Shock Flashcards
What is shock
inadequate tissue perfusion, starts to kill the cells then organs start to fail
what is hypovolemic shock
a decrease in intravascular volume - too little circulating blood - decreases preload, venous return, stroke volume
what is cardiogenic shock
failure of the heart to pump effectively due to a cardiac factor like MI or decreases cardiac output/MAP
what is obstructive shock
impairment of the heart to pump effectively as a result of a non cardiac factor like cardiac tamponade, tension pneumothorax, PE, pulmonary artery stenosis
what is disruptive shock
vasodilation and increased capillary permeability - blood is not distributed correctly so it cant perfuse organs
what are the stages of shock
initial, compensatory, progressive, refractory
what happens in the initial stage of shock
decrease MAP, vascular constriction (so increase HR)
what happens in the compensatory stage of shock
body compensates to increase CO to restore tissue perfusion (increase vitals - decrease output)
what happens in the progressive stage of shock
compensatory mechanisms start to fail (decrease in MAP over 20), rapid weak pulse, cool moist skin, decreased O2
what happens in the refractory stage of shock
irreversible shock with organ failure, then more organ failure – death (toxic metabolites, MODS, DIC) non palpable pulse, cold dusky extremities, shallow respirations, unmeasurable O2
what are some causes/risk factors for hypovolemic shock
hemorrhage, ulcer, inadequate clotting, dehydration, severe vomiting/diarrhea, diuretic therapy, elderly, NPO status,
how is hypovolemic shock managed
fluid and blood replacement to restore volume, with normal saline, LR, plasma, RBCs, meds that vasoconstrict, trendelenburg, O2
what do vasoactive agents (norepinephrine) do for hypovolemic shock
increase peripheral resistance, increase venous return, increase myocardial contractility
what do positive inotropic agents (dobutamine, epinephrine) do for hypovolemic shock
strengthen cardiac contraction and increase CO
what does vasopressin do for hypovolemic shock
cause vasoconstriction, increase systemic vascular resistance - increase BP
what is cardiogenic shock
direct pump failure
what are some risk factors for cardiogenic shock
MI, dysrhythmias, cardiomyopathies, myocardial degeneration, valvular rupture or stensosis
what are the ss of cardiogenic shock
increase HR/RR, decrease BP, cool clammy skin, oliguria, cyanosis, confusion , PE, PAP increases
How is cardiogenic shock managed
O2, angioplasty/stenting, balloon pump, pulmonary artery catheter insertion, pain managed, vasodilator, diuretics
what is septic shock
systemic inflammatory response from sepsis, endotoxins cause vasodilation, inflammation, and capillary permeability
Patient is in septic shock if they require vasopressor therapy to maintain…..
MAP > 65 mmHg, and lactate is > 2mmol/L
what are some risk factors for septic shock
immunosuppression, cancer, infants, elderly, malnourished, injury, chronic illness, central lines, foley catheters
what are some ss of septic shock
ARDS, MODS evident, Poor clotting with uncontrolled bleeding, Low WBC count, Cold, clammy skin, Increased risk of death
what is included in the septic bundle
within 1 hour, draw lactate level/blood cultures, broad spectrum antibiotics, fluids, vasopressors, urine cultures, ches x ray, sputum, and wound culture,
what is anaphylactic shock
exposed to an antigen, IgE antibodies bine and create inflammatory response
what are some ss of anaphylactic shock
hypotension, pruitits, rhinorrhea, tachycardia, bronchospasms (stridor), hives
how is anaphylactic shock treated
remove antigen, o2, meds (epinephrine, diphenhydramine), albuterol, IV fluids
what are some risk factors for neurogenic shock
head trauma, spinal cord injury, anesthesia, meds
what are some ss of neurogenic shock
dry,warm skin, hypotension, bradycardia, impaired breathing
what is the tx for neurogenic shock
immobilize, restore sympathetic tone, IV fluids
what are the meds used to tx neurogenic shock
dopamine, atropine, norepinephrine, phenylephrine (increases BP not HR)
