Shock Flashcards
Shock definition
A physiologic state characterized by a significant reduction of systemic tissue perfusion, resulting in decreased oxygen delivery to the tissues
Cellular effects of shock
Cell membrane ion pump dysfunction, intracellular edema, leakage of intracellular contents into the extracellular space and inadequate regulation of intracellular pH
Systemic effects of shock
Alterations in serum pH and endothelial dysfunction, stimulation and release of pro- and anti-inflammatory mediators
General signs for all types of shock
- low BP
- decreased urine output
- altered mental status
4 main types of shock
hypovolemic
cardiogenic
distributive
obstructive
Pre-shock
AKA warm shock or compensated shock
Characterized by rapid compensation of diminished tissue perfusion by various homeostatic mechanisms
Early ssxs of shock
Hypotension Tachycardia Dyspnea Mental confusion Restlessness Diaphoresis Cool, clammy skin
Late ssxs of shock
Dropping or unobtainable BP Rapid, thready pulse Dusky discoloration of skin Skin cool or cold to touch Irregular, gasping respirations Decreased level of consciousness with eventual unresponsiveness
Causes of hypovolemic shock
Loss of blood
External loss of fluids (vomiting, diarrhea, burns)
Internal loss of fluids (ascites, pancreatitis)
What is one of the more common causes of increased bleeding?
Use of non-sterioidal anti-inflammatory drugs
Aspirin: Thromboxane production inhibited = decreased platelet aggregation. Irreversible.
Ibuprofen: Reversible inhibitors of the COX 1 and COX 2 enzymes.
How does Warfarin act?
Inibits vit k production in the gut
vit k dependent coagulation factors: II, VII, IX, X
Shock index
patient’s heart rate divided by their systolic BP
Used to better assess risk of pts for increasing transfusion needs and mortality
Normal SI
0.5-0.7
SI > 0.9
Approach pt as if they are actively bleeding
Predicts twice the risk of massive transfusion
SI > 1.1
Predicts 4x the risk of massive transfusion
