Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

XIO > Shock > Flashcards

Shock Flashcards

1
Q

SHOCK (MCH is in shock)

A

is defined as a syndrome characterized by decreased tissue perfusion , resulting in cellular, metabolic and hemodynamic instability.
All shock results in ineffective tissue perfusion and acute circulatory failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Shock is initiated by a Drop in MAP (mean arterial Pressure) - how to calculate MAP?

A

Leads to impaired tissue perfusion

MAP = SBP + 2(DBP)/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how does shock start?

A

Shock begins with an inciting event:
focus of infection: abscess, UTI
Injury: gun shot wound, burn…
This event produces a systemic circulatory abnormality that may progress through several stages :

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SVR - Systemic Vascular Resistance - SVR is the same as afterload

(sever the afterload)

A

The resistance that the left ventricle must pump against to eject bld. (Afterload)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Afterload (after the force) (same as SVR)

A

Force Left ventricle pumps against to eject blood into body. (SVR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Preload- when does it start?

A

Filling pressure of left ventricle Amount of blood in left ventricle at the end of diastole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Left ventricular end diastolic pressure (pre - end in the lungs)

A

= Preload = pressure in the lungs or in the right side of the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Chronotrope med (rate chron news)

A

Affects heart RATE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Inotrope med (I NO I contract)

A

Affects contractility of heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Stroke Volume- normal amount- (stroke it for 60 min)

A

Amt of blood ejected from ventricle with each contraction (60—130ml)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sympathetic Receptors: (the alpha is not sympathetic)

A

alpha, beta 1 and beta 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Alpha

(the alpha is smooth and constricts)

A

(vascular smooth muscle) Vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

beta 1

(beta take care of my one heart)

A

(1 heart) (Cardiac tissue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

beta 2 (2 lungs) - and drug ex? YOU know this

A

(2 lungs)
Relaxes vascular smooth muscle, vasodilation of lung tissue = bronchodilators (albuterol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

PCWP or PAWP: (Swanz Ganz Catheter)

(P for preload)

A

Pulmonary cap wedge pressure = Left ventricular end diastolic pressure
Same as preload pressure in the lungs or in the right side of the heart
normal 5-12 mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

SVO2/ScvO2 measurements - used for what? (just think O2)

A

Used to monitor adequacy of tissue oxygenation
CVP and PA catheters can have SVO2/ScvO2 sensors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

MAP:

A

Mean Arterial Pressure
Normal 70-90.
MAP= SBP + 2(DBP) /3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CO Cardiac Output - equation

A

SV X HR = CO
60-130ml X HR
Example: 80 bpm X 100ml = 8L/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Response to Shock - first a drop in what?

A

Initially there is a drop in the MAP
Shock may develop rapidly or gradually depending on the severity of the insult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Compensatory Stage of Shock (major organs)

A

Compensatory measures kick in to maintain perfusion to vital organs

Brain
Heart
lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Compensatory Stage of Shock - which nervous system?

A

Inhibition of Baroreceptor activity:
Stretch receptors in aorta/carotid sinus respond to ↓ MAP and stimulates the vasomotor center of medulla.
This causes activation of the Sympathetic Nervous System

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Sympathetic Nervous System stimulation - cause release of what? and stimulates what?

(epi is sympathetic)

A

Causes release of the catecholamines:
Epinepherine
Norephinepherine
These stimulate
alpha-adrenergic
beta-adrenergic receptors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Alpha-adrenergic receptors (alpha constricts bc he needs more blood in his brain and heart)

A

Cause selective peripheral vasoconstriction
↑ Blood flow to the brain and heart
↓ Blood flow to the kidneys, GI, muscles and skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Beta-adrenergic receptors - Beta 1

(beta get your 1 HR up)

A

Beta 1 = ↑ HR, ↑ contractility
Increases CO = ↑ BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

ADH (Antidiuretic Hormone)

A

ADH is released from the pituitary
ADH ↑’s water resorption by the kidneys
This increases fluid volume and Blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

PROGRESSIVE STAGE of SHOCK

A

MAP continues to fall
Compensatory mechanisms start to fail
Aggressive intervention is necessary to save the patient
Every system in the body is effected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Clinical manifestations of compensatory shock - most reliable signs in compensatory

A

may be subtle and easy to overlook.
Most reliable sign in compensatory stage:
Restlessness, irritability, apprehension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

PROGRESSIVE SHOCK - CNS - behaviors

A

All body systems are affected:
CNS:
Cerebral hypo-perfusion:
anxiety
apprehension
restless.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

PROGRESSIVE SHOCK - Cardiovascular - and what about the pancreas?

