Shock Flashcards
What is SIRS?
Wide spread inflammatory response from a multitude of pathological causes
What is MODS?
Altered organ function in the acutely I’ll where homeostasis cannot be maintained
Initial shock is what?
The first stage of shock. There is no indication of hypo perfusion yet
The second shock stage, compensatory shock is what?
The neuroendocrine system is attempting to compensate to restore perfusion. (Barorrceptor reflex, SNS stimulation; CNS response, hormonal response)
What is the progressive stage of shock?
The inability of the neuroendocrine system to maintain tissue perfusion. Tissue perfusion decreased is now evident
Refractory shock is what?
Irreversible stage, unresponsive to vasopressors
What are some causes of hypovolemix shock?
Bleed DKA/HHS Addisons NGT suction DI Diuretic Burns Heat exhaustion
3rd spacing- intestinal obstruction, cirrhosis, pancreatitis, hypoprotenemia
At what percentage of blood loss will you begin to see low BP and PP?
15% or greater
What ratio do you replace crystaloids on a blood loss patient?
3:1 ratio
NS
LR
Plasmalyte
Blood product replaces blood at war ratio?
1:1
PRBC
FFP
Hextend
If someone looses 15% of blood or less, how much do you give them back?
1L crystaloids the. Maitanence
If someone loses 15-30% blood how do you replace them?
2L crystaloids then reevaluate
If someone loses 30-40% or more blood how do you replace it?
2L crystaloids reevaluate, replace blood product at 1:1 ratio and maintain urine at>0.5mL/kg/HR
What is the S1Q3T3 on an EKG? What does it tell you?
S wave in lead 1
Q wave in Lead 3
T inversion in lead 3
Could indicate a PE, PNX, tamponade
What options for treatment do you have for obstructive shock?
Anticoagulation
Thrombocytes
Embolectomy
Filter placement
How to you treat cardiogenic shock with ischemia?
Inotropes, Revascularization, afterload reduction: Meds vs VAD or IABP
How do you treat aortic dissection with AI?
Surgery, afterload reduction
How do you treat neurogenic shock?
Atropine
Dopamine
Fluids
Pacing
How do you treat anaphulylactic shock?
Elevate lower extremities Evaluate airway Fluids Epi 1:1000 0.2-0.5 SQ (can repeat 2-3 times at 10-15 minute interval) Epi gtt H1 (benedryl) H2 ranitidine Steroids
What are some general criteria for Sepsis?
Increased or decreased temp Increased RR AMS Edema Increased blood sugar
What are some inflammatory criteria for Sepsis?
Leukocytosis or leukopenia
Plasma C reactive protein
Procalcitonin
A P/F ratio of what indicates ALI? What about ARDS?
ALI is P/F ratio of < 300
What do you want to CVP at in sepsis?
8-12
What is a goal MAP in sepsis?
> 65
What is the goal Urine output in sepsis?
> 0.5ml/kg/hr
What is the goal ScVO2 or SVO2 (mixed venous oxygen) in sepsis?
ScVO2- 70%
SVO2- 65%
How quickly should ABX be started in sepsis?
Within the first hour for a duration of 7-10 days
I’d during a fluid challenge in sepsis a patient becomes metabolic acidosis what do you do?
Can give bicarbonate gtt if pH
What is the first line pressor for sepsis?
Levo, then Vaso, then Epi
If patient is in refractory shock what other medication can you give if patient is pressor dependant?
Steroids
Hydrocortisone up to 200mg/day
