Hypotension (Exam 4) Flashcards
Technically, At what systolic and diastolic pressures, do we consider a pt to be hypotensive?
Systolic 90mmHG or lower
Diastolic 60mmHG or lower
True or false?
Some people’s normal blood pressure runs at 90/60mmHg or lower.
True!
**Clinically, we appreciate that a patient is hypotensive if signs or symptoms of end-organ damage are present or that the patient is symptomatic
True or false?
Older, thicker folks tend to have lower BP.
False.
Younger, fitter, thinner folks tend to have lower blood pressure
___________ hypotension is an acute drop in blood pressure after a change in body position (laying/sitting to standing) secondary to a delay in the normal compensatory ability of the autonomic nervous system
Orthostatic
Orthostatic hypotension may be a “random occurrence” but is often a sign of _________ or medication side effects.
hypovolemia
In order for a pt to be diagnosed with orthostatic hypotension, their BP must either: 1.) decrease in systolic blood pressure by __mmHg OR 2.) decrease in diastolic blood pressure by __mmHg, within three minutes of standing, when compared to their BP from sitting or supine position. OR their pulse must rise by more than __ bpm within 3 mins of standing.
20
10
20
Shock is a life-threatening condition secondary to ________ _________ __________.
inadequate tissue perfusion
___________ shock is caused by Inadequate circulating volume.
Hypovolemic
___________ shock is caused by Inadequate cardiac function; heart not pumping properly.
Cardiogenic
__________ shock is Associated with physical blockage of the great vessels or the heart itself.
Obstructive
Distributive shock is the Abnormal distribution of blood flow that results in inadequate supply of blood to the body’s tissues and organs, due to profound ____________ in a system (ex: sepsis, anaphylaxis)
vasodilation
What clinical features might you see in a pt who is in shock?
- Hypotension
- tachycardia
- evidence of end-organ damage
- AMS
- decreased urine output
- cyanosis
- low cardiac output (ECHO)
- other sx’s based on etiology of the shock; fever w/ sepsis, JVD w/cardiogenic, etc
If you suspected sepsis in a pt you believe to be in shock, what lab would you order?
What would you expect the result to be if the pt was in septic shock?
Lactate
> 4mmol/L
(*note lactate can be elevated in other conditions than sepsis; like dehydration, ischemia, pseudo, etc. Only depend on this if the pt has signs of infxn.)
True or False?
WBC’s will always be elevated in an infection.
False.
WBC’s can be elevated or depleted (low) in an infection.
If you ordered a BMP in a potential shock pt, what would you be looking for?
electrolyte deficiencies
renal impairment
acidosis (BUN/Creatinine)
What would a CBC tell you about a pt who is potentially in shock for an unknown cause?
H/H–> anemia vs. dehydration
WBC’s–> infection?
RUSH Protocol encourages a rapid _________, in pt’s with signs of shock and/or acute hypotension
ultrasound
Which type is the most common type of shock?
hypovolemic
Hypovolemic shock Typically occurs after a loss of ____% of a persons circulating blood volume.
> 20% (appx 1 liter)
A 50 yr old pt presents to the ER after an MVC. Pt's pulse is 120; weak and thready, BP of 80/55mmHg and a temp of 95.7F. Her skin is cool and clammy. Which type of hypovolemic shock do you suspect? What lab(s) would you definetly want to order?
HEMORRHAGIC
labs to order:
-CBC (dont order to early, false normal)
-Type & screen or Type & Cross–> EARLY!!
What type of blood would you give to a pt that you did not yet have a type and screen or type and cross on??
O -
universal blood type
What are the 4 components of “whole blood”?
- Plasma
- Platelets
- RBC’s
- WBC’s
On a trauma pt, who is in hemorrhagic shock, what blood product would you order ?
(not blood “type”, but think whole blood vs, platelets, etc)
PRBC’s
Packed red blood cells
A dialysis pt presents to the ER due to excessive thirst, dry mouth, and extreme weakness for the last 12 hrs. You notice he has a weak, rapid pulse and that his BP is hypotensive. He was last dialyzed yesterday. What condition do you suspect?
Non-hemorrhagic hypovolemic shock
What would you expect to see on a pts lab results, who has non-hemorrhagic hypovolemic shock?
(I.e. High/low H/H?, high/low BUN?, electrolytes?)
- ELEVATED H/H - 2/2 hemoconcentration
- ELEVATED BUN
- NA usu. elevated
- addt’l electrolyte derangements possible
True or false?
When considering IV fluid resuscitation for a hypolemic pt, you should choose LR over NS if available.
TRUE
______ ________ occurs when fluid moves from the intravascular space (blood vessels) into the interstitial space; the nonfunctional area between cells.
“Third Spacing”
What are 3 common conditions caused by Third spacing?
Ascites
edema
pancreatitis
What are 2 common causes of cardiogenic shock?
massive MI
heart failure
_____________ are a class of medications that increase BP by increasing “squeeze” or vasoconstrictors. These might be considered in a pt in cardiogenic shock.
Vasopressors
ex: Dobutamine for left heart failure or Dopamine for MI
This type of shock could be caused by cardiac tamponade, PE, or tension PTX.
Obstructive
Occurs when an extra-cardiac obstruction impedes cardiac filling or emptying
There are __ categories of distributive shock. What are they?
4
- SIRS (Systemic inflammatory response -syndrome)
- Anaphylaxis
- Neurogenic shock
- rewarming in hypothermia
SIRS CRITERIA -need to memorize!!! (slide 23)
What are the 4 criteria?
How many does a pt need to meet SIRS criteria?
- Fever >100.4 or <96.8
- HR > 90 bpm
- RR >20 breaths per min
- Abnormal WBC count
Pt needs 2 or more to meet criteria.
Know the 3 criteria for septic shock. (slide 23)
Criteria 1- suspected or known infection
Criteria 2- Meets 2+ SIRS criteria
Criteria 3- Evidence of organ dysfunction
–>SBP<90, lactate>2, resp distress, Cr>2, Bili>2, INR>1.5, Platelets<100,000
If you suspect distributive shock due to SIRS/Sepsis, you should initiate what systemic abx? What other tx must you initiate immediately??
Vancomycin + imipenem (Zosyn)
FLUIDS FLUIDS FLUIDS (30mL/kg bolus, then maintenance) (LR>NS)
–may consider vasopressor if still hypotensive after fluids
This type of distributive shock is caused by a widespread release of inflammatory mediators (histamine, leukotrienes, prostaglandins) leading to massive peripheral vasodilation.
Anaphylaxis
How would you treat a pt with anaphylaxis?
- Antihistamines (Benadryl, Cimetidine)
- Corticosteriods (Solu-Medrol)
- Beta2 Agonists (Albuterol)
- Epinephrine (for unstable and/or sig resp distress)
This type of distributive shock occurs when an acute spinal cord injury occurs above the level of T6 causing autonomic system dysfunction
Neurogenic
When treating a pt in hypovolemic shock with fluid resuscitation, you want their urine output to be ___ cc’s per hour, which indicates success!
30
When doing fluid resuscitation on a pt, what condition could they develop? what s/sx’s would you want to watch out for?
Pulmonary edema
Watch for hypoxia, or if pt complains of SOB
