Nontraumatic Shock Flashcards
State of circulatory insufficiency that creates an imbalance b.w tissue O2 supply and demand resulting in end-organ dysfx
Shock
4 categories of shock
Hypovolemic
Distributive
Cardiogenic
Obstructive
Type of shock (31-36%) occuring when there is dec intravascular fluid or dec blood vol
Hypovolemic
Type of shock (33-50%) wherein there is relative intravascular volume depletion d/t marked systemic vasodilation
Distributive (e.g. septic & anaphylactic)
Type of shock (14-29%) wherein there is inc preload, inc afterload, inc SVR, dec CO
Cardiogenic shock
Most common cause of cardiogenic shock
Myocardial infarction
Type of shock (1%) wherein there is dec preload, inc SVR, dec CO
Obstructive shock (PE, pericardial tamponade, tension PTX)
CO is determined by:
HR x SV
MAP is dependent on:
CO & SVR
Normal venous lactate levels
<2.0 mmol/L
Marker of impaired O2 delivery or utilization; correlates w short-term prognosis of critically-ill px
Elevated lactate
Blood pressure is an insensitive marker for global tissue hypoperfusion. TRUE or FALSE?
TRUE because BP may not drop if there is increase in peripheral vascular resistance. SHOCK MAY OCCUR W A NORMAL BP. HYPOTENSION MAY OCCUR W/O SHOCK.
MAP in shock
<65 mmHg
Initial diagnostics to evaluate a px in shock
CBC w diff ct Elec, Glucose, Ca, Mg, Phos BUN, Crea Serum lactate ECG UA CXR PT, PTT, INR ABG ALT, AST Cultures Cortisol lvl Preg test CT as indicated by hx and PE
ABCDE tenets of shock resuscitation
Establishing AIRWAY Controlling work of BREATHING Optimizing CIRCULATION Ensuring O2 DELIVERY Achieving END points of resuscitation
Tredelenburg position improve cardiopulmonary performance compared w supine position. TRUE or FALSE?
FALSE. It may worsen gas exchange and predispose to aspiration. Passive leg raising above level of the heart may be effective.
Balanced crystalloids such as LRS may offer a small mortality advantage over NSS. TRUE of FALSE?
TRUE.
For large fluid volumes, consider using LRS to avoid what type of acidosis assoc with PNSS?
hyperchloremic metabolic
1st line vasoactive agent in most situations (++ contractility, ++++ vasoconstriction, 0 vasodilation)
Norepinephrine (0.5-50 mcg/min)
Vasoactive agent w inotrope only effect
Dobutamine (2-20 mkm)
At 2.5-5 mkm, dopamine acts on ___
cardiac contractility
At 5-20 mkm, dopamine produces ___
vasoconstriction
At 0.5-2 mkm, dopamine produces ___
vasodilation
Pure alpha-agonist; used in px w shock w tachycardia or supraventricular arrhythmias
Phenylephrine (10-200 mcg/min)
Vasoactive agent w/c is b1 agonist but in large doses w some b2 and a1 effect
Dobutamine