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Therapeutics I > Shock > Flashcards

Shock Flashcards

1
Q

What is shock?

A

Life threatening condition with inadequate blood perfusion leading to low oxygen perfusion and low nutrient delivered

O2 delivery < O2 demand

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2
Q

What is the subjective presentation of shock?

A
  1. DZ
  2. Fatigue
  3. SOB
  4. Fast pulse
  5. excessive sweating
  6. N/V
  7. Cyanosis
  8. Cold, clammy, pale skin
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3
Q

What are the objective presentations of shock?

A
  1. Hypotension
  2. Increased RR
  3. Decreased UO, SV, CO
  4. Increased HR
    SBP<90, MAP less than 65
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4
Q

What is the most determining factor for O2 delivery in shock?

A

MAP

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5
Q

What is MAP dependent on?

A

CO and SVR

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6
Q

What is the CO dependent on?

A

HR and SV

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7
Q

What are the types of shock?

A
  1. Cardiogenic
  2. Distributive (Septic and anaphylactic)
  3. Obstructive
  4. Hypovolemic
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8
Q

What are the causes of cardiogenic shock?

A
  1. MI
  2. Arrhythmias
  3. Myocarditis
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9
Q

What are the causes of Distributive shock?

A

Allergy (ana)
Infection (septic)
Adrenal crisis (Addison’s) - can be either

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10
Q

What are the causes of obstructive shock?

A
  1. Pulmonary embolism
  2. Pneumothorax
  3. Pericarditis
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11
Q

What are the causes of hypovolemic shock?

A
  1. Trauma (blood loss)
  2. Dehydration
  3. GI Bleeding
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12
Q

What are the stages of shock?

A
  1. Initial
  2. Compensatory
  3. Progressive
  4. Refractory
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13
Q

What occurs in the initial stage? Causing?

A

Aerobic → Anaerobic metabolism

Elevated lactic acid → decrease in pH → vasodilation

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14
Q

What occurs in compensatory stage?

A

SNS responses → increased HR and RR

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15
Q

What occurs during the progressive stage? Symptoms?

A

Organ functionalities damaged

Altered mental status, increased sCr or BUN, Increased AST or ALT

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16
Q

What occurs during the refectory stage?

A

Irreversible → organ failure no/minimal response to treatment

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17
Q

What are the treatments for shock?

A
  1. O2
  2. Fluids (isotonic-NS and LR)
  3. Vasopressors
  4. Inotropes
  5. Supportive care
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18
Q

What is the purpose of using inotropes?

A

Vasoconstriction and increase contractility

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19
Q

What are the types of vasopressors used for shock?

A

Phenylephrine and Vasopressin

20
Q

What are types of inotropes used for shock?

A
  1. Levophed (NE)
  2. Inotropin (Dopamine)
  3. Adrenaline (Epinephrine)
21
Q

What are the doses of dopamine?

A

Low: 05 mcg/kg/min
Med: 5-10 mcg/kg/min
High: 10-20 mcg/kg/min

22
Q

Describe the medications used for shock and their effects?

23
Q

What is the use of isoproterenol?

A

Bradycardia

24
Q

Know the vasopressor charts on 10 and 11

25
Q

What is cariogenic shock?

A

Heart is impaired → inadequate blood perfusion → Decreased blood volume circulating

26
Q

Signs and symptoms of cariogenic shock?

A

Decreased BP, Decreased CO, Increased HR, confusion, rapid breathing

27
Q

How do you diagnose cariogenic shock?

A
  1. SBP below 90 for more than 30 minutes OR supportive intervention to maintain SBP above 90
  2. ECG/EKG, blood tests, Echo, angiogram, lactate
  3. BNP and Troponin levels
28
Q

Treatment for cariogenic shock?

A
  1. O2 → 90%
  2. Give fluids: crystalloids in bolus of 250 - 500 mL
  3. Inotropes (Dobutamine and milrinone)
  4. Vasopressors: E
  5. Treatment that targets the underlying condition
29
Q

What is distributive shock?

A
  1. Characterized by severe peripheral vasodilatation (vasodilatory shock)
  2. Majority of blood is inadequately distributed throughout the vasculature
30
Q

How do diagnose septic shock?

A
  1. Hypotension SBP<100
  2. Altered mental status
  3. Tachypnea RR >22/min
  4. ≥2 criteria suggests a greater risk of a poor outcome
31
Q

Labs to diagnose septic shock?

A
  1. Lactate >2 mmol/L
  2. ElevatedAST/ALT
  3. Platelet<100
  4. PT/INRelevation
  5. UOP<0.5
32
Q

Signs and symptoms of anaphylaxis?

A
  1. Mucosal tissue region (Itching, flushing, swollen lips or tongue)
  2. Respiratory compromise
    (Dyspnea, wheeze/bronchospasm, hypoxemia)
  3. GI symptoms (Abdominal pain, vomiting)
33
Q

Treatment for septic shock?

A
  1. Antibiotics within 1st hr
  2. Isotonic fluids: 30 mL/kg first 3 hr
  3. 1st line VP: NE>vasopressin>EPI>phenylephrine
34
Q

Treatment for anaphylactic?

A

1st line: IV E
2nd line Benadryl,

35
Q

Treatment for anaphylactic?

A

1st line: IV E
2nd line Benadryl, Famotidine, Prednisone

36
Q

What is obstructive shock?

A

Blockage inblood vessels or in the surrounding area of the heart that prevents blood from being pushed forward

37
Q

What are the signs and symptoms of pulmonary embolism?

A
  1. Tachycardia
  2. Tachypnea
  3. Hypoxia
38
Q

What are the signs and symptoms of tension pneumothorax?

A
  1. Reduced breath sounds
  2. SOB
  3. Chest pain
39
Q

What is the lab diagnosis of obstructive shock?

A
  1. Echocardiogram (ECG)
    2, POCT: Point of Care Testing
  2. CT scan
  3. Chest X-ray
40
Q

What is the treatment for pulmonary embolism?

A
  1. O2
  2. Thrombolytic: Alteplase, Reteplase, Tenecteplase
  3. Heparin (prevention of fibrin formation)
41
Q

Treatment for tension pneumothorax?

A
  1. Needle decompression
  2. Chest tube thoracotomy
42
Q

What is hypovolemic shock?

A

Circulatory failure due to reduced intravascular loss of blood or fluids → tissue hypoperfusion and tissue hypoxia

43
Q

Signs and symptoms of hypovolemic shock?

A
  1. Reduced turgor
  2. Dry mucous membrane
  3. Hypotension
  4. Pale skin
  5. Increased thirst
44
Q

Labs to diagnose hypovolemic shock?

A
  1. Increase BUN and sCr
  2. Hyper or hyponateremia
  3. Hyper or hypokalemia
  4. Lactic acidosis
  5. Decrease Hit/Hgb
  6. Increase urine osmolaltiy
45
Q

Treatment for hypovolemic shock?

A
  1. Isotonic (NS, LR, plasma-lyte) - Dose 30 mL/kg
  2. Blood products: Hgb<7

Therapeutics I (32 decks)

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