Test 1 🏁 > Shock > Flashcards

Shock Flashcards

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1
Q

shock (decreased tissue perfusion):

A
  • a syndrome of hypoperfusion and hypotension that leads to inadequate oxygen delivery to the tissues and impaired cellular metabolism that ultimately results in organ dysfunction/failure.
    — A state of hypoperfusion/hypotension (low blood pressure)
    — Oxygen does not get to the tissues (causing global hypoxia)
    — Cells don’t function property (they shift from aerobic metabolism into anaerobic metabolism when they don’t get enough oxygen). Anaerobic metabolism results in the production of lactate and ultimately leads to metabolic acidosis.
    — Organs start to fail
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2
Q

TYPES OF SHOCK

A
  • Hypovolemic shock
  • Distributive shock
  • Cardiogenic shock (weak heart)
  • Obstructive shock(impeding blood flow)
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3
Q

Hypovolemic shock:

A
  • occurs when the body loses too much fluid through bleeding, vomiting, diarrhea, burns, polyuria, and third spacing
  • Resulting in decreased Venus return to the heart, which then leads to decreased cardiac output and hypoperfusion
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4
Q

Hypovolemic shock: S/S

A
  • decreased cardiac output
  • Increased SVR (normal = 900-1300)
  • Decreased CVP (normal = 2-6 mmHg)
  • Cool skin, delayed Cap refill
  • Low BP, low urine output
  • Tachycardia
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5
Q

Hypovolemic shock: Treatment

A
  • Administer blood/fluids
  • treat the source of the loss (stop bleeding/vomiting)
  • Insure two large bore IVs
  • Monitor patient for improvements in HR, BP and urine output
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6
Q

Distributive shock:

A

decreased peripheral vascular resistance

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7
Q

Types of Distributive shock

A
  • Septic shock (infection)
  • Anaphylactic shock (allergic)
  • Neurogenic shock (neuro/ Spinal trauma)
  • Endocrine disorders
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8
Q

Septic shock (infection)

A

occurs in cases of severe infection that trigger a complex series of events leading to massive vasodilation and increased capillary permeability. The result is hypotension and global tissue hypoxia.

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9
Q

Septic shock (infection) S/S:

A
  • Elevated temperature above 38 (100.4) (elderly/young children/immunocompromised, May have low temps below 36)
  • Tachycardia
  • tachypnea
  • Elevate WBC/ very low WBC
  • Decreased CVP
  • Decreased SVR
  • Hypotension, despite fluid resuscitation
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10
Q

Septic shock (infection): treatment

A
  • Fluids
  • Vasopressors
    — Levophed: 1st
    — vasopressin: 2nd
    — Epinephrine/ phenylephrin: 3rd (to increase SVR/blood pressure)
  • Antibiotics
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11
Q

Anaphylactic shock (allergic):

A

occurs with massive allergic reactions. Large amounts of vasoactive substances are released from mast cells, causing systemic vasodilation and increased capillary permeability. This result is a sudden and global drop in blood pressure. The most acute problem your patient has is the respiratory compromise that accompanies the reaction

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12
Q

Anaphylactic shock (allergic): S/S

A
  • Hypotension
  • Tachycardia
  • Wheezes, hives (urticaria), itching (pruritis), cutaneous flushing
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13
Q

Anaphylactic shock (allergic): Treatment

A
  • Maintain airway
  • Epinephrine
  • Fluids to support blood pressure
  • Histamine blockers
  • Bronchodilators
  • Steroids to reduce airway inflammation
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14
Q

Neurogenic shock (neuro/ Spinal trauma):

A

occurs in patients with spinal cord injury, and is due to a loss of sympathetic innervation. It’s more likely to present in patients with an injury at C3–C5 level

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15
Q

Neurogenic shock (neuro/ Spinal trauma): S/S

A
  • Massive vasodilation and decreased Venous return leading to decreased SVR, CVP, CO and PAWP
  • Decreased heart rate
  • Pooling up blood vessels
  • Warm,flushed skin
  • Hypotension
  • Wide pulse pressure
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16
Q

Neurogenic shock (neuro/ Spinal trauma): Treatment

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A
  • Stabilize the spine
  • Backboard/ C- spine collar
  • IV. Fluids to help restore preload.
  • Vasopressors
  • Treat bradycardia as needed
17
Q

Cardiogenic shock (weak heart)

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A

occurs when the heart has failed. This can be due to a massive MI, a valve problem, arrhythmias, or cardiomyopathy.

