Shock Flashcards
CVP = 8 to 12 mmHg
*The CVP is elevated in obstructive or cardiogenic shock, while it is decreased in septic or hypovolemic shock.
Elevated CVP is indicative of myocardial contractile dysfunction and/or fluid retention.
On the other hand, low central venous pressure is indicative of volume depletion or decreased venous tone.
Shock
Patho: it is a critical condition where the body has decreased tissue perfusion eventually leading to organ failure and death.
(5 types of shock: septic, neuro, hypovolemic, cardio, anaphylactic)
4 Stage of Shock:
1. initial = anaerobic metabolism, absent s/s
2. Compensatory = Tachycardia, Tachypnea, decreased oxygen
3. Progressive = Cold and Clammy skin is a sign of no perfusion in body.
4. Irreversible = Death is imminent.
Septic Shock
Tx:
Supplemental oxygen, IV fluids, antibiotics.
s/s
* Low BP
*Increased WBC > 10,000
*Cold clammy pale
* Temp low = hypothermia (96 F)**
*Capillary refil decreased
*Hypoxemia - Confusion, Disorientation
Hypovolemic Shock
** SPO2 sensor should be palced in forehead instead of extremities** Due to lack of perfusion
Causes: Blood and volume loss due to surgery, trauma, diarrhea, vomiting
*Note HOB high folwers in Autonomic Dysreflexia.
* In Hypovolemic Shock = lower HOB
*In hypovolemic shock is to increase the intravascular fluids and then administer vasopressors.
Critical DO NOT DELAY
+A new bag of norEPI
+MAP > 65 mmHg
+ CVP = 2-6 mmHg
Priority = Cold and Clammy skin = sign of progressive Hypovolemic Shock.
s/s
1. Tachycardia HR> 110 BPM
2. Hypotension : SBP < 80-90 mmHg
3. Low CVP
Note maintain CVP = 2-6 mmHg.
Less than 2 mmHg = CVP = increase the rate of IV fluids (dehydration)
Interventions:
Priority -> Hemodynamic stability
1. Lower the HOB right away (never place the HOB in High Fowler’s Position).
2. IV Normal saline
3. Then, Vasopressors like norephnephrine and dopamine
1 Drug at 1st sign of anaphylaxis is EPI. Helps with cardiac and respiratory arrest.
Anaphylactic Shock (severe allergic reaction from bee sting, peanut allergy, food etc..)
How do you know it is an anaphylactic reaction?
Ans. ABC + Hives
*Sequence of drug administeration in Anaphylactic Shock
- Epi
- Diphenhydramine
- Albuterol & Steroids
Hold epi pen in place for 10 secs
About Epi
## Repeat epi until s/s resolve.
How do you know Epi is doing it’s job?
1. BP increases 130/76
2. HR increases 110
Hold epi pen in place for 10 secs
How to use Epi Pen?
Repeat epi until s/s resolve.
stab pen into outer thigh
- Inject into outer thigh at 90 degree angle at onset of s/s
#hold in place for 10 secs
- Seek immediate medical attention after use. Go to the hospital
- Store Epi pens in dark place at room temp (not too cold or not too hot)
Cardiogenic Shock
causes;
HF, (heart attack), MI = heart cells/ tissues die
Heart fails to pump adequately.
Low BP goes lower and lower with increasing HR, and RR. (BP = 88/58, RR = 32, HR = 118)
Cardiogenic Shock treatment:
- Digoxin 2. Dopamine (Vasopressors)
+ve inotropic (forceful contractions) drugs.
Dopamine Adverse Effect:
1. Tachycardia (HR>100 BPM)
2. ARRHYTHMIAS
When you see spinal cord injury…think what killds the patient first???
Autonomic Dysreflexia
Priority Interventions T1 spinal injury with throbbing headache, nausea, elevated BP.
Ans. Palpate the bladder/ Check urinary catheter for kinks.
Interventions for T1 spinal cord injury with flushing, diaphoresis, and pulse 58 is?
- Assess for bladder distention
- Remove tight clothing
- Measure BP
- High Fowler’s position
Neurogenic Shock = Autonomic Dysreflexia
*Spinal injury above T6 and High BP and HA.
Interventions for Autonomic Dysreflexia
- Notify HCP
- Correct the cause
2.1 Bladder assessment (palpate bladder, bladder scanner, check the Foley for Kinks)
2.2 Bowel assessment
2.3 Remove constrictive clothing
2.4 Measure BP - BP meds like clonidine after assessment.
Neurogenic Shock or Autonomic Dysreflexia
s/s
Bradycardia**
*Hypertension upto 300 SBP
*Throbbing HA
*Flu like symptoms like facial flushing, nasal congestion, diaphoresis, piloerection (goosebumps)
*Skin = Warm, Pink, Dry
due to pooling of blood, the blood does not return to the heart, so decreased CO
NOTE: Autonomic Dysreflexia intervention is
Raise HOB = High Fowler’s position
*not Trendenlenberg, not flat, not supine, not left lateral
Neurogenic shock admission key sign
Bradycardia
Neurogenic shock again interventions
** IV normal saline to increase BP
** foley for emptying bladder
** laxatives for constipation
** loose tight clothing
