Shock

Question 1

What is shock?

Answer 1

• sign. reduction of systemic tissue perfusion

- Cell membrane dysfunction

Question 2

General signs of shock:

Answer 2

• low BP
• decreased urine output
• altered mental status

Question 3

*What are the main 4 types of Shock?

Answer 3

1. hypovolemic
2. cardiogenic
3. distributive
4. obstructive

Question 4

What is the cause of hypovolemic shock? SSx?

Answer 4

• LOSS OF VOLUME of blood or fluids

- so you will see… rapid, weak, thready pulse w rapid shallow breathing (acidosis)

Question 5

*What are some drugs that can cause hypovolemic shock?

Answer 5

• NSAIDS, aspirin, ibuprofen, heparin, coumadin

Question 6

*What do NSAIDS do?

Answer 6

• inhibit aggreg. of platelets increasing risk of bleeding

Question 7

*Is aspirin, ibuprofen, heparin, coumadin reversible? How to reverse?

Answer 7

• Reversible: ibuprofen, heparin (protamine sulfate), coumadin (vit K)
• Aspirin is irreversible… normal when platelets are replaced

Question 8

*In what drugs is PT, PTT, and INR checked?

Answer 8

PT, INR: Coumadin
PTT: Heparin
*hemophiliacs have prolonged PTT

Question 9

*What does Coumadin do?

Answer 9

• inhibits production of vit K in gut so inhibits production of coag factors
• if want to reverse, supplement vit K

Question 10

*What labs to check with pt using Coumadin? If Pt has hx of PE or DVT, what happens to INR?

Answer 10

• PT, INR

- INR doubles

Question 11

What is PT and what does it measure? INR?

Answer 11

Prothrombin Time
measures extrinsic pathway of coagulation (factors 2, 7, 9, 10).
- INR is a world-wide standardization for PT

Question 12

• Shock Index:
• Formula
• predictor of what?
• see need for?

Answer 12

• HT Rate/Systolic BP
• predictor of impact of blood loss
• transfusion, mortality
• so if heart rate is higher than systolic BP (> 0.9), tx pt has though they are bleeding
• normal = 0.5-0.7

Question 13

*If you don’t have a BP cuff and the pt looks like they in shock, how do you find BP?

Answer 13

measures SYSTOLIC: if this pulse is palpable..

• Radial pulse: 80
• Brachial: 70
• Femoral:60
• Carotid: 50
• first check radial! whew! they might be ok…
• no! its not there, check further up, the brachial! is it there? no?! ahhh femoral nooo…. weird…. okay check closest to heart, carotid! are they alive?!?!
• think… CAROTID, OK YOU ARE HALF ALIVE = 50… radial, 80% alive at least!!

Question 14

*49 yo M in a car accident found on the street…. you run over and make sure he’s breathing.. establish airway and protect the cervical spine! oxygen! He’s thirsty and asking for your juice…. what do you do?

Answer 14

no food or drink bc they may need surgery!

Question 15

What is Cardiogenic Shock?

- ex. Eti

Answer 15

primary failure of ventricles… largely irreversible.

- dysrhythmias after MI

Question 16

SSx of Cardiogenic Shock

Answer 16

low BP, tachycardia, low urine output, JVD, pulsus paradoxus, weak or absent pulse

Question 17

*What is Distributive Shock and what is MC cause?

Answer 17

output of heart is normal, but vessels become bigger causing a lack of pressure

• MC cause is SEPSIS
• —> DIC
• other causes: anaphylactic, neurogenic, vasodilator, endocrine

Question 18

Eti of Obstructive Shock

Answer 18

• PE, severe Aortic Stenosis, Cardiac Tamponade

- physical obstruction of great vessels of the HT

Question 19

*Class I Hemorrhage

Answer 19

Hemorrhage involves up to 15% of blood volume. There is typically no change in vital signs and fluid resuscitation is not usually necessary.

Question 20

*Class II Hemorrhage

Answer 20

involves 15-30% of total blood volume. A patient is often tachycardic with a narrowing of the difference between the systolic and diastolic blood pressures. The body attempts to compensate with peripheral vasoconstriction
Volume resuscitation with crystalloids such as hypertonic saline solution or lactated Ringer’s solution is generally required.
If the source of blood loss has been adequately treated than a blood transfusion is generally not required.
~livedo reticularis?

Question 21

*Class III Hemorrhage

Answer 21

involves loss of 30-40% of circulating blood volume. The patient’s blood pressure drops, the heart rate increases, peripheral hypoperfusion (shock), such as capillary refill worsens, and the mental status worsens. Fluid resuscitation with crystalloid and blood transfusion are usually necessary.

Question 22

*Class IV Hemorrhage

Answer 22

involves loss of >40% of circulating blood volume. The limit of the body’s compensation is reached and aggressive resuscitation is required to prevent death.