Shock Flashcards
What are the 4 types of shock
Hypovolemic shock
Cardiogenic shock
Distributive shock
Obstructive shock
What is pre-shock
Stage of shock characterized by rapid compensation of diminished tissue perfusion by various homeostatic mechanisms
What are general signs of all types of shock
low blood pressure, decreased urine output, and altered mental status
what are the early signs of shock
hypotension, tachycardia, dyspnea, mental confusion, restlessness, diaphoresis and cool, clammy skin
What are late signs of shock
Dropping or unobtainable blood pressure, a rapid, thready pulse, dusky discoloration of skin, skin is cool or cold to the touch, irregular, gasping respirations and decreased level of consciousness with eventual unresponsiveness
What are causes of hypovolemic shock
- Loss of blood: examples include trauma with either external or internal bleeding - may be referred to as hemorrhagic shock.
- External loss of fluids: examples include vomiting, diarrhea, burns and severe exfoliative dermatitis (i.e. SJS and TSS).
- Internal loss of fluids (“third spacing”): examples include ascites and pancreatitis
What are the ssx of hypovolemic shock
A rapid, weak, thready pulse due to decreased blood flow combined with tachycardia.
Rapid and shallow breathing due to sympathetic nervous system stimulation and acidosis.
Hypothermia due to decreased perfusion and evaporation of sweat.
Thirst and dry mouth, due to fluid depletion.
Cold and mottled skin (livedo reticularis), especially extremities, due to insufficient perfusion of the skin
Who is at risk for hypovolemic shock
Those with: Disorders involving vascular integrity
Disorders of platelet number and/or function
Disorders of coagulation factors
Medications
How long does the effect of ibuprofen on platelets last
48-72 hours
How long should aspirin be discontinued before surgery
7 days at least, 10 is better, 14 is best
What labs should be checked if someone is on Warfarin
INR (standardized PT)
What is checked if some one is on heparin
PTT. normally you are switched of heparin
What is the action of warfarin (coumadin)
Poisons the liver pathway, so antidote with vitamin K
What is the antidote for hepatin
protamine sulfate
What common drug can cause bleeding in those on warfarin
antibiotics, as the number of vitamin K producing gut bacteria can be significantly reduced
What is a shock index
patient’s heart rate divided by the pt’s systolic blood pressure
Why is the shock index used
SI has been shown to be a stronger predictor of the impact of blood loss than either the heart rate and blood pressure alone.
The shock index has been used to better risk stratify patients for increasing transfusion requirements and for mortality
What is a normal shock index
Normal SI = 0.5 - 0.7
What is a class 1 hemorrhage
Involves 1-15% of person’s blood volume. typically no change in vitals and fluid resuscitation is not normally necessary
What is a class 2 hemorrhage
15-30% blood volume loss. A patient is often tachycardic with a narrowing of the difference between the systolic and diastolic blood pressures. In class II hemorrhage, the body attempts to compensate for decreasing circulatory blood volume with peripheral vasoconstriction; the skin may look pale and be cool to the touch
What is the minimum treatment for class 2 hemorrhage
Volume resuscitation with crystalloids such as hypertonic saline solution or lactated Ringer’s solution is generally required
What is livedo reticularis
Livedo reticularis is a common skin finding consisting of a mottled reticulated vascular pattern that appears as a lace-like purplish discoloration of the skin. The discoloration is caused by swelling of the venules owing to obstruction of capillaries by small blood clots.
What is class 3 hemorrhage
30-40% blood volume loss. Blood pressure drops, heart rate increases, peripheral hypoperfusion increases and mental status worsens with altering level of consciousness
What is class 4 hemorrhage
> 40% blood volume loss. The limit of the body’s compensation is reached and aggressive resuscitation is required in order to prevent death
How do you estimate BP
If a radial pulse is palp. - B/P is ≈ 80 syst.
If a brachial pulse is palp. - B/P ≈ 70 syst.
If a femoral pulse is palp. - B/P ≈ 60 syst.
If a carotid pulse is palp. - B/P ≈ 50 syst
What should be done if there is hemorrhagic shock due to trauma
Establish a patent and protected airway while protecting the cervical spine
Maximize oxygenation
Gain intravenous access and initiate fluid resuscitation
Control hemorrhage
Monitor level of consciousness and reassess V/S at least every 3 - 5 minutes
What is a big no-no if someone has hemorrhagic shock
No food or drink!! (they probably have to go to surgery and there is a risk of vomiting)
What causes cardiogenic shock
A shock that results from an inadequate circulation of blood due to primary failure of the ventricles of the heart, resulting in insufficient perfusion of tissue to meet the demands for oxygen and nutrients.
What are ssx of cardiogenic shock
Drop in blood pressure Distended jugular veins due to increased jugular venous pressure Weak or absent pulse Arrhythmias, often tachycardias Pulsus paradoxus in case of tamponade Congestive heart failure
What is the treatment for cardiogenic shock
Depending on the type of cardiogenic shock, treatment involves infusion of intravenous fluids, or in shock refractory to fluids, inotropic medications, anti-arrhythmic agents may be administered.
If cardiogenic shock is due to a MI, attempts to open the heart’s arteries may help.
Intra-aortic balloon pump
What is distributive shock
Output of heart is normal but vasoconstriction prevents perfusion
What subclasses of distributive shock
Septic shock Anaphylactic shock Neurogenic shock Vasodilator drugs Endocrine related shock (addisonian crisis)
What is obstructive shock
form of shock associated with physical obstruction of the great vessels or the heart itself.
What are common causes of obstruct shock
Pulmonary embolism, emboli to the cardiac vessels, severe aortic stenosis and cardiac tamponade forms of obstructive shock
