Shock Flashcards
During shock Inadequate oxygen is delivered to____.
Poor oxygenation leads to _______.
____ products accumulate in _____.
_____ and _____ death occur
- Cells
- anaerobic cellular metabolism
- Waste/Cells
- Cell and organ
Clinically, shock is defined by the following numbers: 1.\_\_\_\_ BP of < or = to \_\_\_\_\_ OR 2.\_\_\_\_ decrease from baseline OR 3.\_\_\_\_ of < or = \_\_\_\_\_ 4. Heart rate of greater than\_\_\_\_\_\_(less than \_\_\_ in neurogenic shock) 5. Signs of \_\_\_\_\_\_
- Systolic/90mmHg
- 40mmHg
- MAP/65
- 100/60
- Hypoperfusion
What are signs of hypoperfusion that might be seen in shock?
- Oliguria
- Hyperlactemia
- Poor Peripheral perfusion
- altered mental status
3 types of shock?
- Hypovolemic - most common
- Cardiogenic
- Distributive
3 external causes of hypovolemic shock?
- Hemorrhage- Blood MOST COMMON CAUSE
- Burns - Plasma
- Dehydration - V/D/Diur/sweat
3 internal causes of hypovolemic shock?
- Third-spacing
- Fluid leakage into the intestinal lumen
- Internal hemorrhage
In a hemorrhage, shock develops after the loss of how much blood?
- Loss of 1/3 of normal amount of 5 liters.
* 15%
S&S for hypovolemic shock? Fill in Blanks
- ___tension
- ___, Thready, ____ pulse
- ___pnea
- ___ urine output
- ___ CO
- ___PAP/CVP
- ___ SVR (900-1400)
- ___/___ skin
- __ ___/thermia
- ____ mucous membranes/ ___
- ____ neck veins
- ___ ___ ____ status
- ____esis
- Hypotension
- Weak, Thready, RAPID pulse
- Tachypnea
- Decreased urine output (less than 30 ml/hr)
- Decreased CO (normal is 4-8)
- Decreased PAP/CVP
- Increased SVR
- Cool/Pale Skin
- Mild hypothermia
- Dry mucous membranes/thirst
- Flat neck veins
- change in mental status
- diaphoresis
1st line of Treatment for hypovolemic shock? 2nd line of treatment?
- FLUID VOLUME REPLACEMENT FIRST
2. Vasoconstrictive drugs (only if fluid doesnt work)
fluids used for hypovolemic shock?
- Isotonic crystalloids ( NS/LR)
- Colloid (Albumin)
- Blood products (Plasma, RBC)
When cardiac output is decreased due to failure of the heart to pump effectively, what is the result?
Fluid retention/pulmonary edema
Clinical definition of cardiogenic shock?
- Low CO/CI
- Hypotension (systolic less than 90 or less)
- Clinical signs of inadequate blood flow to tissues
Normal CI? Normal CO? what would a CI look like in cardiogenic shock?
- CI- 2-4 L/min (less than 1.8 in cardiogenic shock)
* CO- 4-8 L/min
2 general conditions causing cardiogenic shock?
- Ineffective heart pumping
* Obstruction in cardiac system (Obstructive shock e.g. tamponade, embolism )
Most common cause of Cardiogenic shock is _____. Occuring when ____ or more of ______ has been damaged.
- Myocardial infarction
- 40%
- Myocardium
S&S for cardiogenic shock? Fill in Blanks
- ___tension
- ___, Thready, ____ pulse
- ___pnea
- ___ urine output
- ____ ____ ____ status
- ____esis
- ___/___ skin
- ____ neck veins
- ____ lungs
- ____/____ edema
- ______ CO
- ______ SVR (900-1400)
- _____ PA/CVP/Wedge pressures
- Hypotension
- Weak, thready, rapid
- Tachypnea
- decreased urine output
- change in mental status
- diaphresis
- Cool/pale skin
- Distended neck veins
- crackles in lungs
- pulmonary/peripheral
- decreased CO
- increased SVR
- Increased PA/CVP/Wedge pressures
Normal range for CVP? What would it be in cardiogenic shock? what does it reflect?
- 2-6
- increased
- Fluid overload
Normal range for PAWP/PCWP? What would it be in cardiogenic shock? What does this reflect?
- 6-12
- Increased above 18
- FIlling pressure in left atrium, increase means backflow (left ventricle failing -> increase in atrial pressure -> increase in PAWP
Normal range for PAP? What would it be in cardiogenic shock? What does this reflect?
- 9 -18
- Increase
- Pressure in pulmonary artery increases due to back up from ineffective pump.