(progressive MnD F uck)

A

Cardiovascular :
Release of MDF: myocardial depressant factor released from the pancreas as it become ischemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

PROGRESSIVE SHOCK - Pulmonary

(progressively arfy lungs)

A

Increased pulmonary capillary membrane permeability: leaky lungs
Microemboli
ARDS
ARF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Clinical Manifestations in Irreversible Shock - types of breathing

(irreversible agony)

A

All body systems fail
Pt unconscious
Brady to agonal rhythm
Slow, shallow, irreg Resp (cheyne-stokes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

For adequate tissue perfusion, you need 3 things

A

Circulating blood volume ( BP/ MAP)
Well functioning cardiac pump
Well regulated vascular tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

shock type - VOLUME PROBLEM

A

Hypovolemic Shock

Loss of intravascular volume.
Normally have 4 – 5 liters of blood circulating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

shock type - pump problem

A

Cardiogenic and Obstructive Shock-

Impaired ability of the heart to pump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

shock type - Distributive - what 3 types of shock?

(distribute the san - itation)

A

Vasodilation & Maldistribution of circulating bld volume.
Septic
Anaphylactic
Neurogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

CARDINAL FINDINGS IN ALL SHOCKS - (take the cardinals SHOAM)

A

HYPOTENSION
OLIGURIA: due to blood shunting or intravavascular blood loss
ABNORMAL MENTAL STATUS: agitation, progresses to confusion and delirium and ends in obtundation and coma
Metabolic acidosis: due to anaerobic metabolism and inability of the liver as well as the kidneys to clear lactate.
Skin: for some cool clammy skin due to vasoconstriction. Pt is early distributive shock may have flushed hyperemic skin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are the 2 types of Hypovolemic shock?

A

Hemorrhage induced
Fluid loss induced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

HYPOVOLEMIC SHOCK -15% total blood volume

A

Spontaneous compensation: 15 % of total blood volume ( around 750 ML)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

ABSOLUTE HYPOVOLEMIC SHOCK:
 MANAGEMENT- what position for pt?
(absolute trendelenberg)

A

ABCs
Restore fluid volume:
NS, LR, Plasma
Blood transfusion:
Whole blood/PRBCs, consider FFP if multiple transfusions or high loss, expect hg to go up by 1 for every unit PRBC
Monitor VS, intravascular volume, I&O
Correct the underlying cause
Trendelenburg or modified Trendelenburg is controversial.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

SHOCK CLASSIFICATION: WHEN THE PUMP FAILS - mortality rate

A

CARDIOGENIC SHOCK: occurs when the heart’s diastolic or systolic dysfunction results in reduced cardiac output, leading to decreased tissue perfusion.
It carries a high mortality rate ranging from 50-80%
Mortality rate is 72 – 84%. ( due to multiple MI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

CARDIOGENIC SHOCK - 4 categories (cardio came)

A

CARDIOMYOPATHY
ARRYTHMIAS
MECHANICAL ABNORMALITIES
EXTRA-CARDIAC ABNORMALITIES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

CARDIOGENIC SHOCK:MANAGEMENT

A

ABCs
Monitor cardiac status for arrhythmias and ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

CARDIOGENIC SHOCK:MANAGEMENT - what meds? (don’t want the heart to work too hard)

A

Vasodilators: to decreased preload and afterload
Antidysrhythmic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

NEUROGENIC SHOCK - what vertebre?

A

A hemodynamic consequence of spinal cord injury or disease at or above the level of T5.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

NEUROGENIC SHOCK
DEFINITION

A

Neurogenic shock is very rare
Massive suppression of sympathetic tone
Leads to extreme vasodilation with ↓ BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

ANAPHYLACTIC SHOCK - causes - what is the main thing that is happening?

