Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

EMED Unit 3 > Hypotension and Shock > Flashcards

Hypotension and Shock Flashcards

1
Q

Which is scarier - hypotension or hypertension?

A

Hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is helpful to know when evaluating a patient you think is hypotensive?

A

Their baseline BP

There’s no set value for hypotension like their is for hypertension - everyone is different

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

If a patient’s BP is low and you don’t know what their baseline is, you should always start by…

A

Giving a small fluid bolus to check fluid responsiveness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why is hypotension bad?

A

Because it can cause hypoperfusion of organs —> end organ damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is shock exactly?

A

When low BP results in a discrepancy between oxygen supply and demand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Shock is a physiological condition of __________ —> decreased ________ —> cellular hypoxia and _________.

A

Inadequate systemic tissue perfusion

Decreased O2 delivery

Cellular hypoxia and metabolic malfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Shock can result in sequential _____, ______, _____, and ______.

A

Cell death

End-organ damage

Multi-system organ failure

DEATH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Systemic tissue perfusion is determined by…

A

Mean Arterial Pressure (MAP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the formula for determining MAP?

A

MAP = CO x SVR

Cardiac Output x Systemic Vascular Resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

SVR is influenced by …

A

Vessel length

Vessel diameter

Blood viscosity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some ways to assess for adequate global perfusion?

A

Mental status (brain perfusion)

Urine output (kidney perfusion)

Serum lactate/acidosis

Peripheral perfusion assessment (warm/cold/cap refill)

Remember - not all patients with hypotension are in shock! Depends on level of perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the stages of shock?

A

Pre-shock
• Warm or COMPENSATED shock
• Tachycardia, peripheral vasoconstriction, low BP

Shock
• Compensatory mechanisms overwhelmed —> SSx of organ dysfunction
• Tachycardia, dyspnea, metabolic acidosis, oliguria, confusion, cool clammy skin

End-organ dysfunction
• Progressive end organ dysfunction
• Irreversible organ damage, coma, death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the five different etiologies of shock?

A

Hypovolemic

Cardiogenic

Obstructive

Neurogenic

Distributive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What types of lines can be utilized in resuscitation of shock patients?

A

Arterial lines
Central lines
Swan-Ganz (pulmonary artery) catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What arteries can be used for arterial lines?

A

RADIAL artery
Brachial artery
Femoral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How are arterial lines used?

A

Invasive arterial BP monitoring

Recurrent ABGs

NOT used for meds or to infuse anything!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Indications for central lines

A

Delivery of caustic or critical medications and measurements of CVP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the different types of central line?

A 
Triple lumen
Double lumen
Dialysis catheters
Swan-Ganz catheter
PICC line
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does PICC stand for?

A

Peripherally Inserted Central Line Catheter

Inserted into Basilic or Cephalic vein in upper arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Normal value for central venous pressure (CVP)

A

5-15 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is central venous pressure (CVP)?

A

Pressure near the right atrium

Correlates to “preload” or overall volume status

Can be obtained with any central line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What type of line is like a central line but provides more info bc it goes through the heart and sits in the pulmonary artery

A

Swan-Ganz Catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What type of shock is the Swan-Ganz Catheter especially useful for?

A

Cardiogenic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the main hemodynamic parameter?

