Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

X Emergency Med Exam 3 > Hypotension/Shock > Flashcards

Hypotension/Shock Flashcards

1
Q

What should always be started with hypotension?

A

Small fluid bolus to check fluid responsiveness

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

What is shock?

A

Physiologic condition of 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
3
Q

What determines systemic tissue perfusion?

A

Mean Arterial pressure (which equals CO x SVR)

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

What influences SVR

A

Vessel length and diameter and blood viscosity

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

Ways to assess adequate global perfusion

A 
Mental status
UOP
Serum lactate/acidosis
Peripheral perfusion assessment
(not all pts with hypotension are in shock)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Stages of shock

A

Pre-shock
Shock
End organ dysfunction

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

What is pre-shock?

A

Warm shock or compensated shock

Tachycardia, peripheral vasoconstriction, hypotension

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

Shock as a stage

A

Compensatory mechanisms overwhelmed and s/s of organ dysfunction appear
Tachycardia, dyspnea, metabolic acidosis, oliguria, confusion, cool clammy skin

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

Categories for the etiologies of shock

A 
Hypovolemic
Cardiogenic
Obstructive
Neurogenic
Distributive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Lines used in resuscitation

A

Arterial line
Central line
Swan Ganz (pulm artery) catheter

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

Arterial line in shock

A

Radial/ brachial/ femoral
Invasive arterial BP monitoring (recurrent ABGs)
Don’t use for meds!!

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

Indications for central line

A

Delivery of caustic or critical meds and measurement of CVP (triple lumen, double lumen, dialysis catheters, Swan-Ganz catheter, PICC line-peripherally inserted central line)

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

Normal value of central venous pressure

A

5-15 mmHg

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

What is central venous pressure?

A

Pressure near right atrium
Correlates to preload or overall volume status
Can be obtained with any central line
*trend it

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

Normal value of pulmonary capillary wedge pressure (hemodynamic parameter)

A

5-15 mmHg

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

Normal value for cardiac output (hemodynamic parameter)

A

4-8 L/min

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

Normal value for SVR (hemodynamic parameter)

A

1000-1500 dynes/sec/cm5

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

When to monitor hemodynamics

A

If cause of shock is unclear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Most appropriate to monitor hemodynamics in cardiogenic shock

A

Swan-Ganz catheters

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

What is used to monitor hemodynamics in all other types of shock?

A

Central lines (include PICC lines) to determine vol status (CVP) and resuscitation

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

Presentation of all types of shock

A

Hypotension (SBP<90 or decrease SBP >40)
Tachycardia and tachypnea
Oliguria
Mental status changes (confusion, lethargy)
Metabolic acidosis
Cool clammy skin
Later: multi organ failure and coagulopathy

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

What shock has a decreased HR?

A

Neurogenic shock

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

What shock has flushed and warm skin?

A

Early distributive and neurogenic shock

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

Why can pregnant pts present differently with shock?

