Shock Flashcards
What are the different types of shock
- Hypovolemic
- Cardiogenic
- Distributive
- Obstructive
What is the definition of shock
State of severe systemic reduction in tissue perfusion
1. Decreased cellular oxygen delivery and utilization as well as decreased removal of waste by products of metabolism
What are the consequences of shock
Disruption of cell membrane ionic pumps
1. Cell swells
2. Cell membrane breaks down
3. Leads to cell death
4. Toxic cellular insult (inflammation)
What is metabolic acidosis due to?
Due to lack of O2 which leads to
1. Cells resort to anaerobic metabolism
2. Lactic acid is produced as a byproduct
What happens if there is widespread cellular death
Leads to multiple organ dysfunction syndrome (MODS)
1. Death if shock becomes irreversible
What is the equation of cardiac output
CO=HR (beats/min) X SV (mL/beat)
What is normal stroke volume
60-100ml/min
What is normal cardiac output
5-8L/min
What is stroke volume dependent on>
- The ventricular end-diastolic filing volume
- State of myocardial contractility
- Afterload
*each variable with SV can be impaired in clinical shock states
What happens if there is inadequate oxygen delivery (hypoperfusion)
- Hypovolemia (hemorrhage)
- Cardiogenic hypoperfusion
What are the patient characteristics at risk for shock
- Trauma or burn
- Vascular catastrophe - ruptured aneurysm
- Acute cardiac disease
- Acute abdominal disease
- Severe intraabdominal infection
What are signs of excellent circulation
- Normotensive
- Normal pulse
- Warm extremities
- Urine output >0.5mL/kg/hr
- Resolution of metabolic acidosis
What are the indicators of shock
- Hypotension
- Tachycardia
- Tachypnea
- Hyperthermia or hypothermia
- Peripheral vasoconstriction and cool extremes
- Hypotension with warm extremities
What are the common tests to complete when a patient is in shock
- CBC
- BMP
- Lactate
- Coagulation studies
- ABG
- CRP
- Cultures
What are the CBC findings of shock
- Leukocytosis or leukopenia
- Decreased platelet count
What are the BMP findings of shock
- Elevated BUN and creatinine
- Decreased calcium
- Elevated glucose
What are the lactate findings of shock
Elevated lactate
What are the ABG findings of shock
Metabolic acidosis
What are the CRP findings of shock
Elevated inflammatory markers
What are the signs of hypovolemic shock
(HR, CO, SVR, PP, mixed venous)
HP: elevated
CO: decreased
SVR: elevated
PP: decreased
Mixed venous: decreased
What are the signs of obstructive shock
(HR, CO, SVR, PP, mixed venous)
HR: elevated
CO: decreased
SVR: elevated
PP: decreased
mixed venous: decreased
What are the signs of cardiogenic shock
(HR, CO, SVR, PP, mixed venous)
HR: elevated
CO: decreased
SVR: elevated
PP: decreased
Mixed venous: decreased
What are the signs of distributive shock
(HR, CO, SVR, PP, mixed venous)
HR: elevated
CO: elevated
SVR: decreased
PP: elevated
Mixed venous: elevated