A

Is caused by antibody-antigen hypersensitivity reaction to a substance(drug, vaccine, food, insect bite, venom) resulting excessive histamine release.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

ANAPHYLACTIC SHOCK - things that cause it - you know this

A

Common antigens:
Food
Diagnostic agents
Biologic agents: blood, insulin
Environmental: pollen, molds
Drugs: antibiotics….
Venom: bees, snakes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

ANAPHYLACTIC SHOCK

A

It can lead to respiratory distress due to laryngeal edema, severe bronchospasm and circulatory failure
Onset of symptoms can be very sudden, chest pain, angioedema , flushed skin, pruritis, wheezing, stridor.
Quick medical intervention is warranted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

ANAPHYLACTIC SHOCK:
 ASSESSMENT - when do symptoms start?

A

Symptoms usually start immediately to 30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

TX of Anaphylaxis

A

Immediately remove the offending agent: stop blood…..
Airway… Airway…Airway…. ? INTUBATION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

SEPTIC SHOCK - what mediators are released?

(septic is necrotic)

A

It is an exaggerated immune/inflammatory body response to an invading microorganism leading to the release of chemical mediators such as : TNF and ILS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

SEPTIC SHOCK - who is susceptable? (ages) - and the big disease

A

Less than 1 or older 68
DM
AIDS
Substance abuse
Malignancies/ malnutrition
Wounds/ trauma/ immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

SEPTIC SHOCK: S&SX - skin?

(septic tank is pink)

A

Fever
Skin pink , warm, flushed, increased temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

SHOCK : TREATMENT MODALITIES

A

Early recognition is key ( nursing assessment)
The Basics: ABCs.
Identify the underlying cause and treat while stabilizing patient:
Cardiogenic: revascularization through PCI or thrombolytics or surgery. Relieve and manage obstruction.
Hypovolemic: stop the hemorrhage
Septic: identify the microorganism and start antibiotics within the first hour.
Neurogenic: stabilize the spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

SHOCK : TREATMENT MODALITIES

A

Fluid resuscitation: volume expansion is corner stone of the therapy ( especially in hypovolemic, septic and anaphylactic shocks).
Drugs therapy
Sympathomimetic drug :
Alpha and Beta adrenergic effect.
Dopamine
Dobutamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Norepinephrine
(Levophed) - TEST question - Norepinephrine - what to do first? or it will cause what?

A

Sympathomimetic/ Vasopressor
Must have enough fluid on board or will cause tissue ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

DOPAMINE - Beta 1 does what? (beta increase contractility)

A

Sympathomimetic / Inotropic
Beta 1: Inotropic = ↑ cardiac contractility,
↑ HR = Chronotrope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

OTHER VASOPRESSORS

A

Neo-Synephrine (Phenylephrine)
Used in Neurogenic shock
Vasopressin
Used when other vaso-constrictors not enough
Epinephrine (Adrenalin)
Anaphylactic Shock
Cardiogenic Shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

NIPRIDE AND NITROGLYCERIN - esp used when? (nifty heart)

A

Used for pts with excessive vasoconstriction and poor tissue perfusion
Especially used in cardiogenic shock.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

MORPHINE SULFATE- what does it dilate? and what does it decrease?

A

(Morphine Sulfate) Narcotic, potent venous dilator that decreases preload, and some arterial dilation to decrease afterload.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Hydrocortisone
Solu-Cortef - used for what types of shock?

(hydrocortisone works, my ass)

A

USED IN:
Anaphylactic Shock if hypotension persists
Septic Shock not responding to fluids and vasopressors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

normal MAP range

A

Normal MAP is 70 to 90 mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

stages of shock (shock needs CPR)

A

Compensatory stage
Progressive stage
Refractory stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Compensatory stage

A

AKA preshock or warm shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Progressive stage

A

the compensatory mechanisms are overwhelmed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Refractory stage

A

irreversible organ damage then death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

beta - Chronotropic drug - EXAMPLE

(chron atop my heart)

A

Chronotropic = ↑ HR (Atropine)

68
Q

beta - Inotropic drug - and examples (D inotropic increases contractility)

A

Inotropic = ↑ contractility (Dopamine, dobutamine)

69
Q

SVO2 (Venous oxygen saturation)

A

SVO2 = mixed venous oxygen saturation of hemoglobin from PA line sensor

70
Q

ScvO2 (think CV)

A

ScvO2 = Central venous oxygen saturation from CVP sensor

71
Q

Mixed arterial and venous blood -
Normal percentage

A

60 – 80%

72
Q

SVO2/ScvO2 = high levels Can indicate (sv02 door)***

A

hypothermia, sepsis (↓ ability of tissue to use O2)

73
Q

SVO2/ScvO2 = = Low levels can indicate (swav is low when his heme and CO are low, but high with O2)***

A

↓ hgb, ↑ O2 demand, ↓ CO (cardiac output)

74
Q

cardiac output - Olympic athletes - how many L a minute?

