >2000, >40%
HR: >140
BP: decreased
resp. rate: >35 
urine output: negligible
CNS/mental status: confused, lethargic
initial fluid replacement: crystalloid and blood
22
Q

what is the basic management principle in the initial management of hemorrhagic shock

A

stop the bleeding

replace volume loss

23
Q

what are the solutions used for initial resuscitation

A

Warmed isotonic electrolyte solutions

  • Lactated Ringer’s
  • normal saline

this type of fluid provides transient intravascular expansion and further stabilizes the vascular volume by replacing accompanying fluid losses into the interstitial and intracellular spaced

an initial, warmed fluid bolus is given. The usual dose is 1 - 2 L for adults and 20mL for pediatric patients

24
Q

cuales son las manifestaciones hemodinamicas mas frecuentes en choque distributivo

A

resistencias vasculares sitemicas bajas
gasto cardiaco elevado
presion venosa central baja

la variedad mas comun es el choque septico

25
Q

caracteristicas del choque distributivo

A

taquicardia e hipotension que NO responde despues de admin. liquidos o vasopresores

26
Q

caracteristicas del choque cardiogenico

A

el dx se establece despues de documentar disfuncion miocardica y excluir causas alternativas de hipotension (hipovolemia, hemorragia, sepsis, embolismo…)

27
Q

cual es la causa mas frecuente del choque cardiogenico

A

infarto agudo al miocardio

28
Q

cuales son las tres variantes clinicas que se puede presentar un un pt con choque cardiogenico

A
  1. normotenso/congestivo
  2. hipotenso/congestivo
  3. hipotension sin congestio
29
Q

cuales son las manifestaciones de bajo gasto

A 
palidez
oliguria (diuresis <20ml/h)
llenado capilar prolongado
reacicon adrenergica:
- piloereccion
- tegumentos frios
- diaforesis
- cianosis periferica
30
Q

caracteristicas del choque neurogenico

A

la variedad mas comun: traumatismo medular

existe una falta de vaso-regulacion sistemica

dependiendo del nivel de lesion medular, pueden presentarse hemiplejia superior con incapacidad para movilizacion de las extremidades, falta de sensibilidad en las mismas, y en muchas ocasiones insuf. respiratorioa

si existe daño medular bajo, se obervara hemiplejia inferior con falta de sensibilidad en las etremidade e incontinencia de esfinteres

c

31
Q

cual es la dosis inicial de dobutamina en presencia de choque cardiogenico

A

dobutamina 5 - 10 microgramos/kg/min (como inotropico de inicio)

32
Q

cual es el vasopresor de primera linea cuando se sospecha disminucion de las resistencias vasculares concurrente con gasto cardiaco alto

A

dopamina

luego sigue: norepinefrina o epinefrina

luego sigue vasopresina

urgencias (7 decks)

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