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CATA 462 > shock > Flashcards

shock Flashcards

1
Q

shock is

A

inadequate tissue perfusion. A clinical state of acute circulatory failure with inadequate oxygen utilization and/or delivery to the cells resulting in cellular hypoxia”

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2
Q

is shock reversible

A

Initially reversible if treatment provided rapidly to prevent
progression to irreversible organ dysfunction.

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3
Q

what happen during compensatory phase

A

the body attempts to maintain
perfusion using its available compensation mechanisms

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4
Q

during decompensation phase what happen

A

During decompensation phase, body is unable to keep up
with demands

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5
Q

what is fick principle

A
  1. On-loading of O2 to RBC in the lung
  2. Delivery of RBC to tissue cells
  3. Off-Loading of O2 from RBC to tissue cells
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6
Q

Factors that can affect oxygen delivery to the tissues:

A
  1. Cardiac Output 2. Available Hemoglobin 3.Oxygen Saturation (SpO2)
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7
Q

Things that can adversely effect oxygen delivery:

A
  • Hypoxia
  • Inadequate circulation
  • Inadequate transport medium (e.g., hemoglobin) * Cellular toxins
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8
Q

Organ Tolerance to Ischemia

A

HEART , BRAIN , LUNG -> 4-6min
❑ KIDNEY,LIVER,GI TRACT -> 45-90min
❑ MUSCLE, BONE, SKIN -> 4-6 hours

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9
Q

T/F A patient with signs of compensation is already in
shock, not “going into shock”

A

T

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10
Q

next stage after decompensated shock

A

death

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11
Q

shock progression

A

Compensatory defenses work well to a point…
❑ When defense mechanisms can no longer overcome volume reduction, …BP
going into DECOMPENSATION

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12
Q

what is hypovolemic shock

A

educed intravascular volume * May occur with acute blood volume loss due to
dehydration (loss of plasma)
* Hemorrhage (loss plasma + RBC), upsets the relationship of fluid volume to size of container balance.

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13
Q

what are the 2 types of hypovolemic shock

A

Absolute Hypovolemia (hemorrhagic cause)
Relative Hypovolemia (non-hemorrhagic causes)
eg: GI losses, skin losses, renal losses third-space losses (shifting of fluid into interstitial space)

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14
Q

how hypovolemic shock occurs with blood loss

A
  1. Heart stimulated  Cardiac Output through release of epinephrine from adrenal glands
  2. Sympathetic system releases norepinephrine to  blood vessel size (to reduce container size)
  3. This closes peripheral capillaries leading to anaerobic metabolism at cellular level
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15
Q

what is distributive shock

A

Vascular container enlarges without proportional increase in fluid volume
* Relatively less fluid will be available for size of container.
* The amount of fluid available to the heart as preload decreases
and cardiac output falls.

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16
Q

how does distributive shock occurs

A

Resistance to flow is decreased because of  vessel size leading to  diastolic BP. Net effect is  systolic & diastolic BPs

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17
Q

neurogenic distributive shock occurs when

A

Can occur when a cervical spine injury damages the spinal cord above where the nerves of the sympathetic nervous system exit.
* Because of loss of sympathetic control vessels dilate below level of injury.

18
Q

difference btw neurogenic shock and spinal shock

A

neuro:Disruption of sympathetic nervous system leading to dilation peripheral arteries
(↓BP, pulse normal-slow, warm dry skin below level, alert oriented, no reflexes)

spina :lnjury to the spinal cord that results in temporary loss of sensory and motor function

19
Q

can spinal and neurogenic shock occurs at the same time

A

yes

20
Q

what is septic chock

A

Cytokines, which are locally active hormones
produced by WBC responding to infection cause damage to the wall of the blood vessels, causing peripheral vasodilation and a leakage of fluid from the capillaries into the interstitial space.

21
Q

what is psychogenic shock

A

Mediated through parasympathetic
Nervous system… vagal nerve stimulation produces bradycardia. Can also lead to transient peripheral vasodilation and hypotension. If severe enough:  Cardiac output and then vasovagal syncope

22
Q

type of obstructive shock

A

mechanical
pericardial tamponade
tension pneumothorax

23
Q

stage of shock

A

Pre-shock (compensated)
The body’s compensatory mechanisms are able to maintain
some degree of tissue perfusion.

  • Shock (decompensated)
    The body’s compensatory mechanisms fail to maintain tissue perfusion (blood pressure falls).
  • End-organ dysfunction (irreversible)
    Tissue and cellular damage is so massive that the organism dies even if perfusion is restored
24
Q

As compensatory mechanisms fully engage, what signs and symptoms would you expect to see?

A
  • Tachycardia
  • Tachypnea
  • Pupillary dilation
  • Decreased capillary refill * Pale cool skin
25
Q

When compensatory mechanisms fail, what signs and symptoms would you expect to see?

A
  • Hypotension
  • Falling SpO2
  • Bradycardia
  • Loss of consciousness * Dysrhythmias
  • Death
26
Q

pulse, skin BP, LOC in compensated shock

A

increased, tachy
white, cool, moist
normal
unaltered

27
Q

pulse, skin BP, LOC in decompensated shock

A

marked increased marked tachy
can progress to brady
white, cold, waxy
decreased
altered from disoriented to coma

28
Q

shock complication

A

Acute Respiratory Distress Syndrome (lung lining damage) ❑Acute Renal Failure (ischemic reaction)
❑ Hematologic Failure (coagulopathy)
❑ Hepatic Failure (liver ischemic reaction)
❑ Multiple Organ Failure
❑ Failure of 1 major body system
leg: lungs, kidneys, blood clotting, liver)
associated with mortality of 40%.

29
Q

first symptom you would except to find for shock

A

increase respiratory rate
increase heart rate

30
Q

Second most common physiological response to the development of shock? plus symptom

A

“Peripheral vasoconstriction”
* Pale skin * Cool skin * Weakened peripheral pulse, flat neck veins

31
Q

As shock progresses – what physiological effects are seen?

A
  • End-organ perfusion falls
    What symptoms would you expect to see? * Altered mental status
  • Decreased urine output (ER)
32
Q

s/s progression of shock

A

Mild anxiety→confusion/altered LOC
* Mild tachypnea → rapid laboured ventilations * Mild tachycardia →marked tachycardia
* Weakened radial pulse → absent radial pulse * Pale or cyanotic skin color
* Capillary refilling time > 2 seconds

33
Q

with which type of shock you would have a lucid LOC

A

neurogenic

34
Q

with which type of shock you would have a normal cap refil

A

neurogenic

35
Q

in which type of shock skin temp is warm and dry

A

neurogenic

36
Q

in which type of shock skin color is pale,cyanotic

A

cardiogenic and hypovolemic

37
Q

n which type of shock skin color is pale and mottled

A

septic

38
Q

n which type of shock skin color is pink

A

neurogenic

39
Q

during shock you need to have a SpO2 of at least

A

94%

40
Q

in shock if not breathing adequately which device you use

A

BVM even if breathing

41
Q

how do you transport patient in shock

A

Trauma patients in shock should be transported supine & neutral unless otherwise indicated

42
Q

effect of elevation of feet in patient in shock

A

May aggravate impaired ventilatory function by placing weight of abdominal organs on the diaphragm.
* May increase intracranial pressure with traumatic brain injury
* Patients in severe hypovolemic shock don’t get significant autotransfusion of blood to the vital organs from the extremities.
* Both Trendelenburg and shock positions contraindicated with suspected spine injury

CATA 462 (22 decks)

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