Shock Flashcards
What is the definition of  shock?
Inadequate tissue perfusion
What are the different types of shock (5)?
Hypovolemic Septic Cardiogenic Neurogenic Anaphylactic
What are the signs of shock?
Pale,diaphoretic,coolskin Hypotension, tachycardia, tachypnea T mental status and pulse pressure, Poor capillary refill,
Poor urine output
What lab tests help assess tissue perfusion?
Lactic acid (elevated with inadequate tissue perfusion),base deficit, pH rom ABG (acidosis associated with inadequate tissue perfusion)
What is the defInition of hipovolemic shock
Decreased intravascular volume
What are the common causes of hypovolemic shock?
- Hemorrhage
- Burns
- Bowel obstruction
- Crush injury
- Pancreatitis
What are the signs of hypovolemic shock?
Early—Orthostatic hypotension, mild tachycardia, anxiety, diaphoresis, vaso- constriction (decreased pulse pressure with increased diastolic pressure)
Late—Changed mental status, decreased BP, marked tachycardia
What are the signs/ symptoms with:
Class I hemorrhage
(  15%or 750 cc blood loss)?
Mild anxiety, normal vital signs
What are the signs/ symptoms with:
Class II hemorrhage (15%–30%or 750– 1500 cc blood loss)?
Normal systolic BP with decreased pulse pressure, tachycardia, tachypnea, anxiety
What are the signs/ symptoms with:
ClassIIIhemorrhage (30%–40%or1500– 2000 cc blood loss)?
Tachycardia(heartrate. 120),tachypnea (respiratoryrate. 30),decreasedsystolic BP, decreased pulse pressure, con usion
What are the signs/ symptoms with:
Class IV hemorrhage (  40%or 2000 cc bloodloss)?
Decreased systolic BP, tachycardia (heart rate . 140), tachypnea (respiratory rate
. 35),decreasedpulsepressure,conused and lethargic, no urine output
What is the treatment of hypovolemic shock?
- Stop the bleeding
- Volume: IVF (isotonic LR) then blood
products as needed
What usually causes failure of resuscitation of hypovolemic shock?
Persistentmassivehemorrhage,requiring emergent surgical procedure
Why does decreased pulse pressure occur with early hypovolemic shock?
Pulse pressure (systolic–diastolic BP) decreases because o  vasoconstriction, resulting in an elevated diastolic BP
What is the most common vital sign change associated with early hypovolemic shock?
Tachycardia
What type of  patient does not mount a normal tachycardiac response to hypovolemic shock?
Patients on B -blockers, spinal shock (loss o sympathetic tone), endurance athletes
Should vasopressors be used to treat hypovolemic shock?
No
Should patients with hypovolemic shock be put into the Trendelenburg position?
No
What is the definition of septic shock?
Documented in ection and hypotension
What is the specific etiology of septic shock??
Most common—gram-negative septicemia Less common—gram-positive septicemia,
fungus
What actorsincreasethe susceptibility to septic shock?
Any mechanism that increases susceptibility to infection (e.g., trauma, immunosuppression, corticosteroids, hematologic disease, diabetes)
Whatcomplicationsaremajor risks in septic shock?
Multipleorgan ailure,DIC,death
What are the signs/ symptoms of septic shock?
Initial—vasodilation, resulting in warm skin and ull pulses;normal urine output
Delayed—vasoconstriction and poor urine output; mental status changes; hypotension
Whatpercentageo blood cultures is positive in patients with bacterial septic shock
Only about 50%!
What are the associated findings of septic shock?
Fever, hyperventilation, tachycardia
What are the associated lab findings of septic shock?
Early—hyperglycemia/glycosuria, respiratory alkalosis, hemoconcentration, leukopenia
Late—leukocytosis, acidosis, elevated lactic acid
(Note: Identi ying organism is important to direct treatment/antibiotics)
What is the treatment of septic shock?
- Volume (IVF)
- Antibiotics (empiric, then by cultures) 3. Drainage o in ection
- Pressors PRN
- Zygris®PRN
What is the definition of cardiogenic shock?
Cardiac insu  ciency; le  ventricular ailure (usually), resulting in inadequate
tissue perfusion
What are the causes of cardiogenic shock?
MI, papillary muscle dys unction, massive cardiac contusion, cardiac tamponade, tension pneumothorax, cardiac valve failure
What are the signs/symptoms on exam of cardiogenic shock?
Dyspnea Rales Pulsus alternans (increased pulse with greater f lling ollowing a weak pulse) Loud pulmonic component o S2 Gallop rhythm
What are the associated vital signs/parameters of cardiogenic shock?
Hypotension, decreased cardiac output, elevated CVP/wedge pressure, decreased urine output (low renal blood  flow), tachycardia (possibly)
What are the signs on CXR of cardiogenic shock?
Pulmonary edema
What is the treatment of cardiogenic shock?
Based on diagnosis/mechanism: 1. CHF: diuretics and a afterload reduction (e.g., ACE inhibitors), with or without pressors 2. Left ventricular failure (MI): pressors, afterload reduction
What are the last resort support mechanisms of cardiogenic shock?
Intra-aortic balloon pump (IABP), ventricular assist device (VAD)
What is the definition of neurogenic shock?
Inadequate tissue perfusion from loss of sympathetic vasoconstrictive tone
What are the common causes of neurogenic shock?
Spinal cord injury:
Complete transection of spinal cord Partial cord injury with spinal shock Spinal anesthesia
What are the signs/ symptoms of neurogenic shock?
Hypotension and bradycardia, neurologic deficit
Why are heart rate and BP decreased in neurogenic shock?
Loss of sympathetic tone
but hypovolemia [e.g., hemoperitoneum] must be ruled out
What are the associated findings of neurogenic shock?
Neurologic def cits suggesting cord injury
What MUST be ruled out in any patient where spinal shock is suspected?
Hemorrhagic shock!
What is the treatment of neurogenic shock?
IV  fluids (vasopressors reserved  or hypotension refractory to  fluid resuscitation)
Whatpercentageo patients with hypotension and spinal neurologic deficits have hypotensiono purely neurogenic origin?
About 67% (two thirds) of patients
What is spinal shock?
Complete  flaccid paralysis immediately following spinal cord injury; may or may
not be associated with circulatory shock
What is the lowest reflex available to the examiner?
Bulbocavernous reflex: checking or contraction of the anal sphincter upon compression o the glans penis or clitoris
What is the lowest level voluntary muscle?
External anal sphincter
What are the classic findings associatedwithspinalcord shock?
Hypotension
Bradycardiaorlacko compensatory
tachycardia
What is the acronym or treatmentoptions or anaphylactic shock?
“BASE”:
- Benadryl
- Aminophylline
- Steroids
- Epinephrine
