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Critical Care Test 2 > Shock > Flashcards

Shock Flashcards

1
Q

what does inadequate systemic oxygen delivery activate?

A

autonomic response to maintain oxygen delivery

-SNS and RAAS

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2
Q

Sympathetic NS

  • what is released
  • what happens when these are released
A
  • NE, Epi, dopamine, cortisole

- vasoconstriction, increased HR, increased cardiac contractility

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3
Q

Renin-Angiostensin Axis

-what happens during this response

A
  • water and sodium are conserved
  • vasosconstriction
  • increases Blood volume and blood pressure
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4
Q

What is another name for the activation of SNS and RAAS system

A

Compensatory stage of shock

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5
Q

Global Tissue Hypoxia define

A

cellular response to decreased systemic oxygen delivery

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6
Q

what happens during global tissue hypoxia

A
  • ATP depletion
  • cellular edema
  • hydrolysis of cell membrane and cell death
  • endothelial inflammation and disruption
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7
Q

Result of global tissue hypoxia

A

Lactic acidosis

  • cardiovascular insufficiency
  • increased metabolic demand
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8
Q

Stage of shock during global tissue hypoxia

A

Progressive Stage of Shock

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9
Q

Multiorgan dysfunction Syndrome MODS

A

progress of physiological effects as shock ensues

  • cardiac depression
  • respiratory distress
  • renal failure
  • DIC
    • organ failure
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10
Q

Phase name for MODS

A

Refractory Stage of shock

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11
Q

Initial Stage of Shock

A

cardiac ouptut decreases

  • reason varies by type of shock
  • tissue perfusion threatened
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12
Q

Compensatory Stage of shock

A

homeostatic mechanisms kick in

-the body is still able to maintian CO, BP, and tissue perfusion

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13
Q

Progressive Stage of Shock

A

The body cannot keep up

  • not enough O2 to cells
  • switches from aerobic to anaerobic
  • acidosis
  • vasodilation
  • inflammatory dilators
  • SIRS
  • every system effected
  • CELLS DIE
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14
Q

Refactory stage of shock

A

unresponsive to treatment

  • irreversible
  • ORGANS DIE
  • MODS
  • death d/t decr. tissue perfusion
  • circulatory system unable to meet body demands
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15
Q

Approach to pt in shock

ABC’s assessment

A 
cardio-respiratory monitor
-pulse ox
-supplement oxygen
-IV acess
-ABGs
Foley cath
-VS
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16
Q

Diagnosis of Shock

A
  • physical exam
  • hemodynamics
  • Infectious source
  • labs
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17
Q

Diagnosis: LABS

A
  • cbc
  • chemistries
  • lactate
  • coagulation
  • cultures
  • ABGs
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18
Q

Shock and pulses:

if carotid pulse is felt-

A

systolic at least 60

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19
Q

Shock and pulses:

-if radial pulse felt:

A

-systolic BP at least 70

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20
Q

Shock and pulses

-if femoral pulse felt:

A

-systolic BP at least 80

21
Q

Shock and pulses:

-if Pedal pulse felt

A

-SBP at least 90

22
Q

Goals of treatment

ABCDE

A 
A-airway
B-control WOB
C- circulation optimized
D- delivery of oxygen
E- end points of resusc. achieved
23
Q

Control WOB

-how to decrease O2 consumption

A
  • Resp. muscles consume a lot of oxygen

* * mechanical ventilation and sedation decrease WOB and improve survival

24
Q

Ways to Maintain O2 delivery

1- decrease O2 demands

A

provide analgesics and anxiolytics to relax muscles and avoid shivering

25
Q

Ways to Maintain O2 Delivery

2- maintain arterial oxygen sats/content

A
  • give O2

- maintain hgb >10 g/dl

26
Q

Ways to Maintain O2 Delivery

3- Lactate levels

A

lactate levels or central venous O2 sats assessed to see tissue extraction

27
Q

End Points of Resuscitation

-Goal

A

maximize survival and minimize morbididty

  • UO: >0.5 mL/kg/hr
  • CVP: 8-12 (if intubated)
  • MAP: 65-90
  • Central venous oxyg. concentration: >70%
28
Q

What do all the types of shock have in common?

