Shock Flashcards
1
Q
- Inadequate oxygen delivery to meet metabolic demands
- results in global tissue hypoperfusion and metabolic acidosis
A
shock
2
Q
What is the pathophysiology of shock?
A
this imbalance between tissue oxygen supply and demand leads to
- stimulation of autonomic response (goal is to maintain cerebral and cardiac perfusion)
- abnormal celluar response
- anaerobic metabolism
3
Q
Causes
- worsening lactic acidosis
- cardiovascular insufficiency
- increase oxygen demand
Results in “End Organ Damage”
- multiorgan dysfunction syndrome (MODS)
- cardiac depression, respiratory distress, renal failure and DIC
A
Global tissue Hypoxia
4
Q
What are signs and symptoms of shock?
A
- mental status changes
- pinpoint pupils
- tachycardia
- other dysrhythmias
- hypotension
- oliguria
- cool, clammy
- lactic acidosis
- fever
- cyanosis
5
Q
- negative inotrope
- bicarbonate is rarely used for treatment
- treat with improved ventilation and mild hyperventilation
A
acidosis
6
Q
what does non-hemorrhagic hypovolemic shock look like?
A
- vomiting
- diarrhea
- bowel obstruction, pancreatitis
- burns
- neglect, environmental (dehydration)
7
Q
what does a hemorrhagic hypovolemic shock look like?
A
- GI bleed
- trauma
- massive hemoptysis
- AAA rupture
- ectopic pregnancy, post-partum bleeding
8
Q
treatment of hypovolemic shock?
A
- ABC- stop the bleeding
- establish 2 large bore IVs or a central line
- crystalloids (normal saline or lactate ringers)
- PRBCs +++ EARLY
- control any bleeding
- permissive hypotension
9
Q
signs of cardiogenic shock?
A
- cool, mottled skin
- tachypnea
- hypotension
- altered mental status
- narrowed pulse pressure
- rales, murmur
10
Q
what is the pathophysiology behind cardiogenic shock?
A
- often after ischemia, loss of LV function
- CO reduction= lactic acidosis, hypoxia
-lose 40% of LV–> clinical shock ensues - stroke volume is reduced
-tachycardia develops as compensation
-ischemia and infarction worsens
11
Q
what is the initial treatment of cardogenic shock?
A
- airway stability and improving myocardial pump function
- cardiac monitor, pulse oximetry
- supplemental oxygen, IV access
- intubation will decrease preload and result in hypotension
12
Q
Treatment of cardiogenic shock?
A
AMI
- aspirin, heparin, antiplatelet
- if no pulmonary edema- IVF challenge
- if pulmonary edema: Dopamine- will increase HR and thus cardiac work (rarely used); dobutamine- may drop blood pressure; norepi; combination therapy may be more effective
- PCI
RV infarct
- fluids and dobutamine (no NTG)
Acute mitral regurgitaiton or VSD
- pressors (dobutuamine and nitroprusside)
13
Q
- air trapped in pleural space with 1 way valve, air/pressure builds up
- mediastinum shifted impeding venous return
- chest pain, SOB, decreased breath sounds
- no tests needed
- rx: needle decompression, chest tube
A
Tension Pneumothorax
Type of obstructive shock
14
Q
- Blood in pericardial sac prevents venous return to and contraction of heart
- related trauma, pericarditis, MI
- Beck’s triad: hypotension, muffled heart sounds, JVD
- dx: large heart CXR, POCUS
- rx: pericardiocentesis, thoractomy
A
cardiac tamponade
type of obstructive shock
15
Q
- Virchow’s triad: hypercoagulable, venous injury, venostasis
- signs: tachypnea, tachycardia, hypoxia
- low risk: D-dimer
- higher risk: CT chest or VQ scan
- rx: Norepi, heparin, consider thrombolytics
- avoid intubation
- catheter directed tx/OR
A
Pulmonary emobilism
type of obstructive shock
