Shock Flashcards
What is distributive shock?
Vascular container enlarges without proportional increase in fluid.
What are the types of distributive shock?
Septic, neurogenic, anaphylactic, and psychogenic.
What is septic shock?
Systemic infection that causes damage to blood vessel walls causing vasodilation.
What is neurogenic shock?
Shock from spinal cord injury interrupting sympathetic nervous system.
What is psychogenic shock?
Shock caused by increase stimulation of vagus nerve usually causing fainting and is self correcting.
What is cardiogenic shock?
Shock that occurs when the heart pumping mechanism cannot function correctly. “Pump failure”
What are intrinsic causes of cardiogenic shock? (Result of direct damage to the heart itself)
Heart muscle damage, dysrhythmia, valvular disruption.
What are extrinsic causes of cardiogenic shock? (Result of problems outside the heart)
Cardiac tamponade, tension pneumothorax.
What percentage of blood/fluid do you lose during hypovolemic shock?
20%
What happens during compensates shock?
Heart is stimulated to increase cardiac output, peripheral blood vessels are stimulated to constrict which results in the shunting of blood from peripheral capillaries to central circulation, metabolism switches from aerobic to anaerobic, and lactic acid builds up.
What happens during decompensated shock?
Blood pressure drops, usually at 1500 ml lost or more.
What are some non-hemorrhagic causes of Hypovolemic shock?
Dehydration from loss of water/electrolytes or vomiting/diarrhea, or burns greater than 20% TBSA.
What are the vitals of class 1 hemorrhage?
Normal heart rate, ventilatory rate, and systolic BP, <15% blood loss.
What are the vitals of class two hemorrhage?
Heart rate >100, ventilatory rate 20-30, normal systolic BP, 15-30% loss of blood.
What are the vitals of class three hemorrhage?
> 120 heart rate, 30-40 ventilatory rate, decrease in systolic BP, 30-40% loss in blood.
What are the vitals of class four hemorrhage?
> 140 heart rate, >35 ventilatory rate, greatly decreased systolic BP, >40% blood loss.
What are the approximate systolic BP’s in the radial, femoral, and carotid arteries?
Radial: 80mmHg
Femoral: 70mmHg
Carotid: 60mmHg
What is the lethal triad?
Hypothermia (<95f)
Acidosis
Coagulopathy
What percentage of the body is water?
60%
What percentage of body fluid is intracellular fluid?
45%
What percentage of body fluid is extrcellular fluid?
15%
What are the two kinds of extracellular fluids?
Interstitial - surrounds tissue cells, includes cerebrospinal and synovial fluid.
Intravascular - found in vessels, such as plasma.
What are colloids?
Solutions of water and large molecules that don’t readily cross capillary membranes.
What are examples of colloids?
Blood products, whole blood, packed red blood cells, fresh frozen plasma, freeze dried plasma, hetastarch (hextend).
How does hextend work?
Osmotic pressure pills additional water from interstitial and intracellular spaces into vessels, with larger hextend particles staying in the vessels for 8 hours or longer.
How much blood volume expansion comes from 500 ml of hextend?
800 ml of blood volume expansion (1.6X expansion).
What are some qualities of crystalliods?
Cannot carry oxygen, have low PH (acidic), do not aid in clotting, and do not significantly contribute to long term intravascular volume expansion.
How much of 1000 ml of lactated ringers solution will remain in the vascular spaces after one hour?
200 ml
What are some example of crystalliods?
Isotonic solutions
Ringers lactate
Plasma lyte
Normal saline
Hypertonic solutions
Ringers lactate description?
Composition similar to electrolyte composition of blood plasma (Gatorade for your blood), low PH (acidic) 6.2.
Ringers lactate indications
Burn casualties, dehydration when casualty cannot take fluids by mouth.
Saline description
Contains same amounts of sodium and chloride found in plasma, 9 grams of sodium chloride per 1000 ml of water, low PH 5.9
Saline indications
Only solution to be used in conjunction with blood transfusions, NOT indicated for restoring lost body fluids.
What are the first choices for fluid resuscitation?
Colloids; whole blood, plasma, RBC’s, and platelets in a 1:1:1 ratio. Plasma and RBC’s in a 1:1 ratio. Reconstituted freeze dried plasma, liquid plasma or thawed plasma or RBC’s alone. Hextend.
What is the second choice for fluid resuscitation?
Crystalloids; lactate ringers, plasma lyte, normal saline.
What systolic blood pressure will perfuse all organs?
80 mmHg
What systolic blood pressure is enough to dislodge blood clots from previous bleeding blood vessels?
100 mmHg
What is the dose and route of TXA?
2 grams slow push of 1-2 minutes.
How does the resQGARD work?
It makes it slightly harder to inhale pulling more blood into the heart.
What are some indications for ResQGARD?
Fainting, hypovolemia, dialysis, blood donation.
What are done contraindications for ResQGARD?
Dilated cardiomyopathy, left side congestive heart failure, pulmonary hypertension and/or cardiac stenosis, flail chest, chest pain/SOB, uncontrolled blood loss.
What is fresh whole blood?
Blood from walking blood bank, if stored at room temp must be used within 24 hours, if refrigerated for more than 8 hours becomes stored whole blood.
What is stored whole blood?
Same as fresh whole blood but refrigerated for more than 8 hours.
What is low titer O whole blood?
Contains low titer of antibody, can be either fresh or stored whole blood.
What are different kinds of component therapy?
Packed red blood cells, fresh frozen plasma, freeze dried plasma, platelets, cryoprecipitate.
What is the order of priority for fluid administration?
Whole blood, blood components at 1:1:1:1 ratio (plasma, platelets, RBC’s, CRYO), fresh whole blood, RBC’s plus plasma at 1:1 ratio, plasma with or without RBC’s, RBC’s alone.
What percentage saline should be used with blood injections?
0.9%
What gauge IV catheter should be used for administering blood to adult patient?
14, 16, 18 gauge.
When does an acute reaction occur after transfusion and what are some types?
Minutes to 24 hours, types are acute hemolytic reaction, uticarial reaction, and anaphylactic reaction.
When do delayed reactions occur after transfusion and what are some types?
Days, months, or years later. Types are delayed hemolytic reaction, over or under transfusion, transfusion associated graft vs host disease. (Delayed reactions are 90% fatal).
Signs and symptom of a transfusion reaction.
Bloody urine, chills, fainting/dizziness, fever, back pain, or rash.
Treatments of transfusion reactions.
Stop transfusion, acetaminophen or meloxicam, diphenhydramine, IV fluids, notify MO.
