SHOCK

Question 1

cardiogenic shock (what is it, causes, treatment

Answer 1

-heart does not pump blood sufficiently
-can be caused by: MI, right side heart failure, acute coronary syndrome, arrhythmias, myocarditis, cardiomyopathy
-treat: first line are inotropic drugs; if inotropic + fluids does not raise BP then give norepi (vasopressor) to stabilize BP

Question 2

obstructive shock

Answer 2

-due to obstruction of outflow (blood flow)
-can be caused by: Massive PE, Tension Pneumothorax, severe aortic stenosis, Pulmonary artery embolism, Cardiac tamponade

Question 3

distributive shock

Answer 3

-Shock characterized by widespread vasodilation and increased capillary permeability
-an endotoxin will vasodilate the arteries/veins increasing their permeability to allow blood flow to escape
-can be caused by anaphylaxis, sepsis, burns, acute pancreatitis, neurogenic, third spacing
-when BP drops it is detected by baroreceptors & stimulate medulla oblongata to vasoconstrict/increase HR

Question 4

4 types of shock

Answer 4

1. hypovolemic
2. cardiogenic
3. distributive
4. obstructive

Question 5

shock (caused by, early s/s, cause which SE)

Answer 5

-caused by poor tissue perfusion or inability of tissues to use O2/nutrients
-early s/s: tachycardia, tachypnea, weak pulse, LOC, cool/clammy sweaty skin, oliguria
-leads to cellular hypoxia (cells dont get enough O2) and build up of toxic metabolites (lactic acid)
-can cause hyperglycemia due to stress response (cortisol increase blood sugar)

Question 6

hypovolemic shock

Answer 6

-caused by: critical loss of intravascular volume, hemorrhage, trauma, burns, dehydration

Question 7

criteria for shock

Answer 7

-SBP <90
-SBP dropping by 40 from baseline HTN
-hypotension with end organ damage
-MAP <65; should be 65-100 if <65=shock if >110=MI, stroke

Question 8

pulse pressure

Answer 8

-difference between SBP and DBP
NV: 40-60
>60= atherosclerosis, nephrosclerosis
<40= HF, shock

Question 9

treatment for shock

Answer 9

1. replace fluids 30 mL per KG of body weight
2. monitor glucose levels; give IV insulin if BS >180 on 2 diff readings
3. central access to prevent digital ischemia

Question 10

norepinephrine (what is it, brand name, treat what, IV consideration)

Answer 10

-vasopressor; alpha 1 agonist; catecholamine
-brand: Levophed
-for hypotension + shock (first line)
-IV can cause tissue necrosis if extravated; use phentolamine to decrease damage

Question 11

anti diuretic hormone (what is it, used for, can cause what)

Answer 11

-vasopressor (vasopressin)
-used with norepi as 2nd line
-when given in high doses can cause mesenteric ischemia

Question 12

epinephrine (what is it, what it does, SE)

Answer 12

asopressor + catecholamine
-stimulates both alpha & beta receptors; least selective of the vasopressors
-at lose doses beta receptors are stimulated to increase HR + contractility
-at high doses alpha receptors are stimulated to increase BP
-SE: arrhythmias
-given to treat cardiac arrest

Question 13

dopamine

Answer 13

-vasopressor + catecholamine
-dose dependent response
-stimulates beta receptors more than alpha + dopamine receptors
-SE: increase risk of tachyarrythmias but less risk than norepi
-given via continuous IV drip using infusion pump

Question 14

phenylephrine

Answer 14

-only stimulate alpha receptors not beta so no tachyarrythmias

Question 15

dobutamine

Answer 15

-inotropic drug, inodilator
-for cardiogenic shock
-sitmulates beta receptors
-use norepi firs

Question 16

anaphylactic shock (what type shock, what it does, how to treat)

Answer 16

\type of distributive shock
-when sensitized person gets exposed to an antigen characterized by acute in vascular permeability & bronchial hyperactivity
-develops rapidly within 20 min of exposure
-the rxn will release histamine causing VSD that will increase cap permeability and cause fluids to leak into the interstitial space + constriction of the bronchioles
-treat: administer oxygen, slow IV push epi, beta 1 blocker to decrease HR, aminophylline + beta 2 agonist for bronchospasm, antihistaminic & steroids to decrease inflammation

Question 17

adrenergic agonists

Answer 17

-used to increase cardiac output to increase BP
-causes increased heart rate, bronchodilation, dilated pupils, decreased gastrointestinal mobility, glycogenolysis
-specificity of these drugs is relative & dose dependent
-produce sympathetic nervous system effects