Shock Flashcards
Overview of shock
failure in tissue perfusion, oxygen and nutrients cannot support cellular function, neither linear or predictable
Types of shock
hypovolemic, cardiogenic, distributive
Types of distributive shock
septic, neurogenic, anaphylactic
Common physiologic response in all types of shock
hypoperfusion, hypermetabolism, activation of inflammatory response
What is occurring with hypoperfusion
activation of sympathetic nervous system, vasoconstriction
What is happening with hypermetabolism
uses all glucose and ATP, cells cannot keep up with energy demand
Stages of shock
initial, compensatory, progressive, irreversible/refractory
Initial stage of shock
blood flow drops slightly and cells start to lack oxygen, no obvious s/s, cells switch to emergency energy production (anaerobic metabolism)
Compensatory stage of shock
the body tries to compensate by increasing heart rate and narrowing blood vessels to maintain blood pressure
When does the sympathetic nervous system activate fight or flight response
compensatory stage of shock
s/s of compensatory stage of shock
tachycardia, cool/pale skin, tachypnea, restlessness, confusion, bp is normal, diaphoresis, decreased urine output, respiratory alkalosis
When and how does metabolic acidosis happen
build-up of lactic acid from increased respiratory rate during the compensatory stage of shock
Treatment for compensatory stage of shock
identify the cause and maintain tissue perfusion
Progressive stage of shock
the body can no longer compensate, blood flow to the organs decrease, hypoperfusion to all organs
Where is blood shunting happening during compensatory stage of shock
blood is being shunted to most important organs (heart, brain, lungs)
s/s of progressive stage of shock
hypotension, cold/clammy skin, weak/absent pulses, severe confusion, shallow and rapid respirations, clotting cascade, impaired liver function
When does MODS begin
progressive stage of shock
Irreversible/refractory stage of shock
organs start to fail and damage is beyond repair, patient does not respond to treatment
s/s of irreversible/refractory stage of shock
complete organ failure, unconsciousness, death
Appearance of shock
cold/clammy skin, pallor, cyanosis of hands/feet, jaundice
vital sign changes during shock
hypotension, tachycardia, tachypnea
Assessment findings of shock
confusion, decreased LOC, low urine output, hypoactive bowel sounds, impaired liver function
What effect does the impaired liver have on the body
less able to metabolize meds and metabolic waste products, cannot filter bacteria from the blood
When to report BP changes
SBP <100, 40 mmHg drop from baseline, MAP <65
Early indicator of shock
narrowing/decreased pulse pressure
Use of supplemental oxygen during shock
increased and optimize O2 saturations in the bloodstream
Why is fluid resuscitation used
restore preload and increase cardiac output to optimize oxygen delivery
What is the first preferred solution for fluid resuscitation
lactated ringers
What should be monitored for during fluid resuscitation
cardiovascular overload, pulmonary edema, abdominal compartment syndrome
How to decrease oxygen consumption
sedation, paralytics, reduce pain and anxiety, maintain normothermia, maintain normal serum glucose
General management of shock
tissue perfusion, vital sign changes, supplemental oxygen, fluid resuscitation, decrease oxygen consumption
What to do before administering paralytic
intubated and sedated
Propofol
drug of choice for sedation, metabolized in liver, turn urine green, can worsen hypotension because it works as vasodilator
Vasopressor action
increase strength of myocardial contractility, regulate heart rate, reduce myocardial resistance, initiate vasoconstriction
Vasopressor action
increase BP through vasoconstriction
Inotropes action
improve heart contractility, increase stroke volume, increase cardiac output
What medication can cause and worsen hypotension
vasodilators
