Hemodynamics and Shock Flashcards
classic definition of hypotension
SBP <90 mmHg or decrease of 40 mmHg from baseline
end organ dysfunction in shock manifestation in CNS
encephalopathy and cortical necrosis
end organ dysfunction in shock manifestation in cardiac
tachycardia/bradycardia, ventricular ectopy, myocardial ischemia/depression
end organ dysfunction in shock manifestation in pulmonary
acute respiratory failure and acute respiratory distress syndrome
end organ dysfunction in shock manifestation in renal
pre renal insults, AKI, ATN
end organ dysfunction in shock manifestation in GI
erosive gastritis, ileus, pancreatitis
end organ dysfunction in shock manifestation in hepatic
ischemic hepatitis, cholestasis, “shock” liver
end organ dysfunction in shock manifestation in hematologic
disseminated intravascular coagulation (DIC), dilution thrombocytopenia
end organ dysfunction in shock manifestation in metabolic
hyperglycemia, glycogenolysis, glyconeogenesis, hypoglycemia (late), hypertriglyceridemia
end organ dysfunction in shock manifestation in immune system
gut barrier function, cellular and humoral immunity depression
cardiovascular clinical presentation
-cardiac index <2.2 L/min/m^2
-SBP <90 or MAP <65 mmHg
tissue hypo perfusion clinical presentation
-cold, clammy, mottled skin
-lactate >2 mmol/L
-Scvo2 <65% or Svo2 <60%
organ dysfunction clinical presentation
-encephalopathy, lethargy, confusion
-liver dysfunction
-urine output <0.5 mL/kg/hr
blood pressure calc
BP = CO x SVR
cardiac output calc
CO = HR x SV
mean arterial pressure (MAP) calc
MAP = 1/3 SBP + 2/3 DBP
ex: 90/60 = 70 mmHg
goals for hemodynamic shock
-MAP > 65 mmHg
-lactate <2 mmol/L
-HR <100 bpm
central venous catheter (CVC)
-measures Scvo2
-admin: fluids, pressors, antimicrobials, parenteral nutrition
arterial line
measures MAP, SBP/DBP, ABG
types of shock
hypovolemic, distributive, cardiogenic, obstructive
hypovolemic shock presentation
↓ PCWP, ↓ CO, ↑ SVR, ↓ Svo2
cardiogenic shock presentation
↑ PCWP, ↓ CO, ↑ SVR, ↓ Svo2
distributive shock presentation
↓ PCWP, ↓↑ CO, ↓ SVR, ↓↑ Svo2
obstructive shock presentation
↑ PCWP, ↓ CO, ↑ SVR, ↓ Svo2
