Shock Flashcards
Cardiogenic shock with RV failure
HR?
MAP?
CVP?
PAOP?
SVR?
HR UP
MAP up/down
CVP up
PAOP normal
SVR up
in hemorrhagic shock, buffering may lead to
decreased O2 release in tissues
loss of % of myocardial tissue leads to cardiogenic shock
40%
catecholamine release in cardiogenic shock
compesnatory catecholamine release > reduced kidney perfuison > Renin angiotenisn activation
aldosterone > increased Na and H20 resorp
secondary MODS
consequence of host response (eg cytokines)
inflammtory host resonse to toxins and other components of microorganism
cardiogenic shoick with biventricular failure
HR?
MAP?
CVP?
PAOP?
SVR?
HR? up
MAP? up/down
CVP? up
PAOP? up
SVR? up
therapy anaphylatic shock
rapid infusion of cristalloid or colloid solution
epi - B2 - brochodilation, iontrope, a-mimetic at high doses (vasoconstriction)
NE if refractive (a-mimetic)
Hypvolemic shock
HR?
MAP?
CVP?
PAOP?
SVR?
HR? up
MAP? down
CVP? down
PAOP? down
SVR? up
Sepsis: at least one of following sx of inadequate organ function:
altered mental state
hypoxemia
elevated plasma lactate
oliguria (urine
Primary MODS
direct result of insult, early in course and directly attributable to insult
progressive shock stage
failing compensation
worsening capilary leakage
metabolic acidosis
increased blood viscosity and micro sludging
organ dysfxn (MODS)
obstructive shock
cardiogenic shock resulting from emchanical impedient
depressed cardiac output
(via PE, tension pneumothorax)
metabolic derangement of cardiogenic shock
lactic acidosis due to systemic malperfusion > cardiac dysfunction
septic shock treatment for
vassopressors for hypotension not responsive to fluid to MAP >65
If persistent arterial hypotension or lactate > 4mmolL:
–measure CVP
–Measure ventral venous O2 sat
remeasure lactate if initital lactate was elevated
DAMPS
inflam mediators released in response to tissue trauma activating same pathway as bacterial products
septic shock criteria
persistent arterial hypotension despite adequate fluid resuscitation or
unexplained tissue hypoperfusion
culture positive bacteremia NOT needed
initital fluid resuscitation in septic shock
crystalloids (increased incidence of renal failure with hydroxyetyhl starches)
(albumin if substantial crystalloids needed)
Cardiogenic shock with LV failure
HR?
MAP?
CVP?
PAOP?
SVR?
HR? up
MAP? up/down
CVP? normal
PAOP? up
SVR? up
Early/Late disrtibitve shock
HR?
MAP?
CVP?
PAOP?
SVR?
HR up
MAP down
CVP down/normal > up/normal
PAOP down normal > up normal
SVR down
organ dysfunction of shock
acute kidney tubular necrosis and subsequent failute
liver congestion with elevated enzymes and coagulopathy
GI ischemia, hemmorhage, peritonitis
ARDS
cinical presentation cardiogenic shock
agitaion
pale, cool, ,clammy skin
RV dysfxn (PE, RCA MI) elevated venous pressure, jugular dist
LV dysfxn (LAD/Cx MI, Acute AI/MR): Pul edema
cardiogenic shock management
optimize ventricular filling
improve cornary perfusion with NE, pehnylepinephrine, ionotrpoics, IABP, mechanical circulatory support
If acute MI casue, coronary angiography + immediate reperfusion
systemic reaction to shock (6)
- progressive vasoconstriction
increased flow to vital organs
increase CO/CI
increase resp rate and tidal volume
reduce urine production
reduced GI activity
criteria of SIRS (need 2)
Tachypnea (>20)
WBC 12000
HR > 90
Fever or hyopthermia
neurogenic shock
profoudn vasodilation or art and venous blood
due to brainstem injury, TBI
massive BP drop and reflex Tachy
in septic shock, for inotropic suport in case of myocardial dysfunction
dobutamien
septic shock treatment,
measure lactate
blood culture prior to antibiotics
broad spectrum antibiotics
cyrtalloid for hypotension or lactate
penyhelphrine in septic shock?
no
EKG of cardiogenic shock
normal, (unlikely due to MI)
compensatory stage of shock
cytokine release
hypeventilation (C02 removal)
catecholamine release
first choice vasopressor in septic shock
NE (epi if more constriction eneded)
initial stage of shock
hypo perfusion
tissue hypoxia
lactic acidosis
hemodynamics cardiogenic shock
Systolic bp < 90,
BP drop >30 for 30 minutes
increased LVEP (PAWP >15)
Reduced Cardiac index (
therapy of hemorrhagic shock
crystalloids (colloid if mild) (PRBC is significant reduction in Hg)
obstructive shock
HR?
MAP?
CVP?
PAOP?
SVR?
HR? up
MAP? down
CVP? up
PAOP? up
SVR? down
decpensated hemorrhagic shock
disturbance of macro and microcirculation (decreased perfusion)
anaerobic metabolism > lactive acidosis
refractory shock stage
irreversible organ damage
cell death
degradation of ATP to adenosine
