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331 Quiz 2 > Shock > Flashcards

Shock Flashcards

1
Q

what will happen to O2 supply and demand during shock

A
  • decreased supply and increased demand
  • leads to cell death and end organ failure
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2
Q

what is cardiogenic shock

A
  • state when the heart can no longer pump blood forward
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3
Q

left side disfunction of ventricles for cariogenic shock show

A
  • pulmonary edema
  • increased preload and after load
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4
Q

right side dysfunction ventricles

A
  • JVD distention
  • peripheral edema
  • increased preload and after load
  • decreased CO and SV
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5
Q

systolic dysfunction

A
  • ineffective forward movement of blood
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6
Q

diastolic dysfunction

A
  • ineffective filling
  • increased pulmonary pressures (edema)
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7
Q

hypoxemia is shown by

A

lowered PaO2 levels

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8
Q

PaO2 levels are:

A

80-100
- after age 60 you minus 1

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9
Q

pH levels are:

A
  • 7.35-7.45 (7.4 being median)
  • if within normal limits if pH is below 7.4 then its more acidic and above more basic
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10
Q

PaCO2 levels are:

A
  • 35-45
  • under 35 is basic and over 45 is acidic
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11
Q

what can cause respiratory acidosis

A
  • COPD, over sedation, head trauma
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12
Q

what can cause respiratory alkalosis

A
  • hypoxia, anxiety, PE
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13
Q

Normal HCO3 levels

A
  • 22-26
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14
Q

what causes metabolic acidosis

A
  • ketoacidosis
  • lactic acid
  • renal failure
  • diarrhea
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15
Q

what causes metabolic alkalosis

A
  • fluid loss from GI
  • diuretic therapy
  • severe hypokalemia (HCO3 gets reabsorbed in kidneys)
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16
Q

common signs and symptoms of cariogenic shock

A
  • tachypnea
  • hypotension
  • high HR
  • decreased urine output
  • chest pain (angina)
  • eat thready pulse
  • pale, cool skin
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17
Q

lab results to look for when cariogenic shock starts

A
  • troponin increases
  • BNP and BUN increases
  • decreased urine Na
  • decreased PaCO2 (alkalosis)
18
Q

signs and symptoms when left ventricle fails and we see pulmonary edema:

A
  • crackles
  • hypoxemia (low PaO2)
  • hear S3 and S4
  • JVD
  • dysrhythmias
19
Q

signs and symptoms for what happens when compensatory mechanism no longer work during cardiogenic shock (7)

A
  • increased HR
  • dysrythmias
  • chest pain
  • respiratory distress
  • respiratory and metabolic acidosis and hypoxemia (increased PaCO2, decreased PaO2 and HCO3)
  • renal failure (increased BUN and creation)
  • decreased LOC (drop in cerebral perfusion pressure)
20
Q

pharmacological management for cariogenic shock:

A
  • inotropic agents to increase contractility (dobutamine)
  • vasopressors to increase BP (norepinephrine)
  • diuretics to decrease preload (lasix)
  • antidysrhythmics (amiodarone)
21
Q

what does inotropic medication do (dobutamine)

A
  • stimulates beta-1 adrenergic
  • increase myocardial contractility
  • decrease LV pressure
  • increases CO without greatly affecting HR
22
Q

what does vasopressors do (norepinephrine)?

A
  • increases BP and CO
23
Q

what does lasix do for cariogenic shock

A
  • inhibits reabsorption of Na and Cl
  • decreases BP but won’t if used with vassopressures
24
Q

what are non-pharmacological agents for cariogenic shock

A
  • support ventilation and oxygenation (keep PaO2 above 80)
  • support contractility (intraaortic balloon pump)
25
Q

what is the pathophysiology of hypovolemic shock

A
  • decreased circulation volume
  • decreased preload, SV, CO,
  • vasoconstriction to fix low BP - increased after load)
  • decreased oxygen perfusion and volume supply to organs and tissues
26
Q

what is absolute hypovolemia

A
  • volume lost from the body
  • vomiting, diarrhea
  • hemmorage
  • diabetes
  • hyperglycaemia
  • over use of diuretics (diuresis)
27
Q

what is relative hypovolemic shock

A
  • no loss of volume leaving the body
  • move from intravascular space to extravascular space (third spacing)
  • vasodilation
28
Q

class 1/mild hypovolemic shock signs and symptoms (15-20%/ 750mL)

A
  • compensatory mechanisms maintain CO
  • mild anxiety
  • free of symptoms
  • as volume loss increases (vasoconstriction, cool extremities, increased cap refill)
29
Q

class II/moderate hypovolemic shock signs and symptoms (15-30%/ 750-1500mL)

A
  • decrease CO (more use of comensatory)
  • high HR
  • increased RR (respiratory alkalosis)
  • postural hypotension
  • decreased urine output (20-30 mL/h
30
Q

class III/moderate hypovolemic shock (30-40% or 1500-2000mL)

A
  • compensatory mechanisms begin to fail
  • decreased BP
  • high HR
  • dysrhythmias
  • ABG = increased lactate, decreased HCO3 (acidic)
  • increased BUN and creation
31
Q

class IV/severe hypovolemic shock signs and symptoms (greater than 40%) (8)

A
  • no tissue perfusion
  • tachycardia
  • hypotension
  • severe lactic acidosis
  • absent peripheral pulses
  • cyanotic, severe diaphoresis
  • organ failure
  • no Urine output
32
Q

management of hypovolemic shock

A
  • control active blood or volume loss
  • initial volume loading
  • vasopressors
33
Q

crystalloid use for hypovolemic shock

A
  • volume expanders
  • isotonic or hypertonic
  • molecules easily enter extravascular space
  • increase preload and SV, CO
34
Q

colloid solution for hypovolemic shock

A
  • volume expanders
  • isotonic or hypertonic
  • large molecules can’t enter extravascular space
35
Q

blood products for hypovolemic shock

A
  • RBC - increase oxygen carrying capacity
  • platelets - bleeding due to low platelet count
  • frozen plasma - deficient in coagulation factors
36
Q

Pathophysiology of septic shock

A
  • Vasodilation (low BP, low preload, low afterload, low CO
  • decreased tissue perfusion
  • inflammation in the blood stream
37
Q

SIRS

A
  • systemic inflammatory response system
  • temp above 38 or less than 36
  • HR above 90
  • RR above 20 and or PaCO2 less than 32
  • WBC - greater than 12000 or less than 4000 (bacteria winning battle)
38
Q

SIRS

A
  • systemic inflammatory response system
  • temp above 38 or less than 36
  • HR above 90
  • RR above 20 and or PaCO2 less than 32
  • WBC - greater than 12000 or less than 4000 (bacteria winning battle)
39
Q

Antibiotics for septic shock management

A
  • start broad then go narrow once we know what to fight off
40
Q

Antibiotics for septic shock management

A
  • start broad then go narrow once we know what to fight off
41
Q

What are the different managements for septic shock

A
  • aggressive fluid resuscitation (increase volume in vasculature)
  • antibiotics
  • vasopressors (increase BP)
  • inotropes (dobutamine) - increase CO and has little effect on HR
  • anticoagulants (assess INR before giving)
  • control blood glucose levels (continuous infusion of insulin and glucose)

331 Quiz 2 (8 decks)

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