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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
What is cariogenic shock?
Heart is impaired → inadequate blood perfusion → Decreased blood volume circulating
26
Signs and symptoms of cariogenic shock?
Decreased BP, Decreased CO, Increased HR, confusion, rapid breathing
27
How do you diagnose cariogenic shock?
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
Treatment for cariogenic shock?
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
What is distributive shock?
1. Characterized by severe peripheral vasodilatation (vasodilatory shock) 2. Majority of blood is inadequately distributed throughout the vasculature
30
How do diagnose septic shock?
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
Labs to diagnose septic shock?
1. Lactate >2 mmol/L 2. Elevated AST/ALT  3. Platelet <100 4. PT/INR elevation 5. UOP<0.5 
32
Signs and symptoms of anaphylaxis?
1. Mucosal tissue region (Itching, flushing, swollen lips or tongue) 2. Respiratory compromise (Dyspnea, wheeze/bronchospasm, hypoxemia) 3. GI symptoms (Abdominal pain, vomiting)  
33
Treatment for septic shock?
1. Antibiotics within 1st hr 2. Isotonic fluids: 30 mL/kg first 3 hr 3. 1st line VP: NE>vasopressin>EPI>phenylephrine
34
Treatment for anaphylactic?
1st line: IV E 2nd line Benadryl,
35
Treatment for anaphylactic?
1st line: IV E 2nd line Benadryl, Famotidine, Prednisone
36
What is obstructive shock?
Blockage in  blood vessels or in the surrounding area of the heart that prevents blood from being pushed forward
37
What are the signs and symptoms of pulmonary embolism?
1. Tachycardia 2. Tachypnea 3. Hypoxia 
38
What are the signs and symptoms of tension pneumothorax?
1. Reduced breath sounds  2. SOB  3. Chest pain 
39
What is the lab diagnosis of obstructive shock?
1. Echocardiogram (ECG) 2, POCT: Point of Care Testing  3. CT scan  4. Chest X-ray 
40
What is the treatment for pulmonary embolism?
1. O2 2. Thrombolytic: Alteplase, Reteplase, Tenecteplase 3. Heparin (prevention of fibrin formation)
41
Treatment for tension pneumothorax?
1. Needle decompression 2. Chest tube thoracotomy
42
What is hypovolemic shock?
Circulatory failure due to reduced  intravascular loss of blood or fluids → tissue hypoperfusion and tissue hypoxia 
43
Signs and symptoms of hypovolemic shock?
1. Reduced turgor 2. Dry mucous membrane 3. Hypotension 4. Pale skin 5. Increased thirst
44
Labs to diagnose hypovolemic shock?
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
Treatment for hypovolemic shock?
1. Isotonic (NS, LR, plasma-lyte) - Dose 30 mL/kg 2. Blood products: Hgb<7

Therapeutics I (32 decks)

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