A

40 L/minute
Normally have 4 – 5 Liters blood in body

75
Q

THREE STAGES OF SHOCK - Compensatory

(compensate for fight or flight)

A

THREE STAGES OF SHOCK:
Compensatory =Fight or flight response

76
Q

THREE STAGES OF SHOCK = Progressive

A

Compensatory mechanisms fail. Aggressive management is necessary

77
Q

Irreversible or Refractory

A

Aggressive management has failed. Death becomes imminent.

78
Q

beta receptors (b for bronchodilation)

A

Beta 2 = Bronchodilation. ↑ breathing

79
Q

shock (K+, acid?)

(shocked by high levels)

A

Hypoxia, acidosis, hyperkalemia, tissue ischemia

80
Q

compensatory stages of shock - BP if pt is supine? HR?

A

If pt supine, Bp may normal or slightly decreased.
Heart rate moderately increased.
Orthostatic hypotension
Respiration increase in depth and rate

81
Q

compensatory stages of shock - urine? pt may complain of what?

A

Urine output decreased and may C/O of thirst.

82
Q

progressive shock - sympathetic nervous system

A

Vasodilation
Cardiac , respiratory and thermal regulator fail

83
Q

progressive shock - cardiovascular
what fails?

A

Myocardial hypo-perfusion
Ventricular failure ensues
Hypotension

84
Q

progressive shock - Hematologic

(just one thing - he’s a progressive dic)

A

DIC

85
Q

progressive shock - GI

(progessive sepsis)

A

hypo-perfused gut and translocation of bacteria causing sepsis.

86
Q

progressive shock - renal

(progressively necrotic kidneys)

A

ATN - Acute tubular necrosis
Other : acidosis

87
Q

irreversible shock - urine and skin

(irrevesibly clammy)

A

Oliguria, anuria
Skin cold and clammy
↓ body temp
Cyanosis
Death

88
Q

Septic

(end the septic)

A

Endotoxins

89
Q

Anaphylactic

A

antibody-antigen reaction

90
Q

Neurogenic

(sympathetic neuro)

A

loss of sympathetic vaso-tone

91
Q

findings in all shock - urine

A

OLIGURIA: due to blood shunting or intravavascular blood loss

92
Q

findings in all shock - neurologic

A

ABNORMAL MENTAL STATUS: agitation, progresses to confusion and delirium and ends in obtundation and coma

93
Q

findings in all shock - acidosis?

A

Metabolic acidosis: due to anaerobic metabolism and inability of the liver as well as the kidneys to clear lactate.

94
Q

findings in all shock - skin
but 1 exception

A

Skin: for some cool clammy skin due to vasoconstriction. Pt is early distributive shock may have flushed hyperemic skin.

95
Q

hypovolemic shock - 15-30% of total blood loss - what is activated?

A

15-30% of total blood loss: SNS activation

96
Q

hypovolemic shock - Over 30% of total blood loss

A

Over 30% of total blood loss: prompt medication intervention is needed for survival

97
Q

when pump fails, treatment

A

TX: Admit CCU, Hemodynamic monitoring, support heart function with meds, IABP….

98
Q

cardiogenic shock - CARDIOMYOPATHY types - 2 of them

A

CARDIOMYOPATHY: AMI, DILATED CARDIOMYOPATHIES

99
Q

cardiogenic shock - ARRYTHMIAS (and the cute one)

A

A.FIB/ FLUTTER, BRADY, ARRYTHMIAS, COMPLETE HEART BLOCK: ALL REDUCE CO. V.FIB: ABOLISHES CO
MECHANICAL

100
Q

cardiogenic shock - MECHANICAL ABNORMALITIES:

A

VALVULAR DEFECTS, SEPTAL DEFECTS/RUPTURE OF PAPILARY MUSCLES.

101
Q

cardiogenic shock = EXTRA-CARDIAC ABNORMALITIES (OBSTRUCTION)

A

PE, TENSION PNEUMO, TAMPONADE, SEVERE PHTN.

