Shock Flashcards
What is shock?
Life threatening condition with inadequate blood perfusion leading to low oxygen perfusion and low nutrient delivered
O2 delivery < O2 demand
What is the subjective presentation of shock?
- DZ
- Fatigue
- SOB
- Fast pulse
- excessive sweating
- N/V
- Cyanosis
- Cold, clammy, pale skin
What are the objective presentations of shock?
- Hypotension
- Increased RR
- Decreased UO, SV, CO
- Increased HR
SBP<90, MAP less than 65
What is the most determining factor for O2 delivery in shock?
MAP
What is MAP dependent on?
CO and SVR
What is the CO dependent on?
HR and SV
What are the types of shock?
- Cardiogenic
- Distributive (Septic and anaphylactic)
- Obstructive
- Hypovolemic
What are the causes of cardiogenic shock?
- MI
- Arrhythmias
- Myocarditis
What are the causes of Distributive shock?
Allergy (ana)
Infection (septic)
Adrenal crisis (Addison’s) - can be either
What are the causes of obstructive shock?
- Pulmonary embolism
- Pneumothorax
- Pericarditis
What are the causes of hypovolemic shock?
- Trauma (blood loss)
- Dehydration
- GI Bleeding
What are the stages of shock?
- Initial
- Compensatory
- Progressive
- Refractory
What occurs in the initial stage? Causing?
Aerobic → Anaerobic metabolism
Elevated lactic acid → decrease in pH → vasodilation
What occurs in compensatory stage?
SNS responses → increased HR and RR
What occurs during the progressive stage? Symptoms?
Organ functionalities damaged
Altered mental status, increased sCr or BUN, Increased AST or ALT
What occurs during the refectory stage?
Irreversible → organ failure no/minimal response to treatment
What are the treatments for shock?
- O2
- Fluids (isotonic-NS and LR)
- Vasopressors
- Inotropes
- Supportive care
What is the purpose of using inotropes?
Vasoconstriction and increase contractility
What are the types of vasopressors used for shock?
Phenylephrine and Vasopressin
What are types of inotropes used for shock?
- Levophed (NE)
- Inotropin (Dopamine)
- Adrenaline (Epinephrine)
What are the doses of dopamine?
Low: 05 mcg/kg/min
Med: 5-10 mcg/kg/min
High: 10-20 mcg/kg/min
Describe the medications used for shock and their effects?
What is the use of isoproterenol?
Bradycardia
Know the vasopressor charts on 10 and 11
What is cariogenic shock?
Heart is impaired → inadequate blood perfusion → Decreased blood volume circulating
Signs and symptoms of cariogenic shock?
Decreased BP, Decreased CO, Increased HR, confusion, rapid breathing
How do you diagnose cariogenic shock?
- SBP below 90 for more than 30 minutes OR supportive intervention to maintain SBP above 90
- ECG/EKG, blood tests, Echo, angiogram, lactate
- BNP and Troponin levels
Treatment for cariogenic shock?
- O2 → 90%
- Give fluids: crystalloids in bolus of 250 - 500 mL
- Inotropes (Dobutamine and milrinone)
- Vasopressors: E
- Treatment that targets the underlying condition
What is distributive shock?
- Characterized by severe peripheral vasodilatation (vasodilatory shock)
- Majority of blood is inadequately distributed throughout the vasculature
How do diagnose septic shock?
- Hypotension SBP<100
- Altered mental status
- Tachypnea RR >22/min
- ≥2 criteria suggests a greater risk of a poor outcome
Labs to diagnose septic shock?
- Lactate >2 mmol/L
- ElevatedAST/ALT
- Platelet<100
- PT/INRelevation
- UOP<0.5
Signs and symptoms of anaphylaxis?
- Mucosal tissue region (Itching, flushing, swollen lips or tongue)
- Respiratory compromise
(Dyspnea, wheeze/bronchospasm, hypoxemia) - GI symptoms (Abdominal pain, vomiting)
Treatment for septic shock?
- Antibiotics within 1st hr
- Isotonic fluids: 30 mL/kg first 3 hr
- 1st line VP: NE>vasopressin>EPI>phenylephrine
Treatment for anaphylactic?
1st line: IV E
2nd line Benadryl,
Treatment for anaphylactic?
1st line: IV E
2nd line Benadryl, Famotidine, Prednisone
What is obstructive shock?
Blockage inblood vessels or in the surrounding area of the heart that prevents blood from being pushed forward
What are the signs and symptoms of pulmonary embolism?
- Tachycardia
- Tachypnea
- Hypoxia
What are the signs and symptoms of tension pneumothorax?
- Reduced breath sounds
- SOB
- Chest pain
What is the lab diagnosis of obstructive shock?
- Echocardiogram (ECG)
2, POCT: Point of Care Testing - CT scan
- Chest X-ray
What is the treatment for pulmonary embolism?
- O2
- Thrombolytic: Alteplase, Reteplase, Tenecteplase
- Heparin (prevention of fibrin formation)
Treatment for tension pneumothorax?
- Needle decompression
- Chest tube thoracotomy
What is hypovolemic shock?
Circulatory failure due to reduced intravascular loss of blood or fluids → tissue hypoperfusion and tissue hypoxia
Signs and symptoms of hypovolemic shock?
- Reduced turgor
- Dry mucous membrane
- Hypotension
- Pale skin
- Increased thirst
Labs to diagnose hypovolemic shock?
- Increase BUN and sCr
- Hyper or hyponateremia
- Hyper or hypokalemia
- Lactic acidosis
- Decrease Hit/Hgb
- Increase urine osmolaltiy
Treatment for hypovolemic shock?
- Isotonic (NS, LR, plasma-lyte) - Dose 30 mL/kg
- Blood products: Hgb<7
