SHOCK Flashcards
What is a life-threatening condition of circulatory failure?
Shock
What is defined as circulatory insufficiency that creates an imbalance between tissue oxygen supply and demand resulting in global tissue hypo-perfusion.
Shock
What is the result of the imbalance between tissue oxygen supply and demand that is seen in Shock patients?
Global Tissue Hypo-perfusion
What are the 4 categories of shock?
CHOD
1) Cardiogenic
2) Hypovelemic
3) Distributive
4) Obstructive
Hypovelemic shock is caused by decreased intravascular volume secondary to ___________ or ______________.
1) Blood Loss
2) Loss of fluid and electrolytes
Cardiac Output =
Stroke volume x Heart rate
How does the body maintain Cardiac Output (CO) in the event of decreased stroke volume prior to the development of Hypovelemic Shock?
Increases Heart Rate
What occurs when the body is no longer able to maintain cardiac output?
Shock
What are common causes of Hypovolemic Shock?
1) Trauma
2) Massive hemorrhage
3) GI Bleed
4) Burns
5) Vomiting or Diarrhea
6) Excessive sweating
7) Hyperosmolar states (DKA)
What type of shock can be caused by:
1) Trauma
2) Massive hemorrhage
3) GI Bleed
4) Burns
5) Vomiting or Diarrhea
6) Excessive sweating
7) Hyperosmolar states (DKA)
Hypovolemic Shock
Hypovolemic Shock:
What is the cause of a patient that was originally Tachycardic, now has Bradycardia?
The Cardiac Output is too low to supply blood to the heart
What is the Systolic BP in a Hypovolemic Shock patient
Systolic BP < 90 mmHg
What are common physical findings in a Hypovolemic Shock patient?
1) Tachycardia, decompensate and becomes bradycardic
2) Hypotension (Systolic BP < 90 mmHg)
3) Mental status changes
4) Oliguria (due to decreased blood flow to the kidneys)
5) Cool extremities (due to peripheral vasoconstriction in order to shunt blood back to the heart)
6) Weak pulse
7) Low Jugular Vein Prominence
Hypovolemic shock leads to what 3 things?
1) Hypoxia
2) Acidosis
3) End organ damage/failure
What is the overall cause of Hypovolemic Shock?
A) Decreased intravascular volume
B) Blood Loss
C) Cardiac Pump Failure
D) Poor right ventricle output
A) Decreased intravascular volume
Hypovolemic shock is caused by decreased intravascular volume SECONDARY TO blood loss or loss of fluid and electrolytes
1) Tachycardia/Bradycardia
2) Hypotension
3) Mental status changes
4) Oliguria
5) Cool extremities
6) Weak pulse
7) Low Jugular Vein Prominence
Hypovolemic Shock
What EKG finding would be a sign of hypoperfusion in a hypovolemic shock patient?
ST Elevation or Depression
What are the labs that should be gotten for a hypovolemic shock patient?
1) Chemistry panel
2) CBC *
3) LFT’s
4) ABG
5) Lactic acid level
6) EKG *
What is the goal of treatment for Hypovolemic Shock?
Maintain adequate tissue perfusion
What is the treatment of Hypovolemic Shock?
1) Fluid Replacement LR 1-2 Liter bolus (Better if it’s warm)
2) Blood transfusion if losing blood (with PRBC, FFP, and Platelets)
3) Vaso-Suppressors:
a) Norepinephrine 0.02 - mcg/kg/min IV
b) Epinephrine 0.014 -0.5 mcg/kg/min IV
c) Dopamine 1-20 mcg/kg/min IV
For every 1 unit PRBC you give your hematocrit should increase ______.
3%
Pump failure secondary to AMI, Cardiac contusion,Arrhythmia, Valvular incompetence or stenosis
Cardiogenic Shock
What could cause the pump failure in cardiogenic shock?
1) AMI
2) Cardiac Contusion
3) Arrhythmia
4) Valvular Incompetence
5) Stenosis
What type of shock?
1) Cardiac Pump Failure =
2) Decreased Intravascular Volume =
3) Reduced Systemic Vascular Resistance =
4) Extracardiac causes of Cardiac Pump Failure =
1) Cardiac Pump Failure = Cardiogenic Shock
2) Decreased Intravascular Volume = Hypovolemic Shock
3) Reduced Systemic Vascular Resistance = Distributive
4) Extracardiac causes of Cardiac Pump Failure = Obstructive
1) Hypotension (SBP < 90 mmHg)
2) Mental status changes
3) Oliguria
4) Cool extremities
5) Elevated JVP **
6) JVD **
7) Tachypnea **
8) Pulmonary edema
9) Irregular pulse if arrhythmia
Cardiogenic Shock
Labs and studies for cardiogenic shock
1) Chemistry panel
2) CBC *
3) LFT’s
4) ABG
5) Lactic acid level
6) EKG *
7) Transthoracic Echocardiogram (TTE) (Not on hypovolemic shock)
What is the focus of initial treatment for Cardiogenic Shock?
Airway stability and improving pump function
What is the treatment for cardiogenic shock?
1) Maintain Airway Stability
2) ACLS if cardiac arrest
3) 250 ml of fluid (Much smaller than hypovolemic)
4) Vaso-supressors:
a) Norepinephrine 0.02 - mcg/kg/min IV
b) Epinephrine 0.014 -0.5 mcg/kg/min IV
c) Dopamine 1-20 mcg/kg/min IV
What type of shock causes a reduction in Systemic vascular resistance?
Distributive
What are the 3 etiologies of Distributive Shock?
1) Septic
2) Anaphylactic
3) Neurogenic
What causes the inability to maintain perfusion in Septic shock?
Bacterial Endotoxins
What is the most common cause of distributive shock?
Septic Shock
What etiology of distributive shock?
1) Caused by a release of bacterial endotoxins
2) Caused by a spinal cord injury
3) Caused by a release of histamines
1) Septic
2) Neurogenic
3) Anaphylactic
1) Fever
2) Tachycardia
3) Elevated CBC
4) Hypoperfusion despite volume resuscitation
5) Elevated WBC
Septic Shock
1) Diffuse urticarial angioedema
2) Bronchospasm
3) SOB
4) Fullness of throat
5) Hoarsness
Anaphylactic Shock
1) Hypotension WITHOUT Tachycardia
2) Bradycardia
3) Warm, dry skin
4) Unresponsive to fluid resuscitation
Neurogenic Shock
Treatment for septic shock
1) ABCs
2) 02 if SPO2 <92
3) Treat infection: Ertapenem 1 gram
4) IV LR
5) If unresponsive to 2L of LR = Vasosupressors
When should Vaso-suppressors be initiated for Septic Shock?
1) IF does not respond to 2 Liters
2) Mean Arterial Pressure is below 60
Treatment for Anaphylactic Shock
1) ABC
2) O2 if SPO2 below 92%
3) Secure airway
4) Epipen every 10-15 minutes
5) IV LR or NS
6) Benadryl, Zantac, Solumedral
Treatment for Neurogenic Shock
1) ABCDE
2) C-Spine
3) IV LR or NS BOLUS
4) Secondary Survey
