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CCRN > Multisystem > Flashcards

Multisystem Flashcards

1
Q

A cellular disease due to either the inadequate perfusion (oxygen demand is greater than oxygen delivered) or inability of cells to utilize the delivered oxygen (oxygen utilization, consultation).

A

Shock

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2
Q

What are the 3 phases of all types of shock?

A
  1. Compensatory
  2. Progressive
  3. Refractory
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3
Q

How is BP maintained during the compensatory phase of shock?

A
  1. Stimulation of the sympathetic nervous system

2. Activation of the RAAS

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4
Q

What are the internal causes of hypovolemic shock?

A

Third spacing, pooling in intravascular compartments.

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5
Q

What are the external causes of hypovolemic shock?

A

Hemorrhage, GI or renal losses, burns, excessive diaphoresis.

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6
Q

How does hypovolemic shock effect blood pressure?

A

NARROWs pulse pressure

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7
Q

When do you want to consider using a fluid warmer?

A

When repalcing >2L in 1 hour and in all trauma patients.

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8
Q

What are the consequences of hypothermia during blood administration?

A
  • Impairment of red cell deformity
  • Platelet dysfunction
  • Increase affinity oh hgb to hold onto O2
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9
Q

Why does Ca and Mg decrease with blood administration?

A

The citrate in transfused blood binds ionized Ca and Mg.

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10
Q

What are the consequences of inadequate 2,3-DPG in transfused blood?

A

Oxyhemoglobin-dissocation curve shifts to the left (increases affinity of hgb to hold onto O2).

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11
Q

What is considered the triad of death?

A

Hypothermia, acidosis, coagulopathy

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12
Q

SIRS criteria:

A

Must have 2 or more of the following:

  • Temp >38 or <36
  • HR >90
  • Resp rate >20 or PaCO2<32
  • WBC >12 or <4 or bands >10 (shift to the left)

Examples of SIRS without sepsis: traumatic injury, pancreatitis, burns

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13
Q

Criteria for severe sepsis?

A

Sepsis plus markers for organ dysfunction

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14
Q

Criteria for septic shock?

A

Systemic MAP <65 after fluid resuscitation thus requiring pressers.

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15
Q

What is the initial fluid resuscitation for sepsis?

A

30 ml/kg.

Goal to keep MAP >65, urine output >0.5 ml/hr/hr, decrease tachycardia.

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16
Q

What are the oxygenation goals with septic shock?

A
  • Maintain SpO2 >95%

- SvO2 >65% or ScvO2 >70%

17
Q

IgE medicated hypersensitivity reaction to protein substances.

A

Anaphylactic Shock

18
Q

What is the difference between anaphylactic and anaphylactoid response?

A

Anaphylactoid is not IgE mediated and does not require a previous exposure.

19
Q

Treatment for anaphylactic shock?

A
  • IM epi
  • Aggressive fluid resuscitation (1-4L)
  • Anti-histamines
  • Inhaled B-adrenergic agents
  • IV steroids (the sooner given, the better)
20
Q

What is the 1st line trauma assessment?

A 
A: airway
B: breathing
C: circulation
D: disability (neuro exam, GCS)
E: expose/environment
21
Q

What is the 2nd line assessment?

A

F: full set of vitals, family presence
G: give comfort measures
H: history
I: inspect posterior, turn the patient over

22
Q

What are the inclusion criteria for therapeutic hypothermia?

A
  • Cardiac arrest with ROSC
  • Unresponsive and not following commands
  • Witnessed arrest with downtime <60 min
23
Q

What are exclusion criteria for therapeutic hypothermia?

A
  • Pregnancy
  • Core temp <35c
  • Age <18, >85
  • Chronic renal failure
  • Refractory ventricular arrhythmias
  • Active bleeding
  • Shock
  • Drug intoxication
24
Q

What is the temp goal with therapeutic hypothermia?

A

33 degree which is maintained for 24 hours.

25
Q

What does glucose do during hypothermia?

A

HIGH

26
Q

How quick do you warm someone?

A

1 degree/hour

27
Q

How soon should you stop potassium prior to re-warming?

A

8 hours

28
Q

When and how much activated charcoal is given?

A
  • 1 g/kg
  • Not necessary for iron, lithium, and alcohols
  • Monitor for arrhythmias and urine output

CCRN (8 decks)

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