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aaa EM Exam > Shock > Flashcards

Shock Flashcards

1
Q

Shock

A

broad term that describes a physiologic state where oxygen delivery to the tissues is inadequate to meet metabolic requirements, causing global hypoperfusion.

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2
Q

Compensated shock

A

normal blood pressure with inadequate perfusion

Thus, pt w/ normal vital signs may still be in shock.

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3
Q

Uncompensated shock

A

hypotension and inability to maintain normal perfusion

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4
Q

Decreased circulatory volume

A

hypovolemic shock

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5
Q

Impaired heart pump function

A

cardiogenic shock

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6
Q

Pathologic peripheral blood vessel vasodilation

A

distributive shock

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7
Q

Non-cardiac obstruction to blood flow

A

obstructive shock

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8
Q

most common shock

A

hypovolemic shock

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9
Q

Pulmonary embolus, tension pneumothorax, tamponade

A

obstructive shock

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10
Q

shock index

A

heart rate divided by systolic blood pressure

A normal index ranges from 0.5-0.7

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11
Q

Acute coronary syndrome, valve failure, dysrhythmias

A

cardiogenic shock

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12
Q

Hemorrhage or fluid loss

A

hypovolemic shock

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13
Q

decreased PO intake or fluid loss due to vomiting, diarrhea, excess urination

A

hypovolemic shock

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14
Q

Chest pain, shortness of breath, leg swelling, or syncope may precede the development of shock due to ?

A

a cardiac (ACS, CHF) or obstructive (PE) cause.

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15
Q

Sudden onset of hives, face or body swelling whether associated with a known trigger or not can signal ______ shock.

A

anaphylactic (distributive) shock

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16
Q

In some cases, however, non-focal, vague symptoms such as ________ may be the only presenting signs of any of the types of shock.

A

weakness, altered mental status, or malaise

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17
Q

Early shock may present with _________; but, if left untreated, tachycardia and hypotension will follow.

A

normal or even elevated blood pressure, and normal heart rate

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18
Q

Hypoperfused patients often exhibit?

A 
cool, pale or cyanotic skin
↓ capillary refill 
dry mucous membranes
AMS
 coma
thready pulses
tachypnea
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19
Q

Sepsis, anaphylaxis, neurogenic

A

distributive shock

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20
Q

heart rate divided by systolic blood pressure

A

shock index

A normal index ranges from 0.5-0.7

21
Q

Shock index values that indicate decreased left ventricular function and are associated with higher mortality.

A

repeated values >1.0

22
Q

lab to gauge the degree of hypoperfusion

A

Lactate

23
Q

Do not cardiovert a fib in the ER if?

A

if possible a-fib has been over 48 hours, do not cardiovert. Possible myxoma has developed–> worse outcome

24
Q

Cardiogenic

HR, CVP, Contractility, SVR

A

HR ↑
CVP ↑
Contractility ↓ ↓
SVR ↑

25
Q

repeated values >1.0 shock index indicate

A

decreased left ventricular function and are associated with higher mortality

26
Q

Hypovolemic

HR, CVP, Contractility, SVR

A

HR ↑
CVP ↓↓
Contractility +/-
SVR ↑

27
Q

WBC common finding in shock

A

elevated or depressed white blood count with left shift

28
Q

Distributive

HR, CVP, Contractility, SVR

A

HR ↑
CVP ↓↓
Contractility +/-
SVR ↓

29
Q

Bicarb in shock

A

↓ serum bicarbonate

-suggests a shift to anaerobic metabolism and tissue hypoperfusion

30
Q

Obstructive

HR, CVP, Contractility, SVR

A

HR ↑
CVP +/- ↑
Contractility +/-

SVR:
↑(tamponade, PE)
↓(tension PTX)

31
Q

First steps in treatment of shock

A

ABCs

IV access

32
Q

HR ↑
CVP ↓↓
Contractility +/-
SVR ↓

A

Distributive (Sepsis)

33
Q

In shock, central venous oxygenation levels targeted above ?

A

70%.

34
Q

HR ↑
CVP ↓↓
Contractility +/-
SVR ↑

A

hypovolemic

35
Q

In most kinds of shock, ____________ should be given as boluses

A

crystalloid fluids

- normal saline or Ringer’s lactate

36
Q

HR ↑
CVP ↑
Contractility ↓ ↓
SVR ↑

A

cardiogenic

37
Q

Be careful with rapid fluid administration to the patient in _________ shock

A

cardiogenic shock with pulmonary edema

38
Q

If volume resuscitation does not improve the patient’s hemodynamic status, vasoactive medications such as ___________n may be used.

A

epinephrine norepinephrine dopamine

vasopressin

39
Q

Hypovolemia due to hemorrhage may warrant ________ control.

A

surgical or interventional

40
Q

Sepsis syndromes should be treated with ?

A
  • early goal-directed therapy
  • maximization of o2 delivery
  • hemodynamic monitoring
  • aggressive antibiotic treatment .
41
Q

Cardiogenic shock may necessitate _____________ procedures

A

e emergent angiography or surgical

bypass/ valve repair,/ IABP

42
Q

IABP

A

a mechanical device that helps the heart pump blood.

device/ catheter with a balloon on the end of it is inserted into the aorta