Shock Flashcards
Shock
generalized inadequacy of blood flow throughout the body, to the extent the the tissues are damaged d/t inadequate cardiac output
Stages of Shock
Compensated
Progressive
Irreversible
Compensated Stage
Deficient perfusion; but not to the degree that CV system begins to deteriorate
Progressive
Circulatory system begins to deteriorate - cycle can end in death
Irreversible
All forms of therapy are inadequate to save the person’s life
Hypovolemic Shock
Loss of whole blood or plasma/Loss of ECF
Causes of hypovolemic shock
HEMORRHAGE
Severe hydration/burns
Excess loss of fluid by the kidneys
Adrenal insufficiency
S/Sx of hypovolemic shock
Hypotension (know baseline) & Orthostatic hypotension Decreased Urinary Output Pale/clammy moist skin Metabolic Alkalosis -->Metabolic Acidosis Poor capillary refill Anxiety/Impending Doom Decreased pulse pressure Brief Rise in BP/HR --> sustained low BP
Tx of Hypovolemic Shock
Replacement of Fluids:
Blood (whole/packed RBCs)
Dextran solutions/salt poor albumin (to increase plasma osmotic pressure=retains fluid in vascular spaces)
NS (restore volume
Lactated Ringers (correct metabolic acidosis)
Elevate legs to 45 degrees (NOT TRENDELENBURG)
Keep covered/ but not too warm
Neurogenic Shock
Normal amount of blood, but extensive dilation of the blood vessels d/t loss of sympathetic tone (SNS not constricting well)
Causes of Neurogenic Shock
Deep General/Spinal anesthesia
Brain damage
Spinal Cord Injury
Severe Hypoglycemia
FAINTING is NOT_______, but rather a massive ________ response
neurogenic shock
parasympathetic response
Anaphylactic Shock
Increase in size and permeability of the vascular bed (whole body is vasodilating)
Type I Anaphylactic Schock
BIG fluid shifts = hypersensitivity response releases vasodilating histamine and SRS-A which increases capillary permeability = huge fluid shifts into the tissues
Type I symptoms
Wheezing, sniffing, laryngeal edema, bronchial edema, suffocation
Treatment for Type I anaphylactic shock
**want BP to go back up
Epinephrine (increases vasoconstriction)
Corticosteriods (decreases capillary permeability/ stabalizes membranes)
Septic Shock
gram - bacteria and their endotoxins
E.coli
Pseudomonas
Proteus
Risk factors for septic shock
Age 65
DM, ETOH, Cancer, Liver, UTI
Cholecystitis - inflamed gallbladder
Ruptured Appendix
SIRS (Systemic Inflammatory Response Syndrome) aka preseptic shock
Bacteria enter blood and are destroyed by macrophages, immune cells, and complement = Release endotoxins and Release chemical mediators
Vasodilation occurs and increases vascular permeability
**dangerous because this is occurring systemically
Stages if Warm Septic Shock
Increased CO and low peripheral vascular resistance
Vasodilation effects histamine, bradykinins, and seratonin = making you look more flushed
Fluid shifts into tissues and 3rd spacing
Fever d/t pyrogens from WBCs
Profound diuresis= excessively urinating d/t dead bacteria and phagocytes/ waste products of cell metabolism
Increased Respiratory Rate
Activation of clotting - petechiae and mottling below knees (darkened appearance)
Decreased cerebral perfusion - endorphins released to help keep person comfortable
Stages of Cold Septic Shock
Hypodynamic = decreased CO (6-72 hours after warm shock starts) DIC releases MDF from pancreas and endorphins depress myocardium
Subnormal body temp = cold clammy pail skiing
ABGs = hypoxemia/acidosis
ARDS = “wet lungs –>respiratory failure
ARF
Tx of Septic Shock
IV fluids
Swan-Ganz monitoring - catheter inserted that measures pressure in L. Atrium and a good for measuring total circulating volume
Antibiotics
Steroids
Why can death of bacteria make a person worse in septic shock
after tx with antibiotics the endotoxins are still released = will get worse before they actually get better
What types of IV fluids do you give for septic shock
NE = vasoconstriction Dopamine = dilates splanchnic and renal vessels
