Shock Flashcards
1
Q
introduction
A
- More than 1 million people arrive in the ED each year in some stage of shock.
- It is crucial to recognize the stages.
- Be prepared to differentiate the causes.
2
Q
stages of shock: compensated
A
- normal blood pressure
- normal to slightly increased heart rate
- tachypnea
- delayed capillary refill
- cool hands and feet
- pale mucous membranes
- restlessness, anxiety
- oliguria
- vasoconstriction maintains blood flow to essential organs, but tissue ischemia occurs i less essential areas
3
Q
stages of shock: decompensated
A
- blood pressure decreasing
- tachycardic >120
- tachypneic > 30-40
- waxy, cool, clammy, skin
- pale or cyanotic mucus membranes
- profound weakness
- metabolic (lactic) acidosis
- anxiety
- absent or decreased peripheral pulses
- blood pressure decreases as the vascular tone decresases
- dysfunction to all organs is imminent
- anaerobic metabolism ensures, causing lactic acidosis
4
Q
stages of shock: irreversible
A
- profound hypotension
- lactate > 8 mEq/L
- metabolic acidosis causes post capillary sphincters to open and release stagnant and coagulated blood
- excessive potassium and acid causes dysrhythmias
- cellular damage is irreversible
5
Q
stages of shock
A
- In most cases, shock occurs in a systematic process. This systematic process has been broken down into the stages of shock which include:
- Compensated
- Decompensated
- Irreversible
- Review each of the stages of shock and how they can be identified by patient presentation.
- Remind students that shock is a continuum and they should always be monitoring the patient to determine how well the patient is compensating.
6
Q
causes of shock
A
- Shock has many causes. Knowing the cause may assist you in determining which of the four categories of shock is present. As the care provider, it will be your job to try to sort causes and cardinal signs quickly as the care the patient may need a life-threatening intervention immediately.
- Causes of Shock
- Review the types of shock and the signs and -symptoms specific to each type.
7
Q
causes of shock: hypovolemic
A
- cool, clammy skin, pale, cyanotic skin,
- decreased BP
- altered LOC
- decreased capillary refill
- hemorrhage: trauma, GI bleeding, ruptured aortic aneurysm, pregnancy-related bleeding
- severe dehydration: gastroenteritis, diabetic, ketoacidosis, adrenal crisis
- administer oxygen
- stop the bleeding
- give IV fluid bolus
- splint fractures
- perform surgery
- blood loss internal or external
- volume loss- vomiting, diarrhea, excessive sweating, excessive urination
8
Q
causes of shock: distributive septic
A
- hyperthermia or hypothermia
- decreased BP
- altered LOC
- infection
- administer oxygen
- give IV fluids bolus
- administer antibiotics
- high WBC
- cultures
9
Q
causes of shock: distributive-anaphylactic
A
- pruritus, erythema, urticaria, angioedema
- increased heart rate
- decreased BP
- anxious
- respiratory distress
- wheezing
- antibody-antigen release
- give epinephrine 1:1000 .3-.5 mg subQ or IM for mild reaction
- give epinephrine 1:10,000 .3-.5 IV for severe reaction over 3-10 mins as needed
- give IV fluid bolus
- give diphenhydramine 1-2 mg/kg IV (max 50mg)
- consider corticosteroids
- consider vasopressors
10
Q
causes of shock: distributive neurogenic
A
- warm, dry, pink, skin
- decreased BP
- alert
- normal capillary refill time
- spinal cord injury
- administer oxygen
- give IV fluid bolus
- consider dopamine
- surgery
11
Q
causes of shock: distributive toxins
A
- based on specific agent
- causes, signs, and management depend on toxin
12
Q
causes of shock: cardiogenic
A
- cool, clammy, skin
- pale, cyanotic skin
- tachypnea
- tachypnea or other abnormal rhythm
- decrease BP
- altered LOC
- distended neck veins
- decreased capillary refill time
- pump failure: AMI, cardio-myopathy, myocarditis, ruptured chordae tendinea, papillary muscle dysfunction, toxins, myocardial contusion, acute aortic insufficiency, ruptured ventricular septum
- dysrhythmia
- administer oxygen
- give IV fluid bolus (minimal)
- rate correction (medication or pacing/cardioversion)
- inotropes
- vasopressors
- intraaortic balloon pump
- associated with cardiac pump failure
- vasopressors»_space;»> over fluids **
- fluids can overload the system and cause death
13
Q
causes of obstructive shock: obstructive
A
- decreased BP
- difficulty breathing, tachycardia, tachypnea
- JVD, unilateral decreased breath sounds, muffled heart tones
- acute pericardial tamponade, massive pulmonary embolus, tension pneumothorax
- administer oxygen, perform needle decompression for tension pneumothorax
- consider surgery
- muffled heart sounds
- pulmonary embolus -> blood thinners
14
Q
distributive shock
A
- neurogenic
- anaphylactic
- septic
15
Q
obstructive shock
A
- cardiac tamponade
- pulmonary emboli
- tension pneumothorax