A

Can compensate for a while b/c increased CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is hypovolemic shock?
Inadequate intravascular volume leads to decrease CO and decreased O2 delivery
26
Etiology of hypovolemic shock
``` Blood loss/hemorrhagic (TRAUMA, GI bleeding, internal hemorrhage, post-surgical) Fluid loss (dehydration-n/v/d, burns, acute pancreatitis) ```
27
What happens in hypovolemic shock?
Switch from aerobic to anaerobic metabolism Decreased BP from baroreceptors activates SNS and vasoconstriction Blood shunted and redistributed
28
Hemodynamic parameters of hypovolemic shock
CVP down <5 CO down <4 SVR up >1500
29
What does the presentation of hypovolemic shock depend on?
Amount of loss (small can be tolerated) | Rate of loss (slow allow for time to compensate)
30
Presentation of hypovolemic shock
Hematemesis, hematochezia, melena N/v/d Abd pain, evidence of trauma Post-op
31
PE of hypovolemic shock
Dry oral mucosa VS: hypotension, tachycardia/pnea, decreased JVP/ CVP/ urine output Cool and clammy with decreased turgor Confused
32
Diagnostic studies for hypovolemic shock
``` CBC, CMP, PT/INR Lactate ABG CXR/ CT Abd x-ray/ CT ```
33
Lactate in hypovolemic shock
Lactate increases during anaerobic metabolism, derangements affecting O2 utilization and decreased hepatic clearance Increased mortality!
34
Management for hypovolemic shock
``` Tx underlying problem Replace vol (crystalloid-normal saline, colloid-albumin, blood) Monitor response (urine output, perfusion, mentation) ```
35
Vasopressors in hypovolemic shock
Must remember that best thing to do replace vol b/c thats the problem! If dire situation (SBP<70) can use while replacing vol
36
What is cardiogenic shock?
Decreased CO secondary to pump failure
37
Etiology of cardiogenic shock
Ischemia (MI, cardiomyopathy) Valvular heart disease Arrhythmias OBSTRUCTIVE (extracardiac- massive PE, cardiac tamponade, tension pneumo)
38
Pathophys of cardiogenic shock
Pump failure- activate SNS Hypotension and decreased CO so decreased renal perfusion (sodium and fluid retention) Increase filling pressure-vol overload in lungs Increase SVR to compensate for decreased CO
39
Hemodynamic parameters of cardiogenic shock
CVP increased >5 (preload) PCWP increased >5 CO decreased <4 SVR increased >1500 (Afterload)
40
Presentation of cardiogenic shock
Chest pain, dyspnea, palpitations, fatigue
41
PE for cardiogenic shock
VS: tachycardia, tachypnea, hypotension Cool and clammy Cardiac: increased JVP, muffled heart sounds, new murmur Pulm: trachea deviated, lungs depend on pathology (crackles if pulm edema)
42
Studies for cardiogenic shock
CBC, CMP Cardiac enzymes ABG, EKG, CXR, echo CT chest
43
Management for cardiogenic shock
``` Treat underlying probs Cardiology consult (preserve function and perfusion) Fluids but be cautious Inotropes (to enhance contractility) Diuresis, anti-arrhythmias, HF meda ```
44
How to treat underlying cause of cardiogenic shock
MI: O2, cath lab Vtach/fib: ACLS Tension pneumo: decompression Cardiac tamponade: pericardiocentesis
45
First line inotrope for cardiogenic shock
Dobutamine
46
Last line management for cardiogenic shock
Assist devices (LVAD, RVAD, total artificial heart) ECMO Heart transplant
47
What is distributive (vasodilatory) shock?
Decreased SVR (vasodilation)
48
Etiologies of distributive shock
``` SEPSIS Adrenal insufficiency Liver disease Anaphylaxis Drugs/meds (SALAD) and neurogenic ```
49
What is septic shock?
Inadequate tissue perfusion and cellular hypoxia from increased O2 demand from tissues to combat systemic infection and septic endotoxins
50
Etiology of septic shock
Any kind of infection (UTI, pneumonia, bacteremia)
51
Pathophys of early septic shock
Initial response to meet increased demand for O2 by cells is vasodilation Decrease SVR and hypotension Detect low BP and increase HR and CO Start to see signs of organ impairment (due to endotoxins) *associated with hyperdynamic response-well compensated but difficult to maintain
52
Pathophys of late septic shock
Capillary leakage and loss of vascular tone so relative hypovolemic and hypotension Stimulate SNS more Increased HR and SVR (vasoconstriction aggravates cellular hypoxia)
53
PE for septic shock
VS: fever, hypotension, tachycardia and tachypnea Extremities: warm early and cool late Confused
54
Common initial physiologic response to septic shock
Tachypnea
55
When to suspect septic shock in elderly or immunocompromised
Unexplained hypotension, mental status changes or signs of organ system dysfunction
56
Hemodynamic parameters of early (warm) shock
Decrease CVP Increased CO Decreased SVR
57
Hemodynamic parameters of late (cold) shock
CVP +/- usually decreased Decreased CO Increased SVR
58
Studies for septic shock
CBC, CMP Lactate Cultures (blood x2, urine, sputum) ABC, CXR
59
Management of septic shoc
``` Goal directed therapy Panculture before abx then empiric Fluid resuscitation Vasopressors Ventilator if needed ```
60
First line vasopressor for septic shock
NE
61
What causes anapylaxis?
Sudden release of mast cell mediators into systemic circulation (IgE usually)
62
Sxs of anaphylaxis
Skin/mucosa: hives, rash, itch, edema, conjunctival swell Resp: discharge, congestion, voice quality, throat swelling, stridor, SOB, wheeze GI: n/v/d, abd pain CV: syncope, dizzy, tachycardia, hypotension
63
Most often death from anaphylaxis
Usually due to asphyxiation due to upper or lower airway obstruction or from CV collapse/shock
64
Tx for anaphylaxis
``` IM Epi 1:1000 (.01 mg/kg IM) Oxygen, airway Fluid bolus H1 antihistamine (diphenhydramine) Maybe steroids (methylprednisolone) ```
65
What is neurogenic shock?
Loss of sympathetic tone, leading to vasodilation and hypotension (bradycardia + hypotension)
66
Etiology of neurogenic shock
Spinal cord injury (disruption b/w brain and spinal cord) | Closed head trauma (injury to brain stem)
67
Pathophys of neurogenic shock
Sympathetics travel down cervical spinal cord etc Release epi and NE to increase HR, contraction and vasoconstriction Disruption of SNS results in unopposed PNS action Hypotension with decreased SVR and normal to decreased HR
68
PE for neurogenic shock
VS: HR normal or decreased and hypotension Altered LOC, para/quadriplegic, senses affected based on lesion, absent or hyperreflexia, warm extremities Decreased sphincter tone
69
Hemodynamic parameters of neurogenic shock
CVP normal or decreased <5 CO normal or decreased <4 SVR decreased <1500
70
Studies for neurogenic shock
CBC, CMP X-rays (C spine to clear ) Head CT (structural lesions or hernation) Spinal CT/MRI
71
Management of neurogenic shock
Co-existing probs Fluids for relative hypovolemia Neurosurgery consult!

X Emergency Med Exam 3 (5 decks)

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