A

Central Venous Pressure (CVP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Why hemodynamic parameters can only be obtained with a Swan-Ganz catheter?
Pulmonary capillary wedge pressure (PCWP) - normally 5-15 mmHg Cardiac Output (CO): blood flow/min (normal 4-8 L/min) Systemic vascular resistance (SVR) - Normal 1000-1500 dynes/sec/cm5
26
When should you monitor hemodynamic parameters?
When cause of shock is unclear Swan-Ganz most appropriate in cardiogenic shock Central lines (including PICC) appropriate for determining fluid status and resuscitation in other types of shock
27
Clinical presentation for ALL types of shock...
Hypotension (SBP <90 or decrease of >40) Tachycardia (Exception = neurogenic shock) Tachypnea*** Oliguria*** Mental status changes (confusion, lethargy)*** Metabolic acidosis*** Cool, clammy skin (exception = early distributive and neurogenic shock = warm, flushed) Later: multi-organ failure, coagulopathy
28
Which type of shock is the only one with Bradycardia instead of tachycardia?
Neurogenic shock
29
Warm skin early, cool skin later
Distributive and neurogenic shock
30
Why are pregnant patients able to compensate for shock for a longer time?
They have increased cardiac output
31
What are the two main etiologies for Hypovolemic shock?
``` Blood loss (hemorrhagic) • Trauma • GI bleed • Internal hemorrhage • Post surgical ``` Fluid loss • Dehydration (incl protracted N/V/D) • Burns • Acute pancreatitis
32
Pathophysiology of hypovolemic shock
⬇️ blood volume (⬇️ preload due to intravascular volume loss) leads to ⬇️ SV ⬇️ SV —> ⬇️ CO and ⬇️ BP ⬇️ BP along with ⬇️ volume leads to impaired oxygen carrying capacity and inadequate tissue perfusion ⬆️SVR to compensate for ⬇️ CO Body switches from aerobic to anaerobic metabolism ⬇️ BP detected by baroreceptors —> reflexive vasoconstriction —> preferential shunting/redistribution of blood
33
Hemodynamic parameters in hypovolemic shock
CVP ⬇️ <5 CO ⬇️ <4 SVR ⬆️ >1500 (COMPENSATORY MECHANISM)
34
Clinical presentation of hypovolemic shock is dependent upon...
Amount of loss (small losses generally tolerated vs large) Rate of loss (slow losses allow for more compensation)
35
Clinical presentation of hypovolemic shock
Hematemesis, hematochezia, melena N/V/D Abdominal pain Evidence of trauma Post-operative
36
Physical exam findings for hypovolemic shock
(THINK ABOUT IT - A VERY DEHYDRATED PATIENT) Dry oral mucosa VS: Hypotension, tachycardia, tachypnea, dec JVP, dec CVP, dec urine output Extremities: cool, clammy, decreased skin turgor Mental status: confused
37
Why is it important to order lactate with your labs when working up a patient with hypovolemic shock?
Lactate increases during anaerobic metabolism derangement affecting O2 utilization and decreased hepatic clearance ORDER EARLY - need to trend - if going DOWN, resuscitation efforts are working Normal lactate is less than 2
38
What diagnostic studies are you gonna get for your patient that’s in hypovolemic shock?
``` CBC (hemorrhagic or not?) CMP PT/INR LACTATE********* ABG CXR/Chest CT Abdominal x-ray/CT ```
39
How do you manage hypovolemic shock?
Treat the underlying problem REPLACE THE VOLUME! • Crystalloids (ie NS) • Colloid (albumin) • Blood (PRBCs, FFP, Platelets) Monitor clinical response • Urine output • Peripheral perfusion • Mentation
40
Do you give vasopressors to patients in hypovolemic shock?
Avoid if possible - constricts vessels harder to get blood places It’s a VOLUME problem - focus on replacing the volume rather than constricting If SBP <70, can use vasopressors short term while restoring volume
41
Name that type of shock: Decreased CO secondary to pump failure
Cardiogenic shock
42
What are the different etiologies of cardiogenic shock?
Ischemia (MI, cardiomyopathy) Valvular heart disease (ruptured papillary muscles/chordae tendineae, critical AS, ventricular septum rupture) Arrhythmias (Vfib, Vtach, complete heart block, Afib, Aflutter, etc) Obstructive (extracardiac)
43
What type of shock is caused by massive PE, cardiac tamponade, or tension pneumothorax?
Obstructive (extracardiac) Problem is outside of the heart but is causing pressure or obstruction on the heart
44
What is the main difference between the pathophysiology of cardiogenic vs hypovolemic shock?
Cardiogenic is pump failure —> decreased BP/CO Vs Decreased volume —> decreased BP/CO
45
Hemodynamic parameters for Cardiogenic Shock
CVP: ⬆️ >5 **** (think preload) PCWP: ⬆️ >5 CO: ⬇️ <4 SVR: ⬆️ >1500 **** (afterload)
46
Clinical presentation of cardiogenic shock?
Chest pain Dyspnea Palpitations Fatigue
47
Physical exam findings for cardiogenic shock
(LIKE A HEART FAILURE PATIENT) VS: tachycardia, tachypnea, hypotension Extremities: Cool, clammy Cardiac exam: Increased JVP, muffled heart sounds, new murmur, tachycardia Pulmonary exam: Possibly deviated trachea, lung sounds dependent on pathology (maybe crackles if diffuse pulmonary edema)
48
What diagnostic studies you gonna get for your patient in cardiogenic shock?
