Name that Shock Flashcards
At this stage, changes occur at the cellular level and compensatory mechanisms are able to maintain tissue perfusion
What is Stage 1 (Pre-shock)
Describe nervous system compensatory mechanisms which occur after baroreceptors are stimulated and send impulses to the vasomotor center of the medulla
SNS Activation Norepinephrine release decrease CO and BP increased sweat gland activity dilation of pupils increase HR = contractility vasodilation of cardiac arteries to increase oxygen to the heart vasoconstriction of vasculature in skin, GI tract, kidneys, venous return, and shunting of blood to vital organs
Name the three sub-types of distributive shock
Septic
Neurogenic
Anaphylactic
Stroke volume is …
the amount of blood ejected by the heart in one contraction
Which symptom is one of the earliest signs of cardiogenic shock?
- 4th heart sound
- cyanosis
- altered mental status
- decreased urine output
Altered mental status
When compensatory mechanisms for hypovolemic shock are activated, which two patient findings do you expect to normalize?
- CO & BP
- metabolic alkalosis and O2 sat
- intensity of peripheral pulses and body temperature
- peripheral pulses and HR
CO and BP
This type of shock is characterized by massive vasodilation due to a release of histamines in response to an allergic reaction
Anaphylactic Shock
You are treating a patient in hypovolemic shock. Which assessment finding indicated you should stop fluid boluses?
- peripheral cyanosis
- tachycardia and hypotension
- crackles throughout the lung fields
- increased O2 saturations
Crackles throughout lung fields
A patient with undifferentiated shock has the following vital signs: BP 92/54, HR 64, elevated PCWP
You are reviewing the chart: which order would you question?
- start nipride infusion unless SBP , 90 mmHg
- keep HOB at 30 degrees
- give NS at 250 ml/hr
- begin dobutamine to keep SBP > 90 mmHg
Give NS at 250 ml/hr
Which finding is the BEST indicator fluid resuscitation for a patient with hypovolemic shock has been successful?
- PAWP is normal
- MAP is 65 mmHg
- Hemoglobin is within normal limits
- Urine output is 60 mL over the last hour
Urine output is 60 mL over the last hour
A patient with cardiogenic shock is cool, clammy, and hemodynamic monitoring reveals a high SVR. Which intervention is appropriate?
- decrease the rate of a prescribed D5W infusion
- increase the rate of a prescribed Nipride infusion
- decrease the rate for the prescribed Nitroglycerine infusion
- initiate a dopamine infusion
Increase the rate of the current Nipride infusion
The agents cause which type of shock?
IV contrast, drugs, insect bites/stings, anesthetic agents, vaccines, foods, materials
Anaphylactic shock
Name 3 key treatments for anaphylactic shock
A-B-C!
Ensure patient airway
Give oxygen
Medications
What type of shock are those medications most likely used in?
Histamine H2 blocker, epinephrine, benadryl, volume expanders, solumedrol, bronchodilatiors
Anaphylactic shock
What is the drug of choice in anaphylactic shock?
Epinephrine
What type of shock are these meds most likely used?
Levophed, Neo-synephrine, dobutamine, vasopressin
Hypovolemic shock after fluid resuscitation is exhausted
This type of shock is characterized by loss of intravascular volume, decreased SV, decreased CO
Hypovolemic shock
In this stage of shock, multisystem organ failure is evident, and death is highly probable
Stage 3 : Irreversible Shock
Name the shock most associated with these causes:
3rd spacing, diuresis, hemorrhage, burns, GI losses (vomiting, diarrhea, NGT output), diabetes insipidus, diabetic ketoacidosis, addison’s disease
Hypovolemic shock
Name the #1 cause of hypovolemic shock
Hemorrhage
List key treatments in hypovolemic shock
Medications Rapid volume replacement Control bleeding Oxygen Hemodynamic monitoring
Name 3 causes of cardiogenic shock
Myocardial infarction
Lethal ventricular arrhythmias
end-stage heart failure
Inability of the heart to effectively pump blood out to the system resulting in decreased CO
Cardiogenic Shock
Which type of shock do these treatments best indicate?
- medication
- IABP
- correction of arrhythmias
- oxygen supplementation
- intubation/mechanical ventilation
Cardiogenic Shock
These medications are used to treat which type of shock?
dobutamine, dopamine, epinephrine, primacor, nitroglycerin, nipride, cardene, morphine
Cardiogenic shock
Massive vasodilation caused by inflammatory response of the body due to an overwhelming infection
Septic Shock
What is the hallmark S/S of septic shock?
Hypotension
List key treatments in septic shock
- antimicrobial therapy
- volume replacement
- cultures (blood, urine, sputum)
- vasopressors
- hemodynamic monitoring
What do these have in common?
- massive vasodilation
- suppression of the SNS
- injury or disease to the spinal cord at the T6 level
- spinal anesthesia
Neurogenic shock
List 3 key treatments/interventions for neurogenic shock
Treat the cause
Airway and Ventilation Support
Vasopressors
These are 3 major effects of which type of shock?
- vasodilation
- maldistribution of blood flow
- myocardial depression
Septic Shock
What is the root cause of this phenomena?
Even with adequate fluid volume resuscitation there is hypotension and hypovolemia
Vasodilation
Name that shock:
- Pooling of blood
- Decreased venous return
- Decreased CO
- Hypotension
- Byradycardia
Neurogenic Shock
This key characteristic of septic shock causes decreased microcirculation and poor oxygen delivery to the tissues = tissue hypoxia
Maldistribution of blood flow
Name that shock:
Decreased EF Hyperventilation Confusion Decreased UOP increased WBC Hypoactive or no bowel sounds Flush/cool extremities
Late-stage septic shock
Tension pneumothorax
cardiac tamponade
pulmonary embolism
aortic dissection
Obstructive Shock
Which stage of shock is characterized by failing compensatory mechanisms and organ dysfunction
Stage 2 (Shock)
What is key to recognition and differentiating the presence of shock?
a good history and physical exam
Name that Shock:
CVP is low
PCWP is low
CO is elevated
SVR is low
Distributive shock
Name that shock:
CVP is elevated
PCWP is elevated
CO is decreased
SVR is increased
Cardiogenic Shock
Name that shock:
CVP is elevated
PCWP is low or high
CO is decreased
SVR is increased
Obstructive Shock
Name that shock:
CVP is decreased
PCWP is low
CO is decreased
SVR is increased
Hypovolemic Shock
