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
if in shock then change in _____
MAPS and decrease in BP
process of how MODS occurs
1) injury
2) release toxins into plasma/bloodstream to fix area of damage
3) cytokines to stop bleeding in area and identify infection (cells fighting infection causes dilation)
4) vasodilaltion, decrease in BP
5) kidney, liver, lungs, brain
6) shock
7) MODS and death
describe hypovolemic shock
too little circulation blood volume
decrease in MAP and O2
**low volume
what to do for hypovolemic shock
1) start two large IV with saline
2) oxygen 8-10 L
3) blood if necessary
4) EKG
5) Foley
6) draw ABGs, labs, electrolytes
7) protect airway
8) start line (EJ or IJ)
what does flail chest indicate
multiple ribs broken (>2)
lungs and chest collapse
**need chest tube
what labs do you draw
4 tubes:
- red/jungle (red/green) are chemistry (K, Cl, CO2, glucose)
- purple: CBC, H & H, platelets, WBC
green: lactate or ammonia
blue: platelets, clotting factors (fluid will be in the tube for clotting)
what tubes do you fill first
blue and purple to prevent clotting
how do you draw up tubes
with 20 mL of fluid
describe cardiogenic shock
- heart muscle is unhealthy and pump is impaired
- heart not working
- MI can be cause
why is open heart surgery done
performed for CABG, valve replace, tumors, cardiogenic shock requiring revascularization, VAD placement
what do you need to tell pt before OHS is done
- it WILL be PAINFUL after surgery
- chest tubes following surgery (medial stinal)
- may come back from surgery intubated (depends on stability)
- get them UP ASAP after surgery, just wait until VS are stable
- recovery time is ICU for two days
what is the process of CABG procedure
1) heart stopped with K solution and then grafting begins
2) heart is rewarmed and observed for patency
3) epidcardial wires are placed and attached to an external pacemaker/pacer boxes
4) medistinal chest tubes placed, usually 4
describe coronary artery bypass surgery
CABG
- very common in pts >65 yrs
- blockage is removed and the pts own venous or arterial blood vessel is used
- before vessels are typically occluded >70%, cannot shunt to all vessels)
what is the ejection fraction for effectiveness
> 40%
_____ % of pts remain pain free 5 yrs post CABG
70 %
what is an internal mammary artery
artery used in CABG
preferred artery
if only 1 or 2 grafts are present
what is a saphenous vein
in the leg
thinner than artery
swelling in the leg is typically after CABG
want OHS to be ____, why?
<4 hrs long
longer bypass, greater risk for clots
thick muscle tissue is scraped
heart will not beat effectively if occluded here
miectomy
what is final product of CABG
take blood from aorta directly to arteries
