Shock 2 Flashcards
stages of shock
1) initial
2) compensatory
3) intermediate
4) irreversible
describe Initial stage of shock
- slight decrease in MAP (<10)
- flow to vital organs is maintained
- loose 1 L of fluid, body can compensate
- increased RR and diastolic BP
- vascular constriction and increased HR to maintain C.O.
- C.O and MAP are relatively maintained
how does initial stage of shock appear
-little cold and clammy
why is diastolic BP increased in initial stage
d/t shunting blood
more blood is going to the heart so diastolic increases about 10
describe compensatory stage of shock
- nonprogressive
- MAP decreases 10-15 mmHg
- body does everything it can to save you
- kidneys and hormones activated
- heart rate is still elevated
- **ACIDIC and hyperkalemia
once K reaches ______ the heart stops working
8
can compensatory be reversed
yes, if stabilized
during compensatory what are the kidneys doing
activate renin, angiotensin, aldosterone to conserve salt which conserves H2O and increases BP
RAAS, epi/norepi is also released
describe why the environment is acidodic and hyperkalemic during compensatory
- build up of lactic acid d/t kidney not functioning
- RR attempting to blow off CO2 but cant
- the more acidodic, less Na pump can work , this increases K
describe intermediate stage of shock
*progressive less vital organs become anoxic ischemia occurs life threatening sustained decrease in MAP (>20 mmHg)
if nothing is done w/in _____ of intermediate shock, pt will die
1 hr
what to do for pt in intermediate shock
1) start 2 large IV lines (1 L of NSS)
can hang blood w/ NSS, any drug is compatible with NSS, eventually give O negative blood
2) give oxygen (8-10 L high flow rate)
*oxygenation, protect airway: facemask, nonrebreather, intubate if gets worse
3) put them on monitor/EKG
4) put Foley in them
additional things to do for pt in intermediate shock
start CKGs of abdomen, labs, ABGs (do them often, done by resp. therapist in artery)
eventually give meds
describe irreversible shock
- refractory
- too much cell death/tissue damage has occurred
- therapy is not effective even if MAP returns to normal
- nothing can be done to fix/prevent death
- warm pt up to see if dead, check for brain wave activity, check ECHO to see if heart is moving
- if coded and started rigor mortus, stop attempting to revive
if renal is affected then it is ______
MODS