Shock Flashcards
What is shock? What is result?
state where the cardiovascular system cannot maintain adequate cellular perfusion ==> resuts in decreased tissue oxygenation nutrient flow –> cellular dysfunction –> diffuse tissue injury –> death
components of tissue perfusion:
- cardaic fucntion: preload, afterload, contractility, HR, venous return
- arterial pressure
- vascular function: distribution of cardiac output, microvascular functions
- cellular function: oxygen delivery, energy gen and substrate utilization
3 types of shock:
1) cardiogenic: severe myocardial dysfunction with severely reduced cardiac output (AMI)
2) hypovolemic: blood loss, severe burns (severe circulatory compromise)
3) distributive: many (*sepsis, drug OD, anaphylaxis, neurogenic, abn shunting of blood flow
Characteristics of shock
- very low arterial SBP
- tachycardia
- oliguria: no urine production
- mental obtundation
- cool, mottled extremities
Etiologies of cardiogenic shock: (dec LVEF)
- acute MI
- dilated cardiomyopathy
- valvular (acute MR, endocarditis)
- arrhythmia (v tach)
most important indication of prognosis?
LEFT VENTRICULAR FUNCTION
Etiologies of hypovolemic shcok (reduced circulating blood volume):
- blood loss (trauma, GI loss such as cholera)
- fluid depletion (vomit, diarrhea, burns)
Etiologies of distributive shock (profound peripheral vasodilation):
-MOST COMMON IS SEPSIS**
consequences of shock:
- myocardial dysfunction
- pulmonary ARDS
- rental ATN
- GI - hepatic injury (nutmeg liver) or inetstinal ischemia/injury
- CNS-post anoxic encephalopathy (no brain perfusion)
===> MULTIORGAN CONSEQUENCES!!!!
Therapy for shcok:
go to the ICU!!
- monitor ECG
- IV meds/fluids - volume expansion
- ventilatory support
- O2 if needed
- vasopressors
- inotrpics (dobutamine)
- antibiotics
What type of solution for fluid resuscitation?**
ISOTONIC