A

INEFFECTIVE TISSUE PERFUSION

ACUTE CIRCULATORY FAILURE

29
Q

5 types of shock

A
  • hypovolemic
  • septic
  • cardiogenic
  • anaphylactic
  • neurogenic
30
Q

Defining characteristic of HYPOVOLEMIC SHOCK

A
  • inadequate Intravascular fluid volume

- ** MOST COMMON TYPE OF SHOCK

31
Q

Hypovolemic shock

1- NON-HEMORRHAGIC

A
  • vomiting
  • diarrhea
  • Bowel obstruction
  • pancreatitis
  • neglect (dehydration)
32
Q

Hypovolemic Shock

2- HEMORRHAGIC

A
  • GI bleed
  • trauma
  • Massive hemoptysis
  • abdominal aortic aneurysm rupture
  • ectopic pregnancy
  • post partum bleeding
33
Q

Treatments for Hypovolemic Shock

A
  • ABC
  • 2 large bore IVs or a central line
  • Crystalloids: NS or LR up to 3 liters
  • PRBC: O negative or crossed matched
  • control bleeding
34
Q

Evaluation of HYPOVOLEMIC SHOCK

A

CBC

  • ABG/lactate
  • electrolytes
  • BUN/Cr
  • Coagulation
  • type and cross match
35
Q

Diagnostic procedures for HYPOVOLEMIC SHOCK

A
  • CXR
  • pelvic xray
  • abd/pelvis CT
  • chest CT
  • GI endoscope
  • bronchoscope
  • vascular radiology
36
Q

Hypovolemic Shock

-effect on hemodynamics

A

Loss of circulating volume (decreased PRELOAD) leads to decreased SV & CO
–> inadequate cellular O2 supply and ineffective tissue perfusion

37
Q

CARDIOGENIC SHOCK

-defining factors

A
  • SBP 18
38
Q

S/S cardiogenic shock

A
  • cool, mottled skin
  • tachypnea
  • hypotension
  • ALOC
  • narrowed pulse pressure
  • rales, murmer
39
Q

Causes of cardiogenic shock

A
  • Acute MI
  • sepsis
  • myocarditis
  • myocardial contusion
  • aortic and mitral stenosis
  • aortic insufficiency
40
Q

Pathophys of Cardiogenic shock

-LV function

A

after ischemia, loss of Left ventricular function

** loss of 40% of LV–> shock

41
Q

Pathophys of cardiogenic shock

- CO reduction

A

-CO reduciton–> lactic acidosis & hypoxia

42
Q

Pathophys of cardiogenic shock

-stoke volume reduction

A
  • tachypnea developes to compensate

- ischemia and infarction worsens

43
Q

Pathophys of Cardiogenic shock

-BOTTOM LINE

A

-heart cant pump blood forward!

44
Q

Diagnostics tests for cardiogenic shock

A

EKG
CXR
CBC, chem 10, cardiac enzymes, coag
echocardiogram

45
Q

Cardiogenic shock treatment

A

revascularization procedure or MI pt
Medications- inotropes, diuretics, antidysrhythmias
-maintain airway
-IABP

46
Q

Anaphylactic shock define

A
  • a severe systemic hypersensitive reaction characterized by multisystem involvement
    • IgE reaction
47
Q

Anaphylactic shock

-Anaphylactoid reaction

A

clinically indistinguishable from anaphylaxis

    • doesnt require sensitizing exposure
  • not IgE mediated
48
Q

Anaphylactic shock patho

A

1- activation of mast cells and basophils (IgE, IgG or non immunologic : cold, heat, ETOH)
2- Release of biochemical mediators (histamine)
3- Vasodilation, permeability, brochoconstriction
4- relative hypov

49
Q

shock definition

A

inadequate oxygen delivery to meet metabolic needs

results in global tissue hypoperfusion and metabolic acidosis

Critical Care Test 2 (6 decks)

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