Shock 1 Flashcards
shock is a ______
condition
shock is a lack of ______ and _______
perfusion and oxygenation
describe hypoxia
no perfusion of organs
inability to oxygenate the rest of the body
describe perfusion
how good blood is flowing to the body
identified by BP, color, warmth
if MAP is maintained then good perfusion is ensured
what is oxedated phosporylation
normally, 36-38 molecules of ATP is produced
if no oxygen, anaerobic cycle produces only 2 molecules of ATP
*cannot survive on this
what is the oxygenation cycle
lungs coronary arteries carotid artery kidneys (get 1/4 of blood supply) liver (get 2/3 blood supply)
why do you go into shock??
no oxygen is going to the organs and eventually no oxygen goes to the heart and lungs
what is the MAP and formula
mean arterial pressure
MAP=systolic + diastolic (2) / 3
what is the minimum the MAP can be
> 70
means perfusing to extremities, kidneys, liver, lungs
if workload is increased, you need a ______ MAP
higher
what is the stroke volume(SV) formula
systolic BP - diastolic BP
what is a normal SV
50-60 mL/beat
what does stroke volume mean
amount of blood per beat that you push out
can be manipulated by vasoconstriction
what happens when you first go into shock
- gets cold
- blood starts SHUNTING UP trunk (no longer in extremities)
- vasoconstriction pushes blood to important liver, heart, lungs (eventually only pumps to heart)
what are the factors that influence MAP
1) total blood volume
2) cardiac output
3) size of vascular bed
what is the cardiac output formula
SV x HR
what is a normal C.O.
4-6 L
describe afterload
SYSTOLIC
force heart has to push to get blood out (push of blood from left ventricle to aorta)
describe preload
DIASTOLIC
left ventricle and diastolic volume
how much blood left after heart pushes out blood
*never pushes ALL out (leftover blood)
describe the ejection fraction
the percent of blood you push out of the heart
what is a normal ejection fraction
70s (65-75)
aka if heart is working well you will push this amount out
pt w/ CHF or MI will have a ______ ejection fraction
decreased
no good cardiac output (may be as low as 20)
describe the vascular bed
where does the blood have to go?
in septic shock: dilation of vessels
not enough blood flow
what are the 4 types of shock
hypovolemic
cardiogenic
distributive
obstructive
describe hypovolemic shock
*total body fluid is decreased
hemorrhage and dehydration
loss of fluid… cannot maintain C.O.
how do you fix hypovolemic shock
easy
give more fluid and blood
describe obstructive shock
*clot
cardiac function decreased by non cardiac functions
fluid is NOT affected
pulmonary HTN, pneumothorax, pericarditis, tamponade
describe cardiogenic shock
**pump failure fluid volume is NOT affected no strength to push blood out of heart r/t HF (something has hurt the heart) cannot pump well d/t MI, valvular problems, dysrthymias, cardiac arrest, myopathies
describe distributive shock
**fluid SHIFTED from central vascular space
body fluid is either normal or increased
two kinds: neural or chemical
describe distributive shock (neural)
loss of vascular tone
cut in spinal cord, cannot maintain C.O. or vascular tone
cannot get epi or sympathetic to work well
what causes shock
- anaerobic environment
* decrease in MAP: d/t decrease in C.O, blood volume, or expansion of vascular bed
what is the chemical process for the start of shock
drop of just 5-10 mmHg is detected by baroreceptors in the aortic arch and carotid sinus which causes shock process
how does the pt appear in shock??
- cold (d/t shunting of blood, elevate legs!!)
- gut/GI doesnt work
- liver doesnt work (no outward sign)
- kidneys stop working (outward sign is decreased renal output, put in foley to monitor)
- head/brain stop working (dizziness, lightheaded, pass out)
- heart and lungs stop working
what is normal urine output
30 mL/ hr (if less than this it is a problem)
full chemical process of shock
1) baroreceptos send info to brain, which starts to shunt blood to vital areas (heart lungs, brain)
2) leads to increased lactic acid, protein destroying enzymes and oxygen radicals
if shock is corrected in ______ it may be reversible, if not can lead to ______
1-2 hrs
MODS
describe baroreceptors
sit on glomerulus
triggered to conserve blood flow, no output
oxygen free radicals attack the heart
what is MODS
multiple organ dysfunction system
d/t lack of oxygenation
