Shock Flashcards
what is shock?
circulatory failure causes tissues to be hypoperfused. when the organs are not perfused, multiple organ dysfunction syndrome occurs and can lead to death
what are the types of shock?
hypovolemic
distributive
cardiogenic
obstructive
what is hypovolemic shock?
hypoperfusion occurs because overall body fluid is decreased
what can cause hypovolemic shock? (fluid loss)
hemorrhage
trauma
surgery
clotting issues
dehydration
vomiting, diarrhea, NG suction
what is distributive shock?
hypoperfusion occurs because of extreme vasodilation that makes it more difficult for vital organs to be properly perfused
blood pools in peripheral vascular system, causes pseudo hypovolemia
what can cause distributive shock?
sepsis
anaphylaxis
spinal cord injury (neurogenic)
what is cardiogenic shock?
hypoperfusion occurs because the heart fails to pump blood
what can cause cardiogenic shock?
MI
cardiac arrest
ventricular dysrhythmias
cardiomyopathy
what is obstructive shock?
hypoperfusion occurs because the heart’s ability to pump is impaired by a factor outside of the heart itself.
what can cause obstructive shock?
pulmonary embolism
cardiac tamponade
tension pneumothorax
what are cardiovascular symptoms of shock?
tachycardia, hypotension, flat neck veins
thready pulse, diminished peripheral pulse
slow cap refill
what are respiratory symptoms of shock?
increased respiratory rate, rapid and shallow
decreased O2 sat
cyanosis
what are GI symptoms of shock?
decreased motility and diminished bowel sounds
N/V
constipation
what are neuro symptoms of shock?
early shock has anxiety and restlessness
late shock has generalized weakness, coma
what are urinary symptoms of shock?
decreased UOP
increased specific gravity
increased BUN and creatinine
what are integumentary symptoms of shock?
cool, pale, mottled skin, cyanosis
moist, clammy
dry mouth
what is good MAP?
MAP should be >65 for proper perfusion
what ABG is characteristic of early shock?
respiratory alkilosis
what ABG is characteristic of late shock?
metabolic acidosis
why are lactate levels elevated with shock?
anaerobic metabolism is taking over because oxygen supply is not meeting demands of the body due to poor perfusion
what should urine output be?
> 30mL/hr
when are hemoglobin and hematocrit increased?
hypovolemia - less diluted in fluid
when are hemoglobin and hematocrit decreased?
hemorrhage - lost with blood loss
what are the stages of shock?
compensatory
progressive
irreversible
what are the findings of compensated shock?
normal BP
tachycardia
tachypnea/hyperventilation (cause of respiratory alkalosis)
cold clammy skin
decreased UOP
confusion and anxiety
what are the findings of progressive shock?
systolic BP <90 with MAP <65
tachycardia >150 BPM with thready pulse
rapid shallow respirations with crackles
mottled skin with petechiae
decreased UOP
lethargy
what does progressive shock do in the body?
inflammatory response occurs
capillaries leak
increased need for mechanical ventilation
AKI from decreased kidney perfusion
clotting cascade activates
hypermetabolic state
how is BP treated in shock?
fluid resuscitation
vasoactive medications
what are the findings of irreversible shock?
systolic BP <90 with MAP <65
erratic heart rate
cyanosis, requires intubation
jaundice
no UOP
unresponsive
how to recognize shock early from BP?
systolic <90
MAP <65
systolic drops by 40 from baseline
when are vasoactive medications used?
when fluid therapy doesn’t keep MAP above 65
what must be done when vasoactive medications are administered?
continuous VS monitoring
doses titrated based on pt response
do not stop abruptly
best to give through central line
what side effect can come from using vasoactive medications?
necrosis of extremities - vasoconstriction decreases perfusion around capillaries
name vasoactive medications
epi, norepi, phenylephrine
vasopressin
dopamine
dobutamine
milrinone
what is the most common type of shock?
hypovolemic shock
what are external vs internal fluid losses?
external - trauma (shot or stabbed), surgical blood loss, vomiting
internal - internal hemorrhage, ascites, third spacing
how is hypovolemic shock treated?
albumin for ascites and third-spacing
blood products for hemorrhage
treat underlying cause - stop fluid loss
assessing cardiogenic shock
monitor ECG
look at lab work for electrolytes and troponin
how is cardiogenic shock treated?
correct underlying cause - stent, valve replacement, or fix electrolyte imbalances
fluid therapy should never be a bolus
vasoactive medications
oxygenation
pain control
signs of obstructive shock
hypotension
tachycardia
chest pain
tachypnea, dyspnea
hypoxia
how is obstructive shock treated?
pericardiocentesis used to relieve tamponade
thrombolytics used to treat PE
needle decompression used to treat tension pneumothorax
what is beck’s triad (signs of cardiac tamponade)
hypotension
JVD
muffled heart sounds
what are the signature signs of tension pneumothorax?
chest pain, SOB
absent lung sounds
tracheal deviation
what is neurogenic distributive shock?
damage to nervous system impairs sympathetic tone
body doesn’t get message to vasoconstrict as needed, vascular system stays dilated
what are the signs of neurogenic shock?
BRADYCARDIA (unlike everything else) and hypotension
dry, warm skin
nausea
confusion
what can cause neurogenic shock?
spinal cord injury
spinal anesthesia
how to treat neurogenic shock
atropine for bradycardia
large bore IV for rapid fluid infusion
C-spine stabilization if pt has spinal cord injury
elevate legs if it it caused by anesthesia
vasoactive meds
what causes anaphylactic shock?
histamines and cytokine release causes systemic vasodilation
signs and symptoms of anaphylactic shock
can occur rapidly or hours after allergen exposure
erythema, flushing, itching
stridor, bronchospasm, dyspnea
angioedema
hypotension
managing anaphylactic shock
remove allergen
remove items from swollen extremities
elevate legs, but elevate HOB if airway is compromised
IV epi, diphenhydramine, nebulizer
IV fluids
administer O2 via NRB, intubate if respiratory arrest
CPR for cardiac arrest