102
Q

cardiogenic shock - meds (doubt it’s cardio)

A

Administer sympathomimetics: must have enough fluids on board:
Inotrope + mild vasodilation
Decreases SVR
doboutamine

103
Q

cardiogenic shock - what procedures?

(Angie in shock)

A

Angioplasty, CABG, thrombolytics
IABP
VAD (ventricular assist device)

104
Q

neurogenic shock - what happens?

(neuro pools)

A

The injury results in massive vasodilation compensation due to the loss of SNS vasoconstrictive tone leading to blood pooling in the vessels.

105
Q

hallmark of neurgenic shock? (just 2 things)

A

The hall mark of this shock is Hypotension and Bradycardia (all other types have tachycardia)

106
Q

neurogenic shock -For hypovolemia: treat with fluids and vasopressors: - which meds?

(my neuro neo needs dopamine)

A

For hypovolemia: treat with fluids and vasopressors:
Neosynephrine or dopamine (high doses)

107
Q

anaphalytic shock - what does histamine do?

(his dilates)

A

Histamine results in massive vasodilation and increased capillary permeability which in turn results in leaking of fluids to the interstitial space.

108
Q

anaphalytic shock - symptoms

A

OTHER MANIFESTATIONS INCLUDE:
BRONCHO SPASMS & CONSTRICTION
LARYNGEAL EDEMA
EXCESSIVE MUCUS SECRETION

109
Q

anaphalytic shock - skin, respiratory - what type of breathing, neuro

A

Cutaneous: pruritis, erythema, urticaria (welts), angioedema
Respiratory: lump in throat, dysphasia, wheezing, stridor
Neuro: restlessness, anxiety

110
Q

anaphalytic shock - GI (you guessed right the first time)

A

GI: N/V/D, abd cramping and pain

111
Q

septic shock - hallmark - just vasodilation - and what type of bacteria?

A

Hall mark: massive vasodilation and maldistribution of blood flow to the tissue.
Gram negative bacteria is responsible for half of the septic shock cases.
Carries a high mortality rate: 24-41% of patients die within one month of the onset of septic shock

112
Q

septic shock - pulmonary? (v/q in the septic tank)

A

Pulmonary vasoconstriction: V/Q mismatch: hypoxemia.
Treatment:
Indentify the infection: blood/urine/wound culture
Initiate ABTX
Surgical intervention: I&D
Temp control
Aggressive fluid resuscitation

113
Q

shock treatment - before you give Norepinephrine, do what?

A

make sure you have adequate circulating volume before administration.

114
Q

Norepinephrine - alpha - test question- what do you need to do before you give it?

A

Alpha (potent vasoconstrictor)
Beta Adrenergic
Inotropic (muscles)
Dilates Coronary arteries

115
Q

Norepinephrine - test question - how much?

A

2 to 20 mcg/min IV infusion

116
Q

dopamine - Alpha does what to the body?

(the alpha constricts me)

A

Alpha: peripheral vasoconstriction

117
Q

dopamine - small doses can cause

(dopamine has small kidneys)

A

Small doses (1 – 4 mcg/kg) cause ↑ renal perfusion

118
Q

dopamine - small, moderate, and high doses?

A

Small doses (1 – 4 mcg/kg) cause ↑ renal perfusion
Moderate doses (5 - 10mcg/kg) causes heart squeeze (↑ heart contractility) High doses (10 – 20mcg/kg) causes total body squeeze (peripheral vaso-constriction)

119
Q

dopamine - high doses do what? (you know this)

A

High doses (10 – 20mcg/kg) causes total body squeeze (peripheral vaso-constriction)

120
Q

nitroglycerin - goal of MAP

A

Goal to maintain MAP 70- 80 mmhg (monitor closely so that IV fluid can be increased or medication decreased.

121
Q

Nipride - how to store it

A

Nipride:
Administer only with D5W+ protect from light (foil wrap)

122
Q

Nipride - warning

(pride the cyanide)

A

Thiocyanate toxicity and cyanide poisoning if used more than 72 hrs

123
Q

Nipride - adminster how?

(pride can’t do PVC)

A

NTG IV:
Must administer with non-PVC tubing and glass bottle to maintain potency.

124
Q

Nipride - monitor for what after you give it?

(pride is tachy)

A

Observe for reflex tachycardia.

