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ED/Surg > Shock > Flashcards

Shock Flashcards

1
Q

What is shock?

A

no tissue perfusion

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2
Q

What is SIRS?

A

systemic inflammatory response system

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3
Q

What are sx of SIRS?

A

fever, hypothermia
leukocytosis or leukopenia
tachypnea, tachycardia

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4
Q

Who are at risk for shock?

A

young/old pts
immunocompromised
very sick people
indwelling catheter

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5
Q

What is bacterial ipopolysacchardie and peptidooglycans?

A

potent activaros that trigger production of cytokines, chemokines, etc –> inflammatory response

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6
Q

What is the hallmark for local inflammatory response?

A

intravascular thrombosis

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7
Q

What can widespread endothelial injury result in?

A

DIC
organ dysfxn
hyporesponse of bone marrow and useless WBC

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8
Q

What is early sign of sepsis?

A

hyperventilation

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9
Q

What are other sx of sepsis?

A

tachycardia
weird WBC ct
encephalopathy
acrocyanosis
necrosis of digits - d/t ischemic tissues
petechaie, purpura - platelets going out of wack -DIC
acidosis -d/t poor tissue perfusion –> lactic acid build up
hyper/hypoglycemia

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10
Q

What are major complications of sepsis?

A

cardiopulm
renal
coagulopathy
hepatic dysfxn

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11
Q

What are cardiopulm complications from sepsis?

A

VQ mismatch -shunting and less perfusion
pulm capillary leakage –> ARDS occurs
heart failure

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12
Q

What are renal complications from sepsis?

A 
oliguria
azotemia - high nitrogen in urine
proteinuria
lyte imbalance
Acute tubular necorsis
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13
Q

What are coagulopathy complications from sepsis?

A

DIC

thrombocytopenia

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14
Q

What are hepatic dysfxn complications from sepsis?

A

dec in clotting factors

glucose, albumin, etc goes out of wack

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15
Q

How is SIRS defined?

A

2 or more of:
Temp: 38C/100F
HR: >90/min
RR: >20/min or PaCO2 12,000 OR >10% bands

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16
Q

How to tx sepsis/septic shock/SIRS? -infxn

A 
tx ASAP
warm pt 
glucose control
empirical abx
remove source of infxn if any (foley, iv catheters
17
Q

How to tx sepsis/septic shock/SIRS? -heart

A

support heart: preload, afterload, contractility, O2, vasopressor (dopamine)

18
Q

How to tx sepsis/septic shock/SIRS? -liver

A

bicarb for severe metabolic acidosis
correct clotting factor
RBC transfusion
hemodialysis

19
Q

What is APACHE II Scores?

A

used to gauge severity of disease
can be used to determine if activated protein C is useful
can use to predict morbidity/morality

20
Q

What is early goal directed therapy?

A

step wise approach

may be used in ICU

21
Q

What is most common cx of DIC?

A

bacterial sepsis
malignant disorder
obstetric complications

22
Q

What leads to bleeding DIC?

A

consumptive coagulopathy - using up coagulation factors and platetles

23
Q

What labs for DIC?

A

PT, PTT

24
Q

How to tx DIC?

A

tx underlying cx
replace clotting factors and platelets
control coagulation state +/- heparin
support

ED/Surg (9 decks)

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