shock Flashcards
inadequate oxygen delivery to meet metabolic demands; results in global tissue hypoperfusion and metabolic acidosis
shock
what is MAP mathematically; what is the lower limit?
- 2/3 DBP + 1/3 SBP
- lower limit is 65
severe sepsis w/ hypotension responsive to fluid resuscitation and perfusion abnormalities
septic shock
myopathic, mechanical, arrhythmic (sinus brady, AV blocks, tachycardia)
what kind of shock
cardiogenic
Signs: cool mottled skin, tachypnea, hypotension, altered mental status, narrowed pulse pressure, rales, murmur
what kind of shock
cardiogenic
Component of spinal shock syndrome; hemodynamic instability seen in them w/ hypotension, bradycardia and hypothermia
what kind of shock
neurogenic
Damage above T6 in sympathetic pathway; resolves in hours to days; always has systemic hypotension
what type of shock
neurogenic
what type of hypovolemic shock
vomit, diarrhea, bowel obstruction, burns, environmental (dehydration)
non-hemorrhagic shock
what type of hypovolemic shock
GI bleed, trauma, massive hemoptysis, AAA rupture, ectopic pregnancy, postpartum hemorrhage
hypovolemic
6 ways to manage hemorrhagic shock
- Tourniquet
- TXA
- pelvic binder
- PRBCs, plasma platelets
- MTP
no test needed; tx w/ needle decompression, chest tube
tension pneumothorax
large heart on CXR, POCUS; tx w/ pericardiocentesis, thoracotomy
cardiac tamponade
tension pneumothorax, cardiac tamponade and PE are what type of shock
obstructive
what is virchows triad
hypercoagulable
venous injury
venostasis
what condition has virchows triad
PE
tachypnea, tachycardia, hypoxia are classic signs of what
PE
test for low risk vs high risk PE
- low risk– d dimer
- high risk– CT test or VQ scan
tx of PE
- NE
- heparin
- thrombolytics
- catheter directed tx
avoid intubation!!!!!!!!
what is Hg goal
more than 10 g/dL
Zosyn 3.375g and ceftriaxone 1g IV OR Imipenem 1g IV
when is this used
empiric tx of septic shock
- 2 large bore IV
- empiric abx
- NE early
- hydrocortisone if adrenal insuff.
septic shock tx
tx of RV infarct
fluids and dobutamine
tx of cardiogenic shock from acute MR or VSD
pressors– dobutamine and nitroprusside
first line therapy in neurogenic shock
atropine
- atropine
- fluids
- steroids or pressors
- phenylephrine 100-180 until stable
neurogenic shock tx
- IV epi
- steroids
- Histamine blockers
- bronchodilators
- glucagon if taking BB w/ refractory hypotension
anaphylactic shock tx
SIRS criteria needs 2+ of
- Temp > 38 C or < 36 C
- HR > 90
- Respiratory rate > 20 resp/min or PaCO2 < 32
- WBC >12K, < 4K or > 10% bands
- Plus existence of an infection
which two types of shock respond to fluids
hypovolemic & septic