``` CBC, CMP Cardiac enzymes ABG EKG CXR Echo CT chest ```
49
How do you manage a patient in cardiogenic shock?
Treat underlying problem (cath lab if MI, ACLS if vtach/vfib, decompression the tension pneumo, pericardiocentesis if tamponade) Cardiology consult BE CAUTIOUS WITH FLUIDS Inotropes (enhance myocardial contractility) - Dobutamine**** Others: • Diuresis • Anti-arrhythmias • Heart failure meds
50
Last ditch efforts you might have to go to for cardiogenic shock if all the other shit you tried don’t work
Assist devices (LVAD, RVAD, total artificial heart) ECMO - perfume heart outside the body) Heart transplant
51
Which type of shock is the only once that you might have to be cautious with giving fluids?
Cardiogenic shock
52
Which type of shock is characterized by decreased SVR?
Distributive (Vasodilatory) shock
53
What are the etiologies of Distributive Shock?
SALAD ``` Sepsis Adrenal insufficiency Liver disease Anaphylaxis Drugs/meds ``` Can also be neurogenic in origin
54
Septic shock is primarily a problem of ...
Oxygen demand Inadequate tissue perfusion and cellular hypoxia result from increased oxygen demand from tissues to combat systemic infection and septic endotoxins
55
Etiology of septic shock
Any kind of infection - UTI, PNA, bacteremia, etc
56
Early septic shock is associated with...
Hyperdynamic response Fairly well compensated but difficult to maintain Circulating endotoxins aggravate cellular hypoxia and exert toxic effects on the soft tissues and organs —> signs of organ impairment
57
What happens in late septic shock?
Start to see CAPILLARY LEAKAGE and LOSS OF VASCULAR TONE —> relative hypovolemia and hypotension Vasoconstriction further compromises tissue perfusion —> aggravating cellular hypoxia —> organ system malfunction
58
Physical exam findings for septic shock
VS: Fever, low BP, tachycardia, tachypnea Extremities: WARM then COOL Mental status: confused (esp elderly)
59
Suspect septic shock in the elderly or immunocompromised if...
Unexplained hypotension Mental status changes Signs of organ system dysfunction
60
Hemodynamic parameters for septic shock
Early (warm) shock: • CVP ⬇️ • CO ⬆️ • SVR ⬇️ Late (cold) shock: • CVP +/- (usually low) • CO ⬇️ (heart poops out) • SVR ⬆️
61
What diagnostic studies do you want for septic shock?
``` CBC, CMP LACTATE***** Cultures (blood x2, urine, sputum) ABG CXR (r/o PNA) Other imaging as indicated ```
62
How do you manage septic shock?
Early, GOAL-DIRECTED therapy ID and treat underlying problem, infection FLUID RESUSCITATION***** Norepinephrine as a vasopressor***** Ventilator support if indicated
63
Anaphylaxis is another type of ______ shock
Vasodilatory
64
Anaphylaxis is an acute, potentially life-threatening multisystem syndrome caused by the sudden release of ______________ into the circulatory system
Mast cell mediators Most often results from IgE mediated reactions to foods, drugs, insect stings, or any agent capable of inciting a sudden, systemic degranulation of mast cells
65
SSx of anaphylaxis
Skin/mucosa: Hives, rash, itching/flushing, periorbital edema, lip edema, conjunctival swelling Respiratory: nasal discharge/congestion, change in voice, sensation of throat swelling, stridor, SOB, wheezing, cough GI: N/V/D, cramps abdominal pain CV: syncope, dizziness, tachycardia, hypotension
66
Death from anaphylaxis usually results from...
Asphyxiation due to upper or lower airway obstruction or from CV collapse/shock
67
First line treatment for anaphylaxis
IM Epinephrine 1:1000 (1mg/ml prep) Give 0.01 mg/kg IM (can repeat q5-15 min) Can consider IV epi infusion if necessary Treat hypotension with fluid bolus
68
Adjunct therapies for anaphylaxis
After you give the Epi... ``` H1 antihistamines (Benadryl 25-50 mg IV) +/- H2 antihistamine (ranitidine 50 mg IV) ``` +/- steroids (1 mg/kg/day methylprednisolone)
69
Neurogenic shock is characterized by...
Loss of sympathetic tone, leading to vasodilation and hypotension BRADYCARDIA and hypotension
70
Etiology of neurogenic shock
Spinal cord injury Closed head trauma (brain stem brain stem) Basically, the sympathetic NS gets cut off —> unopposed parasympathetic stimulation
71
Physical exam findings for neurogenic shock
VS: HR normal or low, low BP ``` Neuro exam: • +/- altered LOC • Motor exam = para/quadriplegic • Sensory exam depends on level affected • DTRs: absent/hyperreflexia • Extremities: warm (due to vasodilation) ``` Rectal exam: reduced sphincter tone
72
Hemodynamic parameters for neurogenic shock
CVP: normal or reduced (<5) CO: normal or reduced (<4) SVR: reduced (<1500)
73
Diagnostic studies you would order for neurogenic shock
CBC, CMP Xrays - cervical spine (need to see C7-T1 to clear C-spine) Head CT to r/o structural lesions, evidence of shift or herniation Spinal CT/MRI
74
How do you manage neurogenic shock?
Address co-existing problems Fluids to correct relative hypovolemia Neurosurgery consult STAT!

EMED Unit 3 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions