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Critical Care > N380 SHOCK, SEPSIS, MODS > Flashcards

N380 SHOCK, SEPSIS, MODS Flashcards

1
Q

Chacterizations of shock include

A

decreased tissue perfusion and impaired cellular metabolism

Imbalance of O2 supply and demand
-Continuous demand for O2 and nutrient supply at cellular level

Low supply of O2 and nutrition leads to cell necrosis, organ damage, and failure.

Metabolic and hemodynamic instability

Drop in blood pressure!

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2
Q

Four classifications of shock

A

cardiogenic
hypovolemic
distribution
obstructive

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3
Q

Name common types of cardiogenic shock

A

MI, cardiomyopathy, dysrhythmias

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4
Q

Name a type of hypovolemic shock

A

hemorrhage, GI bleed, vomiting, diarrhea

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5
Q

Name some types of distribution shock; there’s three

A
  1. neurogenic- spinal cord injury
  2. anaphylactic- insect bites, anesthetics, vaccines, contrast media, snake venom
  3. septic- PNA, Peritonitis, Cholangitis
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6
Q

Name three types of obstructive shock

A

cardiac tamponade, pneumothorax, SVC syndrome

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7
Q

define systolic dysfunction and some examples

A

inability of the heart to pump blood forward and affects primarily the left ventricle

cardial infarction, cardiomyopathy, blunt cardiac injury, severe systemic or pulmonary
hypertension, myocardial depression from metabolic problems

most common cause of systolic dysfunction= acute MI

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8
Q

What are the three major pathophysiologic effects of septic shock

A

-vasodilation, maldistribution of blood flow, and myocardial depression

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9
Q

Causes of SIRS include?

A

Burns, crush injuries, surgical procedures
Abscess formation
Ischemic or necrotic tissue: Pancreatitis, vascular disease,
Microbial invasion: Bacteria, viruses, fungi, parasites

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10
Q

Name two reasons why the increased cytokine levels seen in SIRS cause a drop in BP?

A
  1. vasodilation

2. increase cellular permeability

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11
Q

term for infection in the blood and BP didn’t drop

A

sepsis

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12
Q

infection in the blood, BP is dangerously low, and organ failure

A

septic shock

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13
Q

Stages of shock

A
  • Initial
  • Compensatory
  • Progressive
  • Refractory
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14
Q

s/sx of initial shock

A
  • Mild tachycardia
  • Mild tachypnea
  • Normal BP, may trend downward a little
  • Normal urine output
  • Slightly cool extremities (hands/feet)
  • Pt may be anxious
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15
Q

stage of shock

When the metabolism changes at cellular level from aerobic to anaerobic, causing lactic acid buildup

A

initial

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16
Q

stage of shock:

Body activates neural, hormonal, and biochemical compensatory mechanisms to overcome the increasing consequences of anaerobic metabolism and to maintain homeostasis and Classic sign of shock: drop in BP

A

compensatory stage

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17
Q

stage of shock

Pulmonary system is often the first system to display signs of critical dysfunction
GI system is also affected by prolonged decreased tissue perfusion
Effect of prolonged hypoperfusion on the kidneys is renal tubular ischemia

A

progressive stage

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18
Q

stage of shock

Decreased perfusion from peripheral vasoconstriction and decreased CO exacerbate anaerobic metabolism
Patient demonstrates profound hypotension and hypoxemia

A

refractory stage

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19
Q

drugs that cause peripheral vasoconstriction and examples

A

vasopressors

norepinephrine, epinephrine, dobutamine, dopamine

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20
Q

effective volume expanders because the size of their molecules keeps them in the vascular space for a longer time

A

colloids

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21
Q

stage in septic shock when decreased tissue oxygenation with barely any observable clinical indications

A

initiation

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22
Q

stage of septic shock body is trying to compensate by activating neural, hormonal, biochemical mechanisms and maintain homeostasis; if unsuccessful this is where the BP drops starts

A

compensatory

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23
Q

stage of septic shock when the tissue hypoperfusion progresses leading to lactic acidosis; failure Na+ and K- pump and cellular edema occurs and the patient needs to be moved to the ICU

A

progressive

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24
Q

stage in septic shock

Severe tissue hypoxia with ischemia and necrosis while acidosis continues to worsen; MODS comes into play; life threatening dysrhythmias, extreme hypotension is not responding to vasopressors, ARF, ARDS, DIC, MI

