Hypotention and Shock Flashcards
Defined as inadequate tissue perfusion from decreased CO
Shock
What is the formula for MAP?
MAP = HR x SV x SVR
what stage of shock is associated with compensation, Tachy, and increased SVR?
pre-shock
what stage of shock is associated with uncompensated organ damage, tachy, dysnpea, metabolic acidosis, oligouria, and cool extremitites?
Shock
what stage of shock is associated with end-organ damage from shock?
End organ dysfunction
what lines can you use to resuscitate a patient?
Arterial lines, Central lines, PICC, and Swan-Ganz Catheter (Pulm)
Can you give meds and monitor ABGs with Arterial lines?
No meds, Yes ABGs
What are 2 central lines
Swan-ganz, PICC
What line can enter the Brachia-cephalic vein and ends at the SVC-RA junction
PICC
What is normal CVP?
5-15 mmHg
What does the Swan Ganz catheter measure
Pulmonary pressure (5-15 mmHg)
What does all Shock types include?
Hypotension, Oligouria, Metabolic acidosis, Cool extremeties, End-organ failure
Pathophys of hypovolemic shock HR_ CVP_ PCWP_ CO_ SVR_
HR_Increase CVP_decrease PCWP_decrease CO_decrease SVR_Increase
Pathophys of Cardiogenic shock HR_ CVP_ PCWP_ CO_ SVR_
HR_ increase CVP_Increase PCWP_increased CO_decrease SVR_increase
Pathophys of Early Sepsis shock HR_ CVP_ PCWP_ CO_ SVR_
HR_increase CVP_decrease PCWP_increase CO_increase SVR_decrease
Pathophys of Late Sepsis shock HR_ CVP_ PCWP_ CO_ SVR_
HR_ Increase CVP_decrease PCWP_increase CO_decrease SVR_increase
Pathophys of Neurogenic shock HR_ CVP_ PCWP_ CO_ SVR_
HR_ decrease CVP_decrease PCWP_decrease CO_decrease SVR_decrease
which shock presents with hematemesis, hematochezia, melena, N/V/D, abdominal pain, trauma, post-op?
hemorrhagic shock
What would a CMP show for shock patients?
elevated lactate - anaerobic respiration
why do you give a patient crystalloid, colloid, and FFP?
Crystalloid = saline Colloid = albumin FFP = frozen fresh blood
What 3 things do you monitor in shock patients?
Urine output
peripheral perfusion
Mentation
When can you give patients Vasopressors
SBP<70 mmHg
what is the number 1 cause of cardiogenic shocK?
Obstructive cardiogenic shock due to Aortic Stenosis, but can also be due to PE, tamponade, or pneumothroax
What happens to SVR to compensate for a low CO
SVR increases (renal salt and water retention also)
PE of cardiogenic shock
JVD, edema, tachy, tachypnea, crackles
How do you manage patients with each issue 1 MI 2 V-tach/fib 3 Tension pnemothorax 4 tamponade
1 Cath lab
2 ACLS (ken)
3 decompress
4 pericardiocentisis
what is a first line Inotrophic drug for shock management?
Dobutamine
whats beta blocker and antiarrythmic called that we need to know?
Sotalol and Amioderone
What is last line of tx for shock patients
LVAD, RVAD, ECMO, Transplant
Etiology of Distributive Shock (think Sepsis Salad)
SALAD
Sepsis, adrenal disease, liver disease, anaphylaxis, Drugs
What shock is charaterized with an increase in 02 demand to combat an infection?
Sepsic shock
what kind of infection can lead to septic shock
Any (UTI, pneumonia, bacteremia, ect)
What stage of septic shock has a decreased SVR, increased CO, and increased Contractility
Early septic
when can early septic shock become late septic shock
when pro-inflammatory cells> anti- inflammatory cells = vasodilation
What stage of septic shock is charaterized with and increase HR, SVR, and hypovolemia, with decreased CO
Late sepsic shock
what populations get septic shock in general
elderly and immuncompromised
in septic shock, do order a Pan-culture before or after antibiotics are administered?
Pan-cultures before antibiotics, but you can tx empirically using coverage based on likely infectious agent.
If you are going to give a vasopressor, what the firs line?
Norepi along with ventilator support
What causes neurogenic shock
pt took a blow to the head that severed the SNS of the thoracocolumnar section of the spine (para/quad)
Why are all (HR, CO, SVR) decreased in neurogenic shock?
suppressed/eliminated SNS response.
how do the DTRs respond with neurogenic shock
absent or hyperreflexia
