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Med Surg 1 > Shock > Flashcards

Shock Flashcards

1
Q

Define Shock

A

condition affecting all body systems in which tissue perfusion is inadequate to deliver oxygen and nutrients to support vital organs, cellular function

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2
Q
  1. Define Hypovolemic shock
  2. What are some examples?
A
  1. shock state resulting from decreased intravascular volume due to fluid loss
  2. e.g., hemorrhage, severe dehydration
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3
Q
  1. Define cardiogenic shock
  2. What are some examples?
A
  1. shock state resulting from impairment or failure of myocardium (cardiac muscle) leading to inadequate systemic perfusion.
  2. e.g., myocardium infarction
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4
Q
  1. Define septic shock
  2. What is an example?
A
  1. Circulatory shock state resulting from systemic inflammatory response causing relative hypovolemia (systemic vasodilation).
  2. Sepsis

Vasodilation throughout the body =, vasoconstriction is not occurring

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5
Q
  1. Define neurogenic shock
  2. What is example?
A
  1. shock state resulting from loss of sympathetic tone causing relative hypovolemia (systemic vasodilation)
  2. brain or spinal cord injury
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6
Q

Define anaphylactic shock

A

circulatory shock state resulting from severe allergic reaction producing relative hypovolemia (systemic vasodilation)

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7
Q
  1. Define obstructive shock?
  2. What are some examples?
A
  1. Inadequate perfusion as a result of blockage, pressure, or obstruction on the heart or lungs.
  2. PE, tension pneumo, cardiac tamponade

Least common shock

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8
Q

What is the most common type of shock?
What is the two 2nd most common?

A

Septic
(2 - Cardiogenic/Hypovolemic)
(3 - Anaphylatic/Neurogenic)

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9
Q

What causes the “early signs” of shock to occur?

A

Decreased tissue perfusion (hypoxia and ischemia) and oxygenation caused by an insult.

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10
Q

What early signs may be seen with shock?

A
  1. SNS response (↑ HR, BP, cardiac contractility = ↑ CO)
  2. ↑ RR = ↑ oxygen saturation and delivery
  3. RAAS activation = Na+/H2O retention = ↑ preload and ↓ UO
  4. Adrenal Gland activation ↑ catecholamines and cortisol = ↑ glucose for metabolism
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11
Q

How much time does the provider have to recognize the early signs of shock to begin aggressive tx to decrease mortality?

A

approx. 3 hours

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12
Q

Which type of shock would have difficulty affecting the SA node to increase HR?

A

Neurogenic shock
(unable to trigger SNS compensatory mechanism due to TBI or Spinal Injury)

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13
Q

Which type of shock would present w/ bradycardia as an early sign?

A

Neurogenic shock

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14
Q

During the compensatory stage of shock blood is shunted away from the body. Where is this seen and what are the signs?

A
  1. Skin = cool, clammy, pale
  2. Kidneys = ↓ UO
  3. GI tract = ↓ bowel sounds, abdominal discomfort

Blood is shunted away to heart and brain

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15
Q

if a patient is just lying in bed and suddenly HR kicks up for no apparent reason; what might this be an early sign of?

A

Shock

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16
Q

Why would metabolic acidosis occur during shock?

A
  • Hypoxia forces cells to perform anaerobic metabolism
  • Anaerobic metabolism byproduct is lactic acid
17
Q

In darker skin patients how can skin be checked for poor perfusion?

A

conjunctiva (pale)
Ashen-grey tongue

18
Q

What happens during acute DIC?

Disseminated intravascular coagulation

A

activation of clotting factors until all factors are used up then risk for bleeding occurs.

entire inflammatory system active → activation of coagulation proteins

19
Q
  • Normal platelet count
  • Worrisome platelet count
A
  • 150 to 400k
  • < 100k
20
Q

What happens to PT and aPTT values as clotting time decreases vs. increases.

A
  • ↓ PT/aPTT = clot faster
  • ↑ PT/aPTT = clot slower

Inverse relationship b/w PT and clot time

21
Q

What are the 4 possible interventions for DIC?

Disseminated intravascular coagulation

A
  • Possibly heparin for clots (temporarily)
  • replace coagulation factors w/ Fresh Frozen Plasma or platelets.
  • Fibrinogen (clots)
  • Plasmapheresis (severe cases)
22
Q

What is the mortality rate of irreversible stage of shock

A

75%

23
Q

What is sign a patient has entered irreversible stage of shock?

A

Presence of altered function of two or more organs in acutely ill patient such that interventions are necessary to support continued organ function

organ failure

24
Q

Metabolic acidosis tx for shock patients

A
  1. Increase RR setting on ventilator or body naturally ↑ RR if not on vent.
  2. Sodium bicarbonate (reduce stomach acids)
25
Q
  • What is the primary and secondary fluid tx for shock patients?
  • What is each used for?
A
  • Crystalloid (NS, LR) primary tx increase blood volume
  • Colloid (albumin) secondary tx used to pull fluids back into blood vessels.
26
Q

How does blood glucose vary throughout shock?

A
  • Early compensatory stage = hyperglycemia
  • Progressive and Irreversible stage = hypoglycemia
27
Q
  • What is the procedure for giving fluid to a shock patient experiencing hypovolemia?
  • What potential risks are associated w/ fluids?
A
  • 250 to 500 ml bolus inital (risk of pulmonary edema if to much fluid given)
  • Check to see if BP increases
  • If BP does not improve; move onto vasoactive medication.
28
Q

What happens within the kidneys as shock progresses?

A
  1. RAAS activation causes water retention and ↓ UO
  2. De-compensation = Oliguria < 30 ml/hr (0.5 ml/kg/hr)
  3. Refractory = Anuria < 50 ml/day and Dialysis*
29
Q

What are the 5 steps of the suriving shock campaign?

begins immediately upon suspection of shock

A
  1. Measure lactate
  2. Obtain blood cultures
  3. Adminster antibiotics
  4. Adminster crystalloid
  5. Vasopressor
30
Q

When should you priortize giving fluids in the suriving shock campaign?

A

SBP < 90 or MAP < 65

31
Q

What is the first line vasoactive medications?

Used when fluid therapy alone does not maintain MAP.

A

norepinephrine (Levophed)

2nd line tx = Epinephrine, Vasopressin

32
Q
  • What is the most common inotrope medication for cardiogenic shock?
  • What risk is it associated with?
A
  • Dopamine
  • risk arrhythmia and
    Gangrene with extravasation
33
Q

What are s/sx of clotting that may be occuring?

A

petechiae, purpura
(mini-clots)

34
Q
  • What are the three shocks that fall under distributive shock?
  • What do all distributive shock have in common?
A

Distributive Shock:
1. Septic
2. Neurogenic
3. Anaphylatic

Distributive Shock is associated w/ causing relative hypovolemia.

Blood stays out in the periphery and does not go back to the heart

Med Surg 1 (7 decks)

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