SHOCK Flashcards
Clinical condition of organ dysfunction resulting from an imbalance betwen cellular oxygen supply and demand. Life threatening condition is common in the ICU
Shock
Determinant of Oxygen Delivery
O2 Delivery -> Cardiac Outout -> HR & SV: Preload, Afterload, Contractility
-> Oxygen Content: O2 Capacity (Hb), Oxygen binding (SaO2), Oxygen Dissolved (PaO2)
- Measure of pressure in the vena cava.
- Estimation of preloaf and right atrial pressure
- Measured using a central venous catheter advanced via the inernal jugular vein and placed in the superior vena cava near the right atrium
- Altered by volume status and/or venous compliance
Central Venous pressure
Normal reading of Central Venous pressure
1-6mmHg
- Indirect estimate of left atrial pressure
- Measured by Swan Ganz catheter
- Measure to dx the severity of left ventricular failure
- Quantify the degree of mitral stenosis
Pulmonary Capillary Wedge Pressure
Normal range of Pulmonary Capillary Wedge Pressure
4-12mmHg
- Peripheral vascular resistance
- Resistance in the circulatory system that is used to create blood pressure, the flow of blood and is also a component of cardiac function
- When blood vessels constrict this leads to increase
- When vasodilation occurs, this leads to a decrease
Systemic Vascular Resistance (SVR)
Classification fo Shock:
- Septic shock- mc
- Pancreatitis
- Severe burns
- Anaphylactic shock
- Neurogenic shock
- Endocrine shock
- Adrenal shock
Distributive shock
Classification fo Shock:
- MI
- Myocarditis
- Arrhythmia
- Valvular: Severe aortic valve insufficiency and severe mitral valve insufficiency
Cardiogenic Shock
Classification fo Shock:
- Tension pneumothorax
- Cardiac tamponade
- Restrictive pericarditis
- Pulmonary embolism
- Aortic dissection
Obstructive shock
Classification fo Shock:
- Hemorrhagic
- GI losses
- Burns
- Polyuria: Diabetic ketoacidosis and diabetes insipidus
Hypovolemic shock
Stages of Shock
- Compensated shock (preshock)
- Shock (Decompensated shock)
- Irreversible shock (MSOF)
Hypodynamic Characteristics of the Major Types of Shock:
- low CVP
- low PCWP
- high Cardiac output
- low Systemic Vascular Resistance
Distributive
Hypodynamic Characteristics of the Major Types of Shock:
- low CVP
- low PCWP
- low Cardiac output
- highSystemic Vascular Resistance
Hypovolemic
Hypodynamic Characteristics of the Major Types of Shock:
- high CVP
- low/high PCWP
- low Cardiac output
- high Systemic Vascular Resistance
Obstructive
Hypodynamic Characteristics of the Major Types of Shock:
- high CVP
- high PCWP
- low Cardiac output
- high Systemic Vascular Resistance
Cardiogenic
Two specific aims of Evaluation of Shock
- COnfirm of the the presence of shock
2. Identify shock etiology
Key principles in the Tx of Shock
- Recognize shoch early
- Assess for type of shock
- Initiate therapy simultaeous w/ the evaluation into the etiology
- Involve all members of the multidisciplinary team
- Aim of therapy is to restore oxygen delivery
- Identify etiologies of shock that require additional lifesaving interventions
Tx for Cardiogenic Shock
Dobutamine
Increase contractility and increase SV
Tx for Distributive shock
Norepinephrine and Epinephrine
- Vasoconstrictors
Tx for Hypovolemic Shock
Crystalloids: 2L bolus
Tx for Obstructive Shock
- Intravascular
- Valvular
- Cardiac
- Extravascular
- Intravascular: thrombolytics
- Valvular: Mechanical Vavle obstruction: OR stat
- Cardiac: tamponade: pericardiocentesis
- Extravascular: needle drcompression/chest tube
