Shock 2 Flashcards
stages of shock
1) initial
2) compensatory
3) intermediate
4) irreversible
describe the initial stage of shock
- first stage
- slight decrease in MAP <10
- flow to vital organs is maintained
- lose 1 L of fluid, body can compensate
- little cold and clammy
- vascular constriction and increase in HR to maintain C.O.
- increase in RR and diastolic BP d/t shunting blood
why does diastolic BP initially increase
more blood is going to the heart so diastolic increases about 10
describe compensatory stage of shock
- nonprogressive
- MAP decreases 10-15
- kidneys and hormones activated (renin, angiotensisn, aldosterone to conserves salt with conserves H2O and increases BP)
- HR is still elevated
- acidodic and hyperkalemia
- can be reversed if stabilized
why does acidosis and hyperkalemia occur in compensatory
- build up of lactic acid (kidneys NOT functioning)
- RR attempting to blow off but cannot
- the more acidodic, less Na pump can work, which increases K
when K reaches ____, heart stops working
8
describe intermediate stage of shock
- progressive
- decrease in MAP >20
- less vital organs become anoxic
- ischemia occurs
- life threatening
if nothing is done within how long of intermediate, pt with die
1 hr
what to do for pt in intermediate
1) start 2 large IV lines (1 L of NSS)
2) give oxygen (8-10 L high flow rate) *protect airway
3) put them on monitor (EKG)
4) put foley in them
why is NSS hung
can hand blood with NSS
any drug is compatible with NSS
eventually give O negative blood
describe irreversible stage of shock
refractory
- too much cell death and tissue damage has occurred
- therapy is not effective, eve in 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
how does the process of MODS occur
1) injury
2) release toxins into plasma/bloodstream to fix area of damage
3) cytokines to stop bleeding in area and identify infection (cells fight infection and cause dilation)
4) vasodilation and decreased BP
5) kidney liver lungs and brain
6) shock
7) MODS/death
how to differentiate if MODS or shock
if renal affected, MODS
if decrease in MAP or BP, shock
broadly describe hypovolemic shock
- too little circulation blood volume
- decrease in MAP and O2
- *low volume
what to do for hypovolemic shock
1) 2 large IV with saline
2) oxygen (8-10 L)
3) blood if necessary
4) EKG monitor
5) foley
6) draw ABGs, labs
7) protect airway
8) start line (EJ or IJ)
what does flail chest indicate
multiple ribs broken
lungs and chest collapse (need chest tube)
describe cardiogenic shock
- heart and muscle is unhealthy and pump is impaired
- heart not working
- MI can cause this
describe CABG
coronary artery bypass surgery
- very common in pts >65
- blockage is removed and the pt own venous or arterial blood vessel is used (internal mammary* artery or saphenous vein)
- vessels must typically be occluded >70%
- ejection fraction is >40% for effectiveness
how long do we want OHS to last
< 4 hrs
longer the surgery, greater the risk for clots
what is the end product of CABG
take blood from aorta directly to coronary arteries
describe the steps in the CABG procedure
1) heart is stopped with K solution and then grafting begins
2) heart is rewarmed and observed for patency
3) epicardial wires are placed and attached to an external pacemaker
4) mediastinal chest tubes placed (usually 4)
what do you tell pt ahead of open heart surgery
- it will hurt after surgery
- chest tube (medial stinal)
- may come back intubated (depends on stability)
- get them UP asap after surgery as long as vital are stable
- recovery time is ICU for about 2 days
why is OHS performed
CABG, valve repair, tumors, cardiogenic shock requiring revascularization, VAD placement
