M5 Perfusion Flashcards
Shock 101
Condition in which vital tissue and organs are not receiving enough blood
Without O2 and nutrients from blood, things start to die
Shock can happen due to any mechanism of action that disrupts
Heart function
Blood volume
Blood pressure
Subjective shock S/S
Feeling sick
Weak
Cold/hot
LOC
Objective shock S/S
Hypotension BELOW 60
SOB
Cardiac output and urinary output with shock
Decreases
Respiratory output with shock
Rate Increase resulting in Resp Alkalosis
Resp Alkalosis is an impending indicator of
SHOCK
O2 sat and shock
Drops
First organs to be affected by shock are heart and brain so what are the earliest symptoms
what about respirations
LOC
BP drop
HR increase
Cardiac output drop
rapid and shallow
5 Types of shock
Hypovolemic
Neurogenic
Cardiogenic
Septic
Anaphylactic
Shock treatment ABC
Airway
Breathing
Circulation
To treat shock, threat
Underlying cause
Supportive measures for shock
IV to expand intravascular volume
Vasopressors to increase BP
Supplemental O2
Keep PT warm
Keep environment quiet
What makes treatment difficult in the later stages of shock
Positive feedback loop
Causes for fluid loss shock
Hemorrhage
Burns
Dehydration
Vomit/diarrhea
Diuretics
Diagnostics scans for Hypovolemic shock
CT
Ultrasound
EGD
detects bleeding
Echocardiography
Labs for hypovolemic shock
ABG
Electrolytes
Renal panel
CBC
Urinalysis
Diagnostic tests for cardiogenic shock
12 lead EKG
Nuclear scan
Cardiac cath
Coronary angiography
Lab tests for cardiogenic shock
All the hypovolemic labs +
CRP
Cardiac biomarkers
Thyroid hormones drugs
Diagnostics and Lab test for neuro shock
12 lead EKG
CT MRI of brain
ABG
lytes
CBC
Urinalysis
Diagnostics and labs for anaphylactic shock
12 lead EKG
sensitization test
ABG
Lytes
CBC
Urinalysis
Diagnostics and labs for septic shock
12 lead EGK
Same as hypovolemic
Diagnostics and labs for septic shock
12 lead EGK
Same as hypovolemic+
Serum lactate
Pro-calcitonin
Coagulation factors
Blood/other CULTURES
Hypovolemic shock is defined as a loss of _% of intravascular volume
15
Difference between hypovolemic and cardiogenic shock
Fluid volume and cardiac health
S/S of hypovolemic shock
cardiac
resp
integument
rapid pulse
low BP-high SVR
rapid respirations-low preload
poor skin turgor, tenting, thirst
Hypovolemic shock management
Replace volume with
BLOOD, COLLOIDS or CRYSTALLOIDS
What hormone to give to hypovolemic shock PTs
ADH
Antidiuretic Hormone
Treat acute massive blood loss with
What is the _% for acute blood less
Whole blood
Know blood admin procedures
More than 30% of total volume
Depending on what is low during hypovolemic shock, what other blood components can we give
Plasma protein fraction
Fresh-frozen plasma
Packed RBCs
Colloids 101
what kind of pressure
Expand plasma by drawing body cell molecules in to blood vessels
Oncotic
When to use colloids
When up to 1/3 of adult blood volume is lost
Colloid types
nonblood
we can administer
Dextran
Hespan
Natural colloids in blood
Albumin
Plasma protein fraction
Serum globulin
Crystalloids 101
Types
Intravenous solutions that contain lytes
replace fluids and promote urine output
Isotonic
Hypotonic
Hypertonic
Crystalloid solution examples
NS
LR
Plasmalyte
Neuro shock patho
Sympathetic v/parasympathetic ^ = v in vascular tone = v SVR = v cardiac output = v tissue perfusion = Impaired Cellular Metabolism
Neuro shock risk factors
Spinal trauma
Regional anesthesia
Autonomic nervous system drugs
Neuro shock S/S
