Shock Flashcards
what does inadequate systemic oxygen delivery activate?
autonomic response to maintain oxygen delivery
-SNS and RAAS
Sympathetic NS
- what is released
- what happens when these are released
- NE, Epi, dopamine, cortisole
- vasoconstriction, increased HR, increased cardiac contractility
Renin-Angiostensin Axis
-what happens during this response
- water and sodium are conserved
- vasosconstriction
- increases Blood volume and blood pressure
What is another name for the activation of SNS and RAAS system
Compensatory stage of shock
Global Tissue Hypoxia define
cellular response to decreased systemic oxygen delivery
what happens during global tissue hypoxia
- ATP depletion
- cellular edema
- hydrolysis of cell membrane and cell death
- endothelial inflammation and disruption
Result of global tissue hypoxia
Lactic acidosis
- cardiovascular insufficiency
- increased metabolic demand
Stage of shock during global tissue hypoxia
Progressive Stage of Shock
Multiorgan dysfunction Syndrome MODS
progress of physiological effects as shock ensues
- cardiac depression
- respiratory distress
- renal failure
- DIC
- organ failure
Phase name for MODS
Refractory Stage of shock
Initial Stage of Shock
cardiac ouptut decreases
- reason varies by type of shock
- tissue perfusion threatened
Compensatory Stage of shock
homeostatic mechanisms kick in
-the body is still able to maintian CO, BP, and tissue perfusion
Progressive Stage of Shock
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
Refactory stage of shock
unresponsive to treatment
- irreversible
- ORGANS DIE
- MODS
- death d/t decr. tissue perfusion
- circulatory system unable to meet body demands
Approach to pt in shock
ABC’s assessment
cardio-respiratory monitor -pulse ox -supplement oxygen -IV acess -ABGs Foley cath -VS
Diagnosis of Shock
- physical exam
- hemodynamics
- Infectious source
- labs
Diagnosis: LABS
- cbc
- chemistries
- lactate
- coagulation
- cultures
- ABGs
Shock and pulses:
if carotid pulse is felt-
systolic at least 60
Shock and pulses:
-if radial pulse felt:
-systolic BP at least 70
Shock and pulses
-if femoral pulse felt:
-systolic BP at least 80
Shock and pulses:
-if Pedal pulse felt
-SBP at least 90
Goals of treatment
ABCDE
A-airway B-control WOB C- circulation optimized D- delivery of oxygen E- end points of resusc. achieved
Control WOB
-how to decrease O2 consumption
- Resp. muscles consume a lot of oxygen
* * mechanical ventilation and sedation decrease WOB and improve survival
Ways to Maintain O2 delivery
1- decrease O2 demands
provide analgesics and anxiolytics to relax muscles and avoid shivering
Ways to Maintain O2 Delivery
2- maintain arterial oxygen sats/content
- give O2
- maintain hgb >10 g/dl
Ways to Maintain O2 Delivery
3- Lactate levels
lactate levels or central venous O2 sats assessed to see tissue extraction
End Points of Resuscitation
-Goal
maximize survival and minimize morbididty
- UO: >0.5 mL/kg/hr
- CVP: 8-12 (if intubated)
- MAP: 65-90
- Central venous oxyg. concentration: >70%
What do all the types of shock have in common?
INEFFECTIVE TISSUE PERFUSION
ACUTE CIRCULATORY FAILURE
5 types of shock
- hypovolemic
- septic
- cardiogenic
- anaphylactic
- neurogenic
Defining characteristic of HYPOVOLEMIC SHOCK
- inadequate Intravascular fluid volume
- ** MOST COMMON TYPE OF SHOCK
Hypovolemic shock
1- NON-HEMORRHAGIC
- vomiting
- diarrhea
- Bowel obstruction
- pancreatitis
- neglect (dehydration)
Hypovolemic Shock
2- HEMORRHAGIC
- GI bleed
- trauma
- Massive hemoptysis
- abdominal aortic aneurysm rupture
- ectopic pregnancy
- post partum bleeding
Treatments for Hypovolemic Shock
- 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
Evaluation of HYPOVOLEMIC SHOCK
CBC
- ABG/lactate
- electrolytes
- BUN/Cr
- Coagulation
- type and cross match
Diagnostic procedures for HYPOVOLEMIC SHOCK
- CXR
- pelvic xray
- abd/pelvis CT
- chest CT
- GI endoscope
- bronchoscope
- vascular radiology
Hypovolemic Shock
-effect on hemodynamics
Loss of circulating volume (decreased PRELOAD) leads to decreased SV & CO
–> inadequate cellular O2 supply and ineffective tissue perfusion
CARDIOGENIC SHOCK
-defining factors
- SBP 18
S/S cardiogenic shock
- cool, mottled skin
- tachypnea
- hypotension
- ALOC
- narrowed pulse pressure
- rales, murmer
Causes of cardiogenic shock
- Acute MI
- sepsis
- myocarditis
- myocardial contusion
- aortic and mitral stenosis
- aortic insufficiency
Pathophys of Cardiogenic shock
-LV function
after ischemia, loss of Left ventricular function
** loss of 40% of LV–> shock
Pathophys of cardiogenic shock
- CO reduction
-CO reduciton–> lactic acidosis & hypoxia
Pathophys of cardiogenic shock
-stoke volume reduction
- tachypnea developes to compensate
- ischemia and infarction worsens
Pathophys of Cardiogenic shock
-BOTTOM LINE
-heart cant pump blood forward!
Diagnostics tests for cardiogenic shock
EKG
CXR
CBC, chem 10, cardiac enzymes, coag
echocardiogram
Cardiogenic shock treatment
revascularization procedure or MI pt
Medications- inotropes, diuretics, antidysrhythmias
-maintain airway
-IABP
Anaphylactic shock define
- a severe systemic hypersensitive reaction characterized by multisystem involvement
- IgE reaction
Anaphylactic shock
-Anaphylactoid reaction
clinically indistinguishable from anaphylaxis
- doesnt require sensitizing exposure
- not IgE mediated
Anaphylactic shock patho
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
shock definition
inadequate oxygen delivery to meet metabolic needs
results in global tissue hypoperfusion and metabolic acidosis
