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Med Surg 3 > Midterm > Flashcards

Midterm Flashcards

1
Q

What parameters are going to be monitored with hemodynamic monitoring?

A

preload (CVP and PAWP)
afterload (PVR ad SVR)
CO/CI

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2
Q

Describe preload

A

Right atrial pressure
- CVP (central venous pressure): 2-8 mmHg

Left atrial pressure
- PAWP (pulmonary artery wedge pressure): 8-12 mmHg

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3
Q

What will be done if the preload is high vs low?

A

high (CVP/PAWP) = pt in fluid volume overload, give diuretics and vasopressors

low = pt dehydrated - fluids (crystalloids/colloids) 1st if CVP is low, but if CVP is high give vasopressors

if CVP and PAWP is on the lower end of the normal range, it is still considered low

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4
Q

Describe afterload

A

Right side of heart
- PVR (pulmonary vascular resistance): 100-250 dynes/sec/cm5

Left side of heart
- SVR (systemic vascular resistance): 800-1200 dynes/sec/cm5

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5
Q

What will be done if the afterload is high vs low?

A

high = give vasodilator
low = give vasopressor

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6
Q

What is the difference between vasopressors and vasodilators?

A

vasopressors increase BP
vasodilators decrease BP

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7
Q

What are examples of vasodilators?

A

nitroglycerin
nitroprusside
morphine
ca channel blockers
ace inhibitors

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8
Q

What are examples of vasopressor?

A

norepinephrine
dopamine
vasopressin
epinephrine

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9
Q

Describe cardiac contractility

A
  • electrolytes and oxygen affect contractility
  • low CO/CI = ineffective contractility

cardiac output (CO)
- volume ejected each min
- 4-8 L/min

cardiac index (CI)
- dependent on height and weight of pt
- 2.5-4.3 L/min/m2

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10
Q

What will be done if the cardiac contractility is high vs low?

A

high = negative inotropes (beta blockers and ca channel blockers)

low = give positive inotropes (dopamine, dobutamine, digoxin)

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11
Q

What is the cause of cardiogenic shock?

A
  • heart not pumping effectively (within the heart)
  • MI
  • HF
  • cardiomyopathy
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12
Q

What is the cause of hypovolemic shock?

A
  • loss of fluid
  • dehydration
  • hemorrhage
  • burn
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13
Q

What are examples of distributive shock?

A

whole body

septic (#1 shock state)
neurogenic
anaphylactic

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14
Q

What is the cause of septic shock?

A
  • infection
  • sepsis (urosepsis)
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15
Q

What is the cause of neurogenic shock?

A

head trauma
spinal cord injury (T6 or higher)

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16
Q

What is the cause of anaphylactic shock?

A

allergy (drug, food, environmental)

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17
Q

What is the cause of obstructive shock?

A

heart not pumping effectively (outside the heart)

  • pulmonary embolism
  • tension pneumothorax
  • aortic dissection
  • cardiac tamponade
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18
Q

What are the signs of cardiac tamponade?

A

beck’s triad
- hypotension
- JVD
- muffled heart sounds

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19
Q

What are the signs of cardiogenic shock?

A
  • high HR , low BP
  • high CVP/PAWP, high SVR
  • low CO/CI
  • confused
  • SOB
  • tachypnea
  • crackles
  • low urine output
20
Q

What is the treatment for cardiogenic shock?

A
  • inotropes (dopamine/digoxin)
  • diuretics
  • stent
  • valve replacement
21
Q

What are the signs of hypovolemic shock?

A
  • high HR, low BP
  • low CVP/PAWP, high SVR
  • low CO/CI
  • altered LOC
  • low urine output
  • cold/clammy skin
22
Q

What is the treatment for hypovolemic shock?

A
  • fluids (NS or LR), but vasopressors (norepi or dopamine if CVP high
  • lower HOB
  • if bleeding = packed RBCs
  • fluid replacement using 3:1 rule (3ml of fluids to every 1 ml of blood loss)
23
Q

What is the difference between sepsis and septic shock?

A

sepsis: systemic inflammatory response

septic shock: sepsis w/ hypotension despite fluid resuscitation

24
Q

What are the signs of early (warm) septic shock?

A

restlessness/confusion
low BP, high HR, high RR
warm, flushed skin
low CVP/PAWP, low SVR
high CO
high lactate, WBC

25
Q

What are the signs of late (cold) septic shock?

