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Module 7 > Shock > Flashcards

Shock Flashcards

1
Q

Stages of shock

A

Initial
Compensatory
Progressive
Refractory

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2
Q

What should we watch when it comes to shock?

A

Watching for vitals , checking for trends and progression
Knowing that it can go back ward n forward

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3
Q

Initial stage

A

No visible changes
Changes occurring at cellular level

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4
Q

Compensatory

A

Body compensating to restore tissue perfusion and oxygenation

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5
Q

Refractory

A

Total body failure

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6
Q

Shock definition

A

Inadequate tissue perfusion
Widespread inadequate oxygen supply to provide nutrients for cellular function

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7
Q

Class 1 shock of hypovolemia is in the initial stage of shock.. what is the blood loss up to ?

A

15%

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8
Q

Initial stage clinical finding

A

Subtle or no clinical manifestations
Hypoxia
( production of pyruvic and lactic acid)

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9
Q

Compensatory clinical findings

A

Confusion
Hypotension
Tachy cardia
Tachypnea
Cool clam
Urinary output decrease
Respiratory alkalosis

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10
Q

For each unit of blood loss is a

A

3% drop of the hematocrit

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11
Q

Skin in a septic shock pt

A

Warm and flushed

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12
Q

Skin in a neurogenic pt

A

Normothermic

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13
Q

In the compensatory stage there is a clas 2 shock due to hypovolemia.. what is the blood loss

A

15-30%

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14
Q

Why is urine output decreased in compensatory

A

Due to compensatory .. the kidneys might want to hang on to what it can

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15
Q

Progressive clinical findings

A

Lethargic and confused
Severe hypotension < 90/60
Tachycardic>150
Tachypneic ,shallow , crackles
Pao2<80mmhg
Paco2 >45mmhg
Mottling,petechia, caprefill >4
Anuria
Metabolic acidosis

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16
Q

GCS at the progressive stage

A

9-12

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17
Q

Pao2 at progressive

A

<80

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18
Q

Paco2 progressive

A

> 45 mmHg

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19
Q

Classic 3 shock hypovolemic in the progressive stage

A

Blood loss 30-40%

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20
Q

Intake goal in critical care

A

1/2/kg/hr

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21
Q

What is contraindicated in a shock pt

A

Trendelenburg position .. increases icp

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22
Q

What is important for hypovolemic pt

A

Get o2
Then fluids

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23
Q

Refractory clinical finding

A

Coma
Hypotension-need vasoconstrictors
Dysrhythmias- (possible MI)
Pulmonary edema , bronchconstriction (respfailure)
Hepatic failure
Renal failure
Tissue ischemia, necrosis
Anasarca
Profound metabolic acidosis

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24
Q

What can we do to treat hypotension in progressive stage?

A

Raising the legs, compressor, vasopressor

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25
Q

GCS for pt in refractory stage

A

8 or less

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26
Q

Dysrhythmias in refractory

A

Asystole
Check pulse
PVC then vtach

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27
Q

Bronchoconstriction

A

Anaphylactic reaction , obstructive, PE

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28
Q

how would you know hepatic and renal failure

A

Jaundice, decrease urinary output , BUN, creatine, ast, alt

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29
Q

What happens when a person is on epinephrine for too long

A

Necrosis

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30
Q

What can vasoconstrictors cause

A

Lack of cap refill

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31
Q

Pump issue in a shock

A

Cardiogenic

32
Q

Volume issue ins hock

A

Hypovolemic

33
Q

Pipe issue in shock

A

Distributive
Obstructive

34
Q

Absolute hypovolemia shock

A

Hemorrhage, bleeding from trauma, surgery, GI bleed, ruptured aortic aneurysm

& non hemorrhagic
Vomiting , diarrhea, excessive diuresis , DI

35
Q

Relative hypovolemic shock

A

Fluid shift that stays internal
Extravascular or intracavity
Such as acites , burn injury, peritonitis , bowel obstruction

36
Q

Cues for hypovolemic a shock

A

Confused, vascular resistance increased, hypotensive, oliguria ,normothermic

37
Q

How much fluid resuscitate for hypovolemia

A

Every 1 unit of blood loss 3 units of fluid for

38
Q

How do we position a hypovolemic pt

A

Lay them flat ..elevate the legs

39
Q

S/s of cardiogenic shock

A

JVD, pulmonary edema( fluid clear ,bubbly,frothy ) , muffled heart sounds

40
Q

What can an injury when the chest pressed against the steering wheel cause?

