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CSI- Winter > Shock > Flashcards

Shock Flashcards

1
Q

Criteria to diagnose as shock

A
  • Hypotension
  • Tachycardia (often first symptom)
  • Oliguria
  • AMS (altered mental status may be only presenting symptom
  • Peripheral hypoperfusion and impaired O2 delivery* MOST IMPORTANT
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2
Q

Basic progression of shock

A
  • Arterial blood flow can not keep up with demand of tissues metabolic needs
  • Resulting in hypoxia to the body as a whole
  • Resulting in anaerobic metabolism to kick in at peripheral tissues
  • *Resulting in lactic acidosis (lactic acid build up, very bad)**

Overall: Decreased oxygen to peripheral tissues

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3
Q

4 types of shock

A

Hypovolemic
Cardiogenic
Obstructive
Distributive

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4
Q

Hypovolemic shock

A
  • Decreased intravascular volume
  • Due to loss of blood or fluid and electrolytes
  • Blood loss from whatever reason (trauma, ruptured ectopic pregnancy, GI bleed, etc)
  • Loss of fluid and electrolytes (N/V/D)
  • Body will compensate by vasoconstricting, but after 15% loss of volume, shock sets in.
  • Anything that decreases BP can cause shock; body responds by vasoconstriction
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5
Q

S/S of Hypovolemic shock

A
  • Oliguria, AMS, cool extremities, diaphoresis, pale
  • Narrow pulse pressure (reduced stroke volume)
  • DECREASED PCWP, CO, & venous return; Elevated TPR (HIGH output failure)
  • Improves with fluids
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6
Q

Cardiogenic shock

A
  • From cardiac failure
  • Heart can not maintain necessary cardiac output
  • Definition: as evidence of tissue hypoxia due to decreased cardiac output in the presence of adequate intravascular volume
  • Could be from MI, cardiomyopathy, valve dysfunction, arrhythmias
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7
Q

S/S of Cariogenic shock

A
  • Oliguria, mental status changes, diaphoresis, cool extremities, jugular venous pressure is elevated, pulmonary edema might be present with respiratory failure.
  • LOW output failure (elev TPR, Low CO & venous return)
  • ELEVATED PCWP (pulmonary wedge pressure)
  • Blood pressure improves with fluids
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8
Q

How to differ between cardiogenic and hypovolemic shock

A

Cardiac echocardiogram

Hypovolemic shock: LV will be small due to poor filling, but maintains contractility (not enough fluid to pump); but contractility is fine

Cardiogenic shock: decrease in LV contractility (THIS IS THE DIFFERENCE; problem with your heart, contractility on echo will be different)

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9
Q

Obstructive shock

A
  • Cardiac tamponade
  • Tension pneumothorax (needle first remember, not chest tube)
  • Massive PE
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10
Q

Distributive shock (septic, SIRS, neurogenic, anaphylaxis)

A
  • AKA vasodilatory shock

- Produces a decreases in systemic vascular resistance; resulting tissue hypoperfusion

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11
Q

S/S of Distributive shock (septic, SIRS, neurogenic, anaphylaxis)

A
  • Normal circulatory volume
  • Low TPR, PCWP
  • Elevated CO, venous return (HIGH output failure)
  • Vasodilation (warm dry skin)
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12
Q

SIRS

A
  • type of distributive shock
  • Systemic Inflammatory Response Syndrome
  • Can occur from an infectious cause, or noninfectious (burns, pancreatitis, trauma, ischemia)
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13
Q

Criteria for SIRS

TEST!

A

Need to have at least two of the following:

  • Temp >100.4, or 90
  • RR >20 or hyperventilation with a CO2 on abg 12 or 10% bands
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14
Q

Septic shock

A
  • SIRS + a source (uti, pneumonia, cellultis, meningitis)
  • Most common type of distributive shock
  • 20-50% mortality
  • Risks are age, DM, immunosupression, recent invasive procedures

Shock in setting of DIC from trauma often is from sepsis

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15
Q

Most common agents that cause septic shock

A

gram negatives (E coli, Pseudomonas, Klebsiella)

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16
Q

Neurogenic shock

A
  • type of distributive shock
  • Caused by traumatic spinal cord injury or by effects of an epidural, or spinal anesthetic
  • Loss of sympathetic tone and systemic vascular resistance
  • Hypotension WITHOUT a compensatory tachycardia
  • A benign other type of neurogenic shock which can result in syncope is “vasovagal syncope”—caused by pain, gastric dilatation, or fright, producing hypotension, bradycardia, and syncope
17
Q

S/S of shock in general

A
  • everything vasoconstricts (brain is last to be effected)
  • Hypotension (this may be masked in early stages by compensatory mechanisms such as tachycardia, increased cardiac contractility, and vasoconstriction)
  • Cool and mottled extremities (red blotches, usually starts in legs, bad sign)
  • Splanchnic vasoconstriction can lead to oliguria (decreased urine output), bowel ischemia, hepatic dysfunction, MSOF (Multi system organ failure- all of the above put together)
  • Altered mental status (AMS is very very common)
18
Q

Sepsis markers in blood

A

Lactate (very bad)

Procalcitonin

19
Q

General treatment

A
  • ABC’s with prompt intervention
  • Respiratory failure not uncommon—due to existing metabolic acidosis. Intubation can reduce O2 demand of respiratory muscles and allow improved oxygen delivery to other hypoperfused tissues.
  • Will develop compensatory respiratory alkalosis (will need to be intubated)
  • Monitor urinary output, possibly foley (may have renal failure)
  • IVF for hypotension
20
Q

What to give first? Blood or saline?

A

Give blood before giving saline, need to increased oxygen carrying capacity, giving BLOOD is more important, can give O- blood immediately (don’t need to waste time typing)

-If you give them fluids when they are in shock, can make it worse (inducing CHF; try giving very small boluses)

21
Q

For Septic shock, the standard is to give

A

GET 30 cc/kg (of weight) of fluid without exception, given all at once
This is a standard- main goal is to reverse hypotension

22
Q

Early Goal Directed Therapy for Septic Shock

Will be a patient case on this on the TEST*

A
  • .9NS (saline) to achieve CVP 8-12 mm Hg
  • Vasopressors to achieve MAP 65 mm Hg or greater
  • PRBCs (packed red blood cells) to achieve Hgb of 10 or greater
  • Results in lower mortality and morbidity*
23
Q

When to give Pressors

A
  • When fluids don’t work to maintain blood pressure
  • Need central line to give (central lines go in VEINS)
  • Dobutamine, Norepinephrine (Levophed), vasopressin, dopamine
24
Q

Can’t give Pressors through IV in arm because

A

it increases the pressure in that area, necrosis will happen in that area, can lose limb (VERY BAD, this can happen if you accidentally put central line in artery)

  • central lines MUST go in veins
  • To see if central line is in artery or vein- draw blood gas from central line, and draw a gas from a known artery, if they are the same- BAD (line is accidentally in artery, ABGs should be VERY different from artery and vein)
25
Q

When to use Corticosteroids

A
  • Used when shock is due to adrenal insufficiency
  • Otherwise, most articles do not show its routine use in shock beneficial

-Goal is to stop inflammation, but only works when problem is adrenal insufficiency

26
Q

Antibiotics are used for

A

Septic shock and SIRS

Nursing home pts- treat for MRSA Treat with Vancomycin

CSI- Winter (44 decks)

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