heart
skin
v cardiac output
hypotension
bradycardia
cold
Dusky
Volume replacement for neuro shock
Crystalloid
Colloid
Meds for neuro shock
Vasopressors
Corticosteroids
Other neuro shock interventions
Cardiac pacing
GCS (Glasgow coma) scale
Ventilation/intubation
Another name for neuro shock
Vasogenic due to dilation
When the medulla does not get enough O2 or GLUCOSE we get
neurogenic shock
SVR
Systemic vascular resistance
Resistance of blood vessels
Used to create blood pressure
Cardiogenic shock 101
Decreased cardiac output
Impaired cellular metabolism
Hypoxia in presence of adequate volume
Causes for cardiogenic shock
HF
Dysrhythmias
Valve dysfunction
Myocardial infection
Massive emboli
Cardiac temponade
Cardiac temponade
Space around heart fills with fluid
Cardiogenic shock risk factors
Age
MI/HF history
DM
CAD
Cardiogenic shock S/S
neuro
resp
integ
cardiac
GI
LOC
Tachypnea, dyspnea due to pulmonary edema
dusky skin
hypotension BELOW 60
Oliguria
Managing cardiogenic shock
Meds
Vasodilator - nitro
Vasopressor - dopamine
Beta-agonist - increase contraction force
Morphine - improve coronary perfusion
Volume replacement with cardiogenic shock
Crystalloid/colloid
Managing airway and cardiogenic shock
Intubation
Surgeries and procedures for cardiogenic shock
Intra aortic balloon
VAD
Revascularization (bypass surgery)
Septic shock 101
Gram positive TLR2 receptor or gram negative TLR 4 receptor activation = Macrophage engagement = SIRS=w/c shock=MODS
SIRS
Systemic inflammation response syndrome
S/S
Fever
Tachycardia
Tachypnea
Leukocytosis
MODS
Multiple organ disfunction
w/c shock s/s
1st warm shock
2nd cold shock
vasodilation
hypotension
hypoperfusion
inflammation
Myocardial depression
Worsening tissue hypoperfusion
Most common sites of entry for septic shock
Lung
Urinary
GI
Wound
Vascular cath
Risk factors for septic shock
age
nutrition
Hx (trauma surgery caths, HF, DM)
Immunosuppression - AIDS, steroids, chemo, post-organ transplant
Early septic shock S/S
heart
GU
Skin
Neuro
Tachycardia
^ Cardiac output
Hypo OR hyperthermia
Deranged renal system
Jaundice
Deterioration of mental status
Labs for septic shock
Culture
C-reactive proteins
Serum lactate
Pro-calcitonin
Coagulation factors
Fluids for Septic shock
Crystalloids
Colloids
Meds for septic shock
Antibiotics (central line cath)
Vasopressors
Steroids
Beta-agonists
Antipyretics
Insulin
Septic shock airway management
Intubation
Anaphylactic shock 101
Hypersensitivity reaction
vasodilation and hypovolemia=decreased perfusion and impaired metabolism
Most common allergens causing anaphylactic shock
Insect bites
Shellfish
Peanuts
Latex
Meds (pcn)
What else is a big allergen that can happen in hospitals
blood transfusion
Anaphylactic shock S/S
neuro
resp
integument
GI/GU
loc
Stridor/Wheezing
Pruritus
Hives
Swollen lips/tongue
Abdominal cramps, oliguria
Cardio S/S of anaphylactic shock
BP drop
SVR drop
Increased Cardiac Output
Meds for anaphylactic shock
Antihistamines
Bronchodilators
Corticosteroids
Vasopressors
Airway management and anaphylactic shock
intubation/ventilation
Fluid replacement to give in anaphlectic shock
Crystalloids/colloids
1st things to remove in anaphylectic shock
ANTIGEN
Vasoconstrictor/sympathomimetic for shock 101
Act on alpha-adrenergic receptors
raise blood pressure
positive inotropic effect
Vasoconstrictor/sympathomimetic meds
Norepinephrine
(Levophe, Levaterenol)
Vasoconstrictor/sympathomimetic adverse effects
tachycardia
hypertension