A

Cardiogenic shock
Bruising or stamp mark

41
Q

Treatment for cardiogenic shock

A

O2
Position of comfort
Diuretics
Lower bp
Nasopresser , metropolol
Watch I&O
Minimize fluids
Balloon pump & VAD

42
Q

Distributive shock (pipes)

A

Anaphylactic
Neurogenic
Septic

43
Q

What should we be careful when it comes to latex allergies

A

Be cautious what you insert like Foley catheters , gloves etc

44
Q

Signs of MODS ( multiple organ dys system )
Multiple organ failure

A

BUN and creatine high with low urine output = kidney

Higher we go up on Fio2 and paO2 goes down shows that the lungs are failing

45
Q

At what stage is MODS considered?

A

Refractory

46
Q

What can we use when a pt has bradycardia for neurogenic shock

A

Atropine(short term)

47
Q

Obstructive shock causes

A

Pulmonary embolism
Pericardial tamponade
Hemopneumothorax
Tension pneumothorax

48
Q

What is tension pneumothorax caused by

49
Q

Physical assessment or obstructive shock

A

Signs of organ perfusion

50
Q

What does someone with pulmonary embolism present

A

Chest pain , dont hear anything abnormal in lungs or heart

51
Q

What would we hear in pneumothorax

A

Decreased breath sounds on the side it is collapsed

52
Q

What would you hear with hemopneumothorax

A

Wont hear anything on side it is ad or it will be decreased

That’s why it is important to listen to all areas of the lungs

53
Q

How to calculate pulse pressure

A

Systolic pressure - diastolic blood pressure

54
Q

Normal pulse pressure

A

Normal 40-60 mmHg

55
Q

Narrow pulse pressure

A

<40 mmHg

Early indication of shock than drop in systolic BP

56
Q

Widened pulse pressure

A

> 80mmhg
Septic pt

57
Q

Sustained intracranial pressure

A

above 20 mmHg
Widened pulse

58
Q

Labs for obstructive shock

A

ABGs respiratory alkalosis to respiratory acidosis
Lactic acid- severe o2 deprivation
CBC - H&H, infection

59
Q

When do we expand volume

A

Septic , hypovolemic, anaphylactic

60
Q

How can we expand the volume

A

Crystaloids (NS , lactated ringers)
Colloid ( albumin, RBC , )

61
Q

Albumin

A

Volume expander
Large protein that pulls volume from out to interstitial vascular space

62
Q

What is important to note about products such as RBC , plasma, albumin when administering

A

Assess for anaphylactic reactions and over load

63
Q

Why do you want to give diuretic with products such as albumin or RBC

A

To help regulate , we dont want to drown them

64
Q

When administering RBCs to patient we want to keep in mind that RBCs do not clot … what intervention should we do in regards to this?

A

Replace clotting factors
Cryo

65
Q

Favorite vasopressor

A

Norepinephrine

66
Q

Volume expansion

A

Septic , hemorrhagic , hypovolemic

67
Q

Fluid responsiveness determined by

A

Vitals
Cerebral, abdominal pressure
Cap refill
Skin temp
Urine output

68
Q

Vasopressor drugs

A

Norepi
Antidiuretic
Dopamine
Phenylehrine

69
Q

Vasodialator

A

Nitroglycerin
Nitroprusside

70
Q

Goal of vasodilator

A

Maintain or achieve MAP greater than 65 mmHg
Decrease the after load

71
Q

Stress ulcer prophylaxis

A

Pantoprazole

72
Q

VTE prophylaxis

A

Heparin , ENOXAPARIN

73
Q

Side effects of gluccocorticods

A

High blood sugar , trouble sleeping

74
Q

How to assess weight

A

One sheet and no more than two pillows

75
Q

When to start tpn

A

Within first 24 hours

76
Q

Important to note about the vasopressor dopamine

A

It increases HR , hardens the heart - watch dosing and keep up with the trends of the HR

77
Q

Phenylephrine vasopresser

A

Over the counter , constricter

Module 7 (24 decks)

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