Shock Flashcards
Shock stages
-compensatory
-progressive
-irreversible
Compensatory Shock stage
-multi system response to decreased tissue perfusion
-the body can compensate for changes
-if the cause is corrected, then minimal residual effects
-pt is experiencing fight/flight = high HR, normal BP
-beta blockers might prevent high heart rate
Progressive Shock stage
-when compensator mechanisms fail
-cardiac profoundly affected, decreased BP and CO, increased capillary permeability, leaky vessels
-Goals: prevent MODS (e.g., add pressors
Irreversible Shock stage
-profound hypotension & hypoxemia
-failure of organs r/t waste products (lactate, urea)
-recovery unlikely
early signs
-pallor
-tachypnea
-confusion
-tachycardia
late signs
-cold, moist skin
-weak, thready pulse
-anuria
-hypotension
-metabilic acidosis
Vasopressors
increase cardiac output
-multiple side effects
-different pressors for different types of shock
Hypovolemic Shock types
-External: fluid losses (fluid lost from the body completely)
-external causes: stabbing, hemorrhage, diarrhea, vomiting
-Internal: fluid shifts (third spacing)
-internal causes: ascites
Hypovolemic Shock causes
-hemorrhage
-GI loss
-Fistula drainage
-DI
-diuresis
-burns
-ascites
-internal bleeding
Hypovolemic Shock presentation
-tachypnea
-hypotension
-tachycardia
-peripheral hypoperfusion
-decreased urine output
-mental status changes
Hypovolemic Shock patho
-decreased venous return to heart leads to decreased CO
Hypovolemic Shock treatment
-Rapid fluid replacement
-correct the cause
-safety of blood transfusion
-rapid infuser
rapid fluid replacement in Hypovolemic Shock
-2 large bore IV lines (14-16g), IO, or central venous catheter
-restore fluids (Blood, IVF)
Cardiogenic Shock types
-coronary (more common, most MI patients)
-noncoronary (conditions that stress the myocardium)
Cardiogenic Shock presentation
-tachypnea
-crackles
-hypotension
-tachycardia
-peripheral hypoperfusion
-decreased urine output
-mental status changes
Cardiogenic Shock causes
-MI (number one cause)
-cardiomyopathy
-cardiac tamponade
-blunt cardiac injury
-hypoxemia
-acidosis
-tension pneumothorax
Cardiogenic Shock patho
decreased cardiac output
-impaired tissue perfusion
-weakens heart and ability to pump
Cardiogenic Shock treatment
GOAL: correct underlying cause
-cardiac Cath/fibrinolytics/CABG/IABP/VAD
-2-6L NC, SpO2 goal: 95%
-morphine for pain control
-use A-line or PA Cath for hemodynamic monitoring
-Labs: BNP, cardiac enzymes, lactate
-fluids: monitor for overload
Cardiogenic Shock medications
-drug of choice: Dobutamine (inotropic) to increase contractibility
-nitrates
-dopamine: increase HR & contractility
-pressors
-antiarrhythmic meds
Distributive shock
-intravascular volume pools in peripheral blood vessels
-leads to relative hypovolemia b/c not enough blood returns to the heart –> inadequate tissue perfusion
-septic, neurogenic, anaphylactic
Septic shock
-persistent hypotension despite adequate fluid resuscitation
-requires vasopressors
-inadequate perfusion resulting in tissue hypoxia
Septic shock major pathophysiologic effects
-vasodilation
-misdistribution of blood flow
-myocardial depression/decreased cardiac output
Septic shock treatment
-aggressive fluid resuscitation (30mg/kg)
-blood cultures before antibiotics
-Vasopressors for BP (norepinephrine is the 1st line)
-monitor temp, glucose, nutritional therapy
-stress ulcer prophylaxis
Neurogenic shock manifestations
-hypotension & bradycardia
-difficulty regulation body temp
what type of SCI does Neurogenic shock typically occur in?
-cervical or high thoracic injury (T6 & above)
SCI in T6 or above….
leads to massive vasodilation, which leads to not compensated due to loss off SNS vasoconstrictor tone, leads to pooling of blood in vessels, tissues, hypoperfusion
Neurogenic shock treatment
-maintain airway
-VTE prophylaxis
-cautious administration of fluids
-Vasopressors
-atropine
-minimize spinal cord trauma with stabilization
-monitor temperature
Anaphylactic shock
-life threatening response to allergen
-massive vasodilation
-increased capillary permeability
-leads to respiratory distress from laryngeal edema or bronchospasm
-sudden onset: wheezing, swelling, incontinence, flushing, purities, angioedema
Anaphylactic shock treatment
-maintain airway
-aggressive fluid resuscitation
-medications: Epi IM, antihistamines, H2 blockers, bronchodilators, corticosteroids
-avoidance of known allergies
Prioritizing Interventions
-ABCs
-mental status assessments
I/Os
-body temp/skin changes
-evidence of adequate tissue perfusion
-restoration of normal BP
recovery of organ function
