Shock Flashcards
what are the different types of compensation
neural
chemical
horomonal
cellular response
is this strictly RBC?
external losses
internal losses
blocked venous return
no it can be plasma, fluid volume or whole blood loss.
what is EBL of class one of shock? (hypovolemia)
S/S? (HR, PP, cap refill, RR, urine output, BP)
what do you need to do to intervene?
40 cap refill brisk RR 15-20 rine outpt >30 BP norma
crystalloid 2000-3000ml
EBL of class 2 hypovolemia? S/S
intervention?
750-1500ml. 15-30%
agitation
HR >100
PP
class 3
EBL
S/S
interventions?
1500-3000ml
30-40%
agitated & confused
HR >120 PP 20-30 cap refill delayed RR 30-40 urineo/p 5-15 BP decreased/varies
needs crysalloid 4500-
blood 2-4 units
class 4
EBL
S/S
interventions?
>2000ml >40% confused and lethargic HR >150 PP 10-20 cap refill no blanching RR > varies and shallow urine o/p negligable BP BP decreased / varies
Needs…
crystalloid 4500 ml +
blood 2-4 units
what is the management of hypovolemic shock?
early recognition
stop the losses
replace losses if indicated
what are the causes of cariogenic shock?
coronary
-ami
post OHS ischemia
noncoronary
cardiomyopathy
tamponade
tension pneumothorax
what are the S/S of cariogenic shock?
forward flow
backward pressure
prgan hypoperfusion
stages of compensation
what is the management of cardiogenic shock?
early recognition
increase myocardial contractility (inotrope)
reduce moycardial oyxygen demands (dilate the coronary arteries)
what are the causes of distributive shock?
septic shock
anaphylactic shock
neurogenic shock
what are the S/S of septic shock?
evidence of infection
organ hypoperfusion
no alpha SNS compensation
what are the S/S of anaphylactic shock?
evidence of exposure
airway reactivity
organ hypoperfusion
no alpha SNS compensation
what are the S/S neurogenic shock?
evidence of injury
organ hypoperfusion
no SNS compensation
what is normal MAP?
70-105mmHg
what is the acid-base balance in each phase/class?
1: resp alkolsis
2: metb acidosis
3: profound acidosis
what is normal pulse pressure?
40mmHg
why does narrowing of pulse pressure occur in shock?
because diastolic will inc because the catecholamines inc the VR from vasoconstriction and the systolic will decrease because of the lack of flow
what is your skin like in class 1 or the compensatory phase of hypovolemic shock?
cold and clammy
what cardiovascular effects might occur from hypovolemic shock?
dysrhythmias and ischemia, chest pain. my have MI. inc cardiac enzymes, myocardial depression and ventricular dilation
what hepatic damage occurs during shock?
dec blood flow dec metb of wastes and more sus. to infect.
ubc liver enzymes and bilirubin –> jaundice
GI effects from shock?
ischemia causes stress ulcers in stomach (inc risk of GI bleed)
bloody diarrhea
bacteria toxins may enter circulation via lymph
enteral feeding in shock states is recommended
would there be an inc in bleeding or clotting in shock?
bleeding due to DIC because all the clotting factors are consumed d/t over activation of inflm response.
might need platelets and clotting factor replacements
why is there hyperglycaemia in shock?
bc the release of the catecholamines, cortisol, glucaogns and inflm cytokines and mediators are released and so there is hyperglycemia and insulin resistance to mobilize glucose for cellular metb
glyconeogensis occurs in the liver and gluconeogensis from proteins and fats cause hyperglycaemia
what medical mgmt is there for shock?
early enteral support, aggressive hyperglycaemic control w IV insulin, antacids, histamine 2 blockers, DVT prophylaxis
how does RL help with the acid-base problem?
it has lactate ion that converts to bicarbonate and buffers the acidosis
whats a disadvantage of using an isotonic solution for fluid replacement?
some of it is lost in the interstitial compartment d/t cellular permeability from the shock
why are colloids better choices for shock therapy?
contain molecules that are too large to pass through capillary membranes and they expand the intravascular volume by exerting oncotic pressure and pull fluid into the intravascular space (none is lost) also longer duration and less vol is required
what are some risks of hypovolemic shock (think external and internal)
external: trauma, sx, diarrhea, vomiting, diabetes insipidus, diuresis
internal: ascites, hemorrhage, burns, peritonitis, dehydration
what are some medications that you might give for hypovolemic shock?
dobutamine nitroglycerin dopamine antiarrthymic medications mechanical assistive devices
what does dobutamine do?
inotropic effects (inc HR, contractility)
what does nitroglycerin do?
acts as a vasodilator and reduces preload and at high doses acts as an arterial vasodilator
what does dopamine do?
sympathomimetic agent. vasoactive effects.. inc the HR and CO
what are some risk factors for septic shock?
immunosuppression, extremes of ages, malnourishment, chronic illness, invasive procedures, pneumonia
what is the patho behind septic shock?
immune response causes inflm response and inc cap perm and vasodilation
what are some early signs of septic shock?
BP remains normal at first, tachycardia begins, hyperthemia, flushing, tachypnea, bounding pulses, possible GI upset, inc serum glucose and insulin resistance, confusion and agitation, inc lactate levels, WBC high or low
what are some major signs of septic shock
BP drops, skin cool, pale and mottled, temp normal or low, Hr and rr remain high, oliguria, MODS and possible death
how soon do u want to treat sepsis?
first hour
what is neurogenic shock?
vasodilation resulting from loss of balance between parasympathetic and sympathetic stimulation-> predom parasympathetic causing bradycardia and drop in BP
what are some causes of neurogenic shock?
spinal cord injury, spinal anesthesia, depressant action of meds, glucose deficiency
medical mgmt for neurogenic shock?
restore sympathetic tone by stabilization of spinal cord injury
glucose if insulin shock
what is some nursing mgmt for neurogenic shock?
prevention- fter spinal ro epi, important to elevate HOB to 30 degrees to prevent spread of anesthetic spinal cord
cardiovascular and neuralgic support, compression socks, elevate feet to prevent pooling
what is anaphylactic shock?
mast cells release vasoactive substances (histamine, bradykinin)
S&S of anaphylactic shock?
resp stress (wheezing, stridor), tachycardia, prolonged cap refill, neurlogical compromise and possible pruitis, abdominal cramping
medical mgmt of anaphylactic shock?
epinephrine, benadryl, albuterol via neb, CPR, intubation, IV inert
what is multiple organ dysfunction syndrome?
develops with cut illness that compromises perfusion
occurs at the end of septic shock
which organ fails first in MODS?
lungs-> dyspnea, resp failure
S&S of MODS?
hotn, hypoxemia, hypercapnia, adventitious breath sounds, inc creatinine, dec Burnie output, thrombocytopenia, coagulation abnormalities, lactic academy, metb acidosis, altered LOC, elevated LFTS, hyperbilirubenimia