18
Q

Cardiogenic shock (weak heart):
Left sided heart failure s/s:

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A
  • Pulmonary congestion
  • Dyspnea
  • Coarse lung sounds
  • Distant heart sounds
  • Elevated PAWP
  • Low cardiac output
19
Q

Cardiogenic shock (weak heart):
Right sided heart failure s/s:

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A
  • Systemic venous congestion and peripheral edema
  • Elevated CVP
  • Jugular Venous distension (JVD)
  • normal or low PAWP
20
Q

Cardiogenic shock (weak heart): Treatment

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A
  • Reduce myocardial oxygen demand while improving oxygen supply
  • Give fluids (unless patient is fluid overloaded)
  • Inotropes to improve cardiac output
    — Dobutamine or dopamine
    — Milrinone to also decrease afterload (has vasodilators effects)
  • Diuretics to remove excess fluid
  • Vasopressors to increase BP via vasoconstriction
  • Very sick patients may need IABP
  • MI= revascularization
21
Q

Obstructive shock(impeding blood flow)

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A

occurs due to a mechanical barrier, such as cardiac tamponade, a pulmonary embolism, tumors, or a tension pneumothorax

22
Q

Obstructive shock(impeding blood flow): PE s/s:

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A
  • SOB, increased WOB
  • tachypnea
  • Decreased O2 sats
  • Feelings of impending doom
  • Chest pain
  • Cough with or without hemoptysis
  • Pulsus paradoxus (SBP increases on expiration, drops on inspiration by 10 mmHg or more)
23
Q

Obstructive shock(impeding blood flow): Pneumothorax s/s:

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A
  • Drop in BP due to decreased Venous return
  • Increased SOB and WOB; drop in O2 sats
  • Displaced trachea
  • Decreased or absent lungs sound on affected side
24
Q

Obstructive shock(impeding blood flow):
Cardiac tamponade s/s:

Study These Flashcards
A
  • Beck’s Triad: elevated CVP, decreased BP, muffled heart tones
  • PEA (pulseless electrical activity)
  • pulsus paradoxus
25
Obstructive shock(impeding blood flow): Treatment
- Tension pneumothorax: needle, decompression/chest tube - Cardiac tamponade: pericardiocentesis - Pulmonary embolism: heparin, thrombolytic therapy and/or an IVC filter
26
General Shock Assessment:
- Heart rate - Respiratory rate and effort - Blood pressure - Hemodynamics - Mentation - Urinary output - Skin - MAP= (2x DBP + SBP)/ 3= MAP - Serum lactic acid - CPP= ICP and MAP
27
Lactic Acid:
- normal: <1 mmol /L - lactic acidosis: >4 mmol/L - liver typically converts lactic acid into pyruvic acid (pyruvic acid turn into glucose via gluconeogenesis) - liver cant keep up=lactic acid builds up= lactic acidosis
28
Stages of shock:
- Initial shock - Compensatory shock - Progressive shock - Refractory shock (irreversible)
29
Initial shock:
- cell switches from aerobic (with O2) to anaerobic metabolism (without O2)= lactic acid — during this phase of shock, the body is typically compensating for the hypoperfusion/ hypotension so signs can be pretty easy to miss
30
Initial shock: S/S
(subtle) - Mildly tachycardic - Mildly tachypneic - Blood pressure usually normal (possible downward trend) - Urine output normal - Skin cool (warm in distributive shock. I.e. septic shock) - Anxiety possible
31
Compensatory shock: (reversible)
- the body really kicks into high gear to compensate at this point, and this is the stage where you most likely to catch that your patient is in trouble — The decreased tissue perfusion triggers and endocrine response triggers the SNS to release epinephrine, and norepinephrine to increase BP, Hr, Contractility it increase perfusion —- body uses a biochemical, Neural and hormonal team (vasoconstriction) to fight effects of anaerobic metabolism - blood is shunted away from non vital organs to vital organs (heart/ brain)
32
Compensatory shock: (reversible): S/S
- Tachycardia - Vasoconstriction; body attempts to increase BP - tachypnea - decreased O2; VQ mismatch - increased glucose - Decreased urinary output - Decreased bowel sounds; risk for paralytic ileus - Delayed capillary refill - Diaphysis possible - skin cool, moist pale
33
Progressive shock:
- the compensatory mechanisms are starting to fail, and hemostasis cannot be maintained - At this stage, the body systems are failing and progressing to multiple organ dysfunction (MODS) - no more compensation at this point
34
Progressive shock: s/s: decreased CO
- Hypotension - MAP <60 - massive edema; Increased capillary permeability - Altered LOC (confused, lethargic, slow speech, agitated, decreased reaction) - tachypnea/ increased WOB - Lactic acidosis - Progressive tachycardia - Progressive decreased skin perfusion - Acute respiratory distress syndrome (ARDS) - Dysrhythmias/ MI - renal failure - Progressive decreased urinary output - Increased BUN/Cr - Metabolic acidosis - GI Bleeding ulcers - liver failure; poor clotting factors - increased ammonia/ bilirubin - Disseminated Intravascular Coagulation (DIC): micro clots for through out the body= decreased platelets/ clotting factors — = easily bleed for any open part of the body (eyes, nose, small iv puncture site)
35
Refractory shock (irreversible)
Is typically not responsive to treatments
36
Refractory shock (irreversible): S/S
- Decreased CRP - increased waste in blood - progressive renal failure - DIC - decreased cardiac activity - Decreased LOC - Urine output very low (usually 5 mL/ hr) - High respiratory rate (usually above 35) - Very poor skin perfusion (possible mottling) - Blood pressure low, despite fluids and vasoactive medication - Low O2 sats, despite oxygen - death
37
General treatment for shock:
- Optimize oxygen delivery - Reduce oxygen consumption - Decrease WOB (intubate, or give oxygen) - Treat pain/anxiety - Keep patient normothermic - Decrease oxygen demand with mechanical ventilation, sedation, or neuromuscular blocking agents

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