A

lethargy/coma
low BP, high HR, low RR
cool, pale skin
low CVP/PAWP, high SVR
low CO
high lactate, low WBC

26
Q

What is the treatment for septic shock?

A

oxygen
IV fluids
antibiotics
vasopressors
maintain glucose levels <180
prevent stress ulcer (PPI)

27
Q

What are the signs of neurogenic shock?

A

massive vasodilation
bradycardia
low BP
temp dysregulation
low preload, afterload, CO

28
Q

What is the treatment for neurogenic shock?

A

fluids (NS, cautious bc it increases BP)
vasopressors
atropine
corticosteroids (reduce inflammation)

29
Q

What are the signs of anaphylactic shock?

A

massive vasodilation
high HR, low BP
decreased RR
SOB, wheezing, stridor

low preload, afterload, CO

30
Q

What is the treatment for anaphylactic shock?

A

epinephrine (IM)
fluids (if they don’t work, give vasopressors)
diphenhydramine
corticosteroid
airway mngmt

31
Q

What are the signs of obstructive shock?

A

high CVP/PAWP, high SVR
low CO/CI
JVD
high HR, low BP, high RR

SOB, tracheal deviation, unilateral breath sounds

32
Q

What is the treatment for obstructive shock?

A

needle decompression
chest tube
pericardiocentesis
thrombolytic therapy
laparotomy
removal of mass

33
Q

What are the stages of shock?

A

initial
compensatory
progressive
irreversible

34
Q

Describe the initial shock stage

A
  • s/s absent
  • subtle changes
35
Q

Describe the compensatory shock stage

A
  • non progressive
  • low oxygen
  • tachycardia
  • tachypnea

ex: neurogenic shock

36
Q

Describe the progressive shock stage

A
  • organ failure
  • lethargic
  • low BP

ex: hypovolemic, anaphylactic

37
Q

Describe the irreversible shock stage

A

death is imminent

ex: cardiogenic

38
Q

What diagnostic studies are done for the different types of shock?

A

hemodynamic monitoring
12 lead ECG
echo
CXR
EGD
lactate above 2 = bad

39
Q

Describe SIRS

A

systemic inflammatory response syndrome

manifested by 2 or more of following:
- 36 C < Temp > 38 C
- HR > 90 bpm
- RR > 20 or PaCO2 < 32
- 4,000 < WBC > 12,000

40
Q

How can a local infection progress?

A

local infection - systemic infection (shock) - SIRS - multiple organ system syndrome (MODS septic shock) - death

41
Q

How does SIRS (organ failure) present?

A
  • neuro: ALOC, fever, lethargy
  • resp: high RR, low O2
  • cardio: tachycardia
  • GI: ulcer, bleed, electrolyte imbalance
  • GU: AKI, high BUN/creatinine
  • hematologic: DIC, bleeding, petechiae, high PTT/aPTT, INR > 1.5, low wbc
42
Q

How is SIRS treated?

A

infection control
maintain oxygen
provide nutrition via enteral route

support of failing organs:
- ARDS: O2 therapy and mech vent
- DIC: blood products
- renal failure: CRRT or hemodialysis

43
Q

What is DIC?

A

disseminated intravascular coagulation

  • not a disease, but a complication
  • proteins that control blood clotting become overactive, causing many blood clots to form all over the body
44
Q

What causes DIC?

A
  • infection/sepsis
  • trauma
  • shock
  • cancer
  • OB complication
45
Q

What are the signs of DIC?

A

severe bleeding everywhere
- petechiae, purpura, epistaxis (nosebleed), hematuria, melena (black tarry stools), hematomas

thrombosis
- brain= CVA (stroke)
- heart= MI (heart attack)
- lung= PE (pulmonary embolism)
- leg= DVT (deep vein thrombosis)

46
Q

What will the labs show for DIC?

A

prolonged PT, aPTT, INR
low platelets
low fibrinogen

47
Q

What is the treatment for DIC?

A

treat underlying cause
O2 therapy
IV fluids
blood transfusion
- packed RBC (blood loss)
- platelets
- FFP
- cryoprecipitate (replaces fibrinogen)
- heparin (decrease clots)

Med Surg 3 (8 decks)

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