A

refractory

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25
Name some symptoms of sepsis
confusion/disorientation, SOB, tachycardia, fever/shivering, extreme pain or discomfort, clammy/sweaty skin
26
Name signs of cardiogenic shock
hypotension, tachycardia, tachypnea, crackles, high PVR, weak pulses, low cap refill, clammy skin
27
Cardiac interventions
- dobutamine and dopamine are the pressors usually used | - patients will most likely need VADs due to increased use of pressor
28
reaction that quickly causes massive vasodilation, release of vasoactive mediators, and increase in capillary permeability is called...
anaphylactic shock
29
anaphylactic shock can lead to
respiratory distress due to | laryngeal edema or severe bronchospasm and circulatory failure from the massive vasodilation
30
immediate treatment for anaphylactic shock are
- GIVE IM EPINEPHRINE (so it can cause peripheral vasoconstriction and bronchodilation) - Diphenhydramine and ranitidine (Zantac) are given as adjunctive therapies to block the ongoing release of histamine from the allergic reaction - maintain patent airway (w/bronchodilators)
31
If a patient presents with anaphylactic shock and has multiple layers of clothing on, how do you proceed with giving the emergent IM dose of epinephrine?
Proceed with giving the injection directly through the clothing
32
What are some causes of SIRS
Burns, crush injuries, surgical procedures Abscess formation Ischemic or necrotic tissue: Pancreatitis, vascular disease, Microbial invasion: Bacteria, viruses, fungi, parasites
33
s/sx of SIRS
tachycardia, tachypnea, hyperthermia
34
s/sx of sepsis
leukocytosis, leukopenia
35
s/sx of septic shock
severe hypotension despite adequate fluid resuscitation with impaired organ perfusion
36
Initial management for hypotension should be ?
0.9% NS using the formula of 30 cc per kg of body weight
37
What is the ratio for fluid resuscitation when a patient is in hypovolemic shock
3:1 Give 3mL of fluid for every 1mL of blood loss
38
Give examples of sympathomimetic drugs
- norepinephrine (Levophed) - Phenylephrine (Neosynephrine) - Vasopressin - Hydrocortisone
39
What are the advantages of central venous access device
Reduce need for multiple venipuncture Infusion of fluids and medications Administration of vesicant drugs, blood products, total parenteral nutrition, hemodynamic monitoring, etc.
40
What is one major disadvantage of a central venous access device
Central Line Associated Bacterial Systemic Infection (CLABSI)
41
Where can central venous catheters be inserted
Rests in SVC if inserted through subclavian or jugular vein Femoral vein sometime accessed
42
Peripheral inserted central catheter
Rests in SVC inserted into a vein (cephalic, median, brachial vein) in the arm For patients who needs vascular access for 1 week to 6 months (sometimes longer)
43
Hypoxemia frequently occurs in patients with ....
SIRS and MODS Interventions that decrease O2 demand and increase O2 delivery are essential Sedation, mechanical ventilation, analgesia and rest may decrease O2 demand
44
If fluid bolus is not helping to raise the BP, the patient most likely needs to be started on...
sympathomimetic drugs such as vasopressors via IV drip
45
If your patient is presenting with shock what is the first and most immediate intervention for your patient?
Give fluids/ fluid resuscitation
46
Shock is a clinical syndrome that is characterized by ....
inadequate tissue perfusion
47
What is the purpose of intra aortic balloon pump (IABP)?
- reduces afterload and augments aortic diastolic pressure - increase coronary blood flow! - separate set of cardiac leads are applied to the patient and the machine syncs with the cardiac cycle
48
What happens when the IABP is inflated on diastole?
-when the aortic valve is closed
49
What happens when the IABP is deflated on systole?
-just before left ventricular ejection
50
ECG is the trigger used to...
start deflation on the upstroke of the R wave (of the QRS) and inflation on the T wave Known as counterpulsation because the timing of balloon inflation is opposite to ventricular contraction.
51
Complications of IABP
- thromboembolism caused by trauma, balloon obstruction of blood flow distal to catheter - thrombocytopenia - hemorrhage from the insertion site - balloon leak or rupture
52
A hemodynamic phenomenon that can occur within 30 minutes of a spinal cord injury and can last up to 6 weeks is known as
neurogenic shock
53
Clinical manifestations of neurogenic shock
Hypotension Bradycardia Patient may not be able to regulate body temperature Skin is warm due to massive vasodilation seen in patients with spinal anesthesia, spinal cord injury (cervical or high thoracic injuries)
54
What is the treatment for neurogenic shock
- Treatment involves the use of vasopressors (e.g. phenylephrine) to maintain BP and organ perfusion - Bradycardia may be treated with atropine - monitor for hypothermia
55
Why should you infuse fluids slowly for a patient with neurogenic shock
Infuse fluids cautiously as the cause of the hypotension is not related to fluid loss The patient with a spinal cord injury also needs to be monitored for hypothermia caused by hypothalamic dysfunction
56
How do we treat the hypotension seen in an anaphylactic shock patients?
IV fluid adminstration
57
fluid volume that moves out of the vascular space into the extravascular space is called?
relative hypovolemic shock
58
fluid lost through hemorrhage, GI such as vomiting and diarrhea, fistula drainage, diabetes insipidus, diuresis
absolute hypovolemic shock
59
Management of hypovolemic shock focuses on
- stopping the loss of fluid and restoring the circulating volume - give IV crystalloids such as NS or lactated ringers
60
this type of shock develops when a physical obstruction to blood flow occurs with a decreased cardiac output
obstructive shock
61
where excess fluid in the pericardium causes increase pressure on the heart and restricts diastolic filling
pericardial effusion/cardiac tamponade
62
What is seen in abdominal compartment syndrome and SVC syndrome
excess pressure is placed on the vena cava causing a decrease in blood returning to the heart from the body Low BP, low CO, JVD, pulsus paradoxus
63
What are the interventions for the following issues that can lead to obstructive shock? a. Pericardial effusion/cardiac tamponade b. Abdominal compartment syndrome c. SVC syndrome d. Pulmonary embolism e. Tension/Hemo Pneumothorax
a. mechanical decompression b. radiation, debulking, removal of the mass or cause c. radiation, debulking removal of the mass or cause d. thrombolytic therapy e. mechanical decompression done by needle or tube insertion

Critical Care (6 decks)

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