SHOCK Flashcards
BASIC CARDIAC PHYSIOLOGY
volume of blood that is pumped by the heart per minute
-> amount of blood being supplied by the heart per minute
cardiac output
an abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation
SHOCK
BASIC CARDIAC PHYSIOLOGY
determined by preload, myocardial contractility, afterload
-> amount of blood being pumped out per heartbeat
stroke volume
BASIC CARDIAC PHYSIOLOGY
initial amount of blood present in the right atrium
volume of venous blood return to the left and right sides of the heart
preload
BASIC CARDIAC PHYSIOLOGY
is the pump that drives the system
if there will be an opposing resistance or force hindering the outflow of the blood from the heart
afterload
BLOOD LOSS PATHOPHYSIOLOGY
progressive ______ of cutaneous, muscular, and visceral circulation to preserve blood flow to the kidneys, heart, and brain
vasoconstriction
BLOOD LOSS PATHOPHYSIOLOGY
___________ is the earliest measurable circulatory sign of shock
tachycardia
TYPES OF SHOCK
_________ is the most common cause of shock
hemorrhage
TYPES OF SHOCK
HEMORRHAGIC SHOCK: CLASS
exemplified by the condition of an individual who has donated 1 unit of blood
compensatory mechanism will restore blood vol. within 24 hours, usually without the need of blood transfusion
Class 1 Hemorrhage
<15%
TYPES OF SHOCK
HEMORRHAGIC SHOCK: CLASS
uncomplicated hemorrhage for which crystalloid fluid resuscitation is required
tachycardia, tachypnea, and decreased pulse pressure
Class 2 Hemorrhage
(15-30%)
TYPES OF SHOCK
HEMORRHAGIC SHOCK: CLASS
complicated hemorrhagic state in which at least crystalloid infusion is required and most will need blood products to reverse shock state
Class 3 Hemorrhage
(>40%)
NON-HEMORRHAGIC SHOCK
suspect a blunt cardiac injury when the mechanism of injury to the thorax involves rapid deceleration
myocardial dysfunction can be caused by blunt cardiac injury, cardiac tamponade, an air embolus or MI
cardiogenic shock
NON-HEMORRHAGIC SHOCK
commonly seen in patients with penetrating thoracic injury
Beck’s triad
cardiac tamponade
NON-HEMORRHAGIC SHOCK
can also present similar manifestations of cardiac tamponade - distended neck veins and hypotension
develops when air enters the pleural space but a flap valve mechanism prevents its escape
tension pneumothorax
NON-HEMORRHAGIC SHOCK
brainstem injuries
cervical and upper thoracic spinal cord injuries can cause hypotension —> loss of sympathetic tone
neurogenic shock
NON-HEMORRHAGIC SHOCK
occur when a patient’s arrival at the ED is delayed for several hours
patients with early septic shock can have a normal circulating volume, modest tachycardia, warm skin, near normal SBP and a wide pulse pressure
septic shock
BLOOD REPLACEMENT
complete crossmatching process approximately 1 hour
if crossmatched blood is unavailable, type O PRBC are indicated for exsanguinating hemorrhage
crossmatched type specific, and type O blood
NON-HEMORRHAGIC SHOCK
heat fluid to 39C before infusion
accomplished by storing crystalloids in a warmer or infusing them through intravenous fluid warmers
prevent hypothermia
NON-HEMORRHAGIC SHOCK
> 10 of PRBC within the 1st 24 hours of admission or more than 4 units in 1 hour
Massive transfusion
NON-HEMORRHAGIC SHOCK
consider collection of shed blood for AT in patients with massive hemothorax
blood generally has only low levels of coagulation factors so plasma and platelets may still be needed
Autotransfusion
NON-HEMORRHAGIC SHOCK
severe injury and hemorrhage result in consumption of coagulation factors and early coagulopathy
COAGULOPATHY
BLOOD PRODUCTS
contains all coagulation factors
lasts up to 1 yr. frozen
fresh frozen plasma
BLOOD PRODUCTS
refrigerated up to 42 days
usually for HgB less than or equal 7 g/dL
Packed RBCs
BLOOD PRODUCTS
precipitate of thawed FFP
high factor Factor VIII (antihemophilic factor) and fibrinogen
cryroprecipitate
BLOOD PRODUCTS
must be agitated to prevent clumps
room temp up to 5 days
Platelets