125
Q

cardiogenic shock - when can you use Dobutamine? (doubt you can use with severe htn)

A

Used if there is no profound hypotension - systolic should be above 90

126
Q

anaphalytic shock - GU

(ana is incontinent)

A

GU: incontinence

127
Q

anaphalytic shock - heart? (same)

A

CV: hypotension, tachycardia

128
Q

hypovolemic shock - Hemorrhage induced

A

causes include blunt or penetrating trauma , upper and lower GI bleed, fractures

129
Q

hypovolemic shock - Fluid loss induced

A

causes include: diarrhea, vomiting, heat stroke, burns,, and third spacing ( relative hypovolemic shock)

130
Q

PCWP or PAWP: (Swanz Ganz Catheter) - helps determine

A

lung from cardiac issues

131
Q

arterial (art) line

A

most accurate way to measure bp

132
Q

compensatory stage - RAS

A

decreased perfusion to kidneys - renin released from kidneys-
angiotensinogen from liver converted to angotensin I by renin
angotensin I joins with ACE from lungs to form angotensin II
angotensin II causes adrenal cortex to release aldosterone -
pituatary releases ADH

133
Q

absolute shock from

(absolute hemmorage)

A

hemmorages

134
Q

hypovolemic shock

A

loss of fluid

135
Q

relative shock (third relative)

A

burns, third spacing, massive vasodilation

136
Q

sepsis - give antibotics how quickly?

A

within the first hour

137
Q

norephenephrine is what type of drug - think veins

A

vasopressor

138
Q

dopamine is what type of drug?

A

inotropic (hr goes up w/ dopamine)

139
Q

dopamine used for what type of shock?

A

cardiogenic

140
Q

HR goes up for all shocks except

A

neurogenic

141
Q

pulse pressure for all shocks?

A

down

142
Q

bp for all shocks?

A

down

143
Q

tx of anaphalyxis - Epinephrine

A

Epinephrine 1:1000 → 0.3 – 0.5mg SQ/IM every 5 – 10 min… then 1 – 4 mcg/min IV of 1:10,000 solution for shock. (can also be given endotracheal)

144
Q

tx of anaphalyxis - fluids

A

Fluids (NS, LR)

145
Q

tx of anaphalyxis - Diphenhydramine - what does it do?

A

Diphenhydramine (H1 blocker) 25 -50mg PO/IM/IV up to 100 mg

146
Q

tx of anaphalyxis - Pepcid

A

Pepcid (H2 Blocker) 20mg IVPB (esp w/ Urticaria)

147
Q

tx of anaphalyxis - Solumedrol

A

Solumedrol 40 – 250mg IVPB: reduces capillary permeability and chemical mediators
Albuterol nebulizer tx

148
Q

alpha med - ex. (Neo is an alpha)

A

Neosynephrine

149
Q

neurogenic shock - what meds for bradycardia?

A

Bradycardia usually present: Tx symptomatically :Atropine
Hypoxemia : chest wall paralysis : may need mechanical vent.

150
Q

neurogenic shock - what about blood pooling? meds?

A

Prevent DVT: from pooling of Blood: SCD, anticoagulation

151
Q

dopamine doses - small

A

(1 – 4 mcg/kg)

152
Q

dopamine doses - moderate

A

(5 – 10 mcg/kg)

153
Q

dopamine doses - high

A

(10 – 20mcwg/kg)

154
Q

when would skin be flushed hyperemic? Only one time

A

Pt in early distributive shock - so SAN

155
Q

V/Q mismatch - which type of shock?

(glen is not septic)

A

septic shock

156
Q

dobutamine - what type of drug?

A

doubt I NO it

157
Q

dopamine - type of drug

A

dope, I NO

158
Q

neurogenic shock - HR

(the neurosurgeon doesn’t stress)

A

decreased - think PNS only working

159
Q

atropine for which shock?

A

neurogenic

160
Q

complaining of thirst? which stage of shock

A

compensatory

161
Q

what stage of shock for ARDS and ARF?

A

progressive

162
Q

trendeleberg for what type of shock?

A

hypovolemic

163
Q

what drug class do you need enough fluid before administering?

A

sympathomemetics (ie norepinephrine)

164
Q

flushed warm skin - what type of shock?

(the septic tank is warm)

A

septic shock

165
Q

what stage is SNS activated?

A

compensatory

XIO (372 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions