Shock Flashcards
Definition of Shock
Inadequate organ perfusion to meet the tissue’s oxygenation demand
What qualifies as Hypotension
<60 or a decrease in 40 systolic
Acidosis
From the accumulation of acid when anaerobic metabolism occurs.
What happens during metabolic acidosis?
ATP production fails, the Na/K pump fails. Leads to cell swelling/rupture/death.
Systemic vascular resistance index
(MAP-CVP)/CI all times 80
Pulmonary vascular resistance index
MPAP - PAWP / ci * 80
When does anaerobic metabolism occur?
If oxygen demand is greater than oxygen consumption.
Signs of organ hypoperfusion
Mental status changes, oliguria, lactic acidosis
4 Categories of shock
Cardiogenic, hypovolemic, obstructive, distributive
Goals of shock resuscitation
Restore blood pressure, normalize perfusion, preserve organ function
Hypovolemic shock
Occurs from low blood volume. From trauma/hemorrhage, diarrhea, dehydration, burns!
Signs of hypovolemic shock
Decreased CO, decreased PAWP, increased SVR
Treatment of hypovolemic shock?
Reverse hypovolemia with crystalloid/colloid. Control hemorrhage. Maybe give pressor agents.
Crystalloid vs colloid
Crystalloids are cheaper. Blood must supplement either. No survival benefit with colloids.
Cardiogenic shock
Defect in cardiac function
Signs of cardiogenic shock
Decreased CO, increase PAOP, increase SVR, decrease LVSW
Coronary perfusion pressure
= DBP -PAWP.
What is the goal coronary perfusion pressure
> 50mmHg
How to treat cardiogenic shock
Fluids first, cautious pressors. Give inotropes too.
Distributive shock
Sepsis, anaphylaxis, acute adrenal insufficiency, neurogenic
Signs of distributive shock
Generally decreased SVR. Not sure about CO or PAOP
Systemic inflammatory response syndrome treatment
Prompt volume replacement, give antibiotic, give inotropes (Da first). If really low map, give DA and then NE
Obstructive shock
Tamponade, tension pneumothorax, massive PE.
Signs of obstructive shock.
Decreased Co, Increase PCOP, Increased SVR
