Shock Flashcards
Shock
broad term that describes a physiologic state where oxygen delivery to the tissues is inadequate to meet metabolic requirements, causing global hypoperfusion.
Compensated shock
normal blood pressure with inadequate perfusion
Thus, pt w/ normal vital signs may still be in shock.
Uncompensated shock
hypotension and inability to maintain normal perfusion
Decreased circulatory volume
hypovolemic shock
Impaired heart pump function
cardiogenic shock
Pathologic peripheral blood vessel vasodilation
distributive shock
Non-cardiac obstruction to blood flow
obstructive shock
most common shock
hypovolemic shock
Pulmonary embolus, tension pneumothorax, tamponade
obstructive shock
shock index
heart rate divided by systolic blood pressure
A normal index ranges from 0.5-0.7
Acute coronary syndrome, valve failure, dysrhythmias
cardiogenic shock
Hemorrhage or fluid loss
hypovolemic shock
decreased PO intake or fluid loss due to vomiting, diarrhea, excess urination
hypovolemic shock
Chest pain, shortness of breath, leg swelling, or syncope may precede the development of shock due to ?
a cardiac (ACS, CHF) or obstructive (PE) cause.
Sudden onset of hives, face or body swelling whether associated with a known trigger or not can signal ______ shock.
anaphylactic (distributive) shock
In some cases, however, non-focal, vague symptoms such as ________ may be the only presenting signs of any of the types of shock.
weakness, altered mental status, or malaise
Early shock may present with _________; but, if left untreated, tachycardia and hypotension will follow.
normal or even elevated blood pressure, and normal heart rate
Hypoperfused patients often exhibit?
cool, pale or cyanotic skin ↓ capillary refill dry mucous membranes AMS coma thready pulses tachypnea
Sepsis, anaphylaxis, neurogenic
distributive shock
heart rate divided by systolic blood pressure
shock index
A normal index ranges from 0.5-0.7
Shock index values that indicate decreased left ventricular function and are associated with higher mortality.
repeated values >1.0
lab to gauge the degree of hypoperfusion
Lactate
Do not cardiovert a fib in the ER if?
if possible a-fib has been over 48 hours, do not cardiovert. Possible myxoma has developed–> worse outcome
Cardiogenic
HR, CVP, Contractility, SVR
HR ↑
CVP ↑
Contractility ↓ ↓
SVR ↑
repeated values >1.0 shock index indicate
decreased left ventricular function and are associated with higher mortality
Hypovolemic
HR, CVP, Contractility, SVR
HR ↑
CVP ↓↓
Contractility +/-
SVR ↑
WBC common finding in shock
elevated or depressed white blood count with left shift
Distributive
HR, CVP, Contractility, SVR
HR ↑
CVP ↓↓
Contractility +/-
SVR ↓
Bicarb in shock
↓ serum bicarbonate
-suggests a shift to anaerobic metabolism and tissue hypoperfusion
Obstructive
HR, CVP, Contractility, SVR
HR ↑
CVP +/- ↑
Contractility +/-
SVR:
↑(tamponade, PE)
↓(tension PTX)
First steps in treatment of shock
ABCs
IV access
HR ↑
CVP ↓↓
Contractility +/-
SVR ↓
Distributive (Sepsis)
In shock, central venous oxygenation levels targeted above ?
70%.
HR ↑
CVP ↓↓
Contractility +/-
SVR ↑
hypovolemic
In most kinds of shock, ____________ should be given as boluses
crystalloid fluids
- normal saline or Ringer’s lactate
HR ↑
CVP ↑
Contractility ↓ ↓
SVR ↑
cardiogenic
Be careful with rapid fluid administration to the patient in _________ shock
cardiogenic shock with pulmonary edema
If volume resuscitation does not improve the patient’s hemodynamic status, vasoactive medications such as ___________n may be used.
epinephrine norepinephrine dopamine
vasopressin
Hypovolemia due to hemorrhage may warrant ________ control.
surgical or interventional
Sepsis syndromes should be treated with ?
- early goal-directed therapy
- maximization of o2 delivery
- hemodynamic monitoring
- aggressive antibiotic treatment .
Cardiogenic shock may necessitate _____________ procedures
e emergent angiography or surgical
bypass/ valve repair,/ IABP
IABP
a mechanical device that helps the heart pump blood.
device/ catheter with a balloon on the end of it is inserted into the aorta
Obstructive shock due to PE often requires ________ treatment
anticoagulation or thrombolysis
cardiac tamponade treatment
emergent drainage of the pericardial fluid may be necessary.
Resuscitation of a shock state is thought to be successful when the following occurs
- normalization of hemodynamic state (BP, HR, and urine output)
- lactate decreases by 1/2 in the first couple of hours
- normal volume status restored
- maximal tissue oxygenation
- resolution of acidosis / return to normal metabolic parameters
shock lactate goal
-lactate decreases by 1/2 in the first couple of hours
shock acid base goal
-resolution of acidosis / return to normal metabolic parameters
Despite proper treatment, the mortality rates from shock can exceed ?
50 percent
Treatment pearl for shock
Do not wait until labs and/or studies return to begin resuscitation; remember the ABCs!
