Shock Flashcards
shock definition
inadequate tissue perfusion
shock initial clinical findings
no visible changes only cellular changes
production of pyruvic and lactic acid
class I shock
blood loss up to 15%
conpensatory stage findings X5
decrease in BP
tachycardia
tachypnea
pale and cool skin
AMS
class II blood loss
15-30%
what happens if shock is corrected during the compensatory stage
pt recovers with little to no residual effects
when does the progressive stage begin
when the compensatory mechanisms fail
progressive shock clinical findings
systolic <80/90
HR >150
rapid, shallow crackles respirations
PaO2 <80, PaCO2 >45
mottled, petechiae skin
anuria
lethargy, AMS
METABOLIC ACIDOSIS
class III shock
blood loss of 30-40%
refractory shock
exacerbation of anaerobic metabolism
accumulation of lactic acid and waste products
third spacing
how can refractory shock be diagnosed
not without an autopsy
refractory shock prognosis
pt will not survive - cannot respond to treatment
class IV shock
> 40%
what does narrow pulse pressure indicate
shock
blood studies for shcok
elevation of lactate
base deficit
imaging for shock
12 lead EKG, tele
CXR
hemodynamic monitoring
2 major complications of large volumes
hypothermia
coagulopathy
interventions after persistent hypotension following fluids
vasopressor (levo) may be added
why are vasodilators used in shock
decrease afterload
achieve/maintain MAP greater than 65
what is tropic feeding
slow drip of small amounts of enteral nutrition to prevent endotoxin development
what causes hypovolemic shock X6
hemorrhage GI loss fistula drainage DI hyperglycemia diuresis
what is relative hypovolemia
results when fluid volume moves out of the vascular space into the extravascular space
what is absolute hypovolemia
loss of blood volume
hypovoleic shock tx
stopping loss of fluid and restoring circulating volume
first line treatment in cardiogenic shock X5
oxygenation
pain control
monitoring
laboratory marker monitoring
pharmacologic
medications and fluids for cardiogenic shock
avoid fluid
pressors, beta blockers diuretics, nitrates
goal for cardiogenic shock
restore blood flow to myocardium by restoring balance between O2 supply and demand
neurogenic shock skin
hot and dry
anaphylaxis hemodynamic changes X3
massive vasodilation
release of vasoactive mediators
increase in capillary permeability
drugs used in anaphylaxis
epi
dipenhydramine
ranitidine
CI in hypotension
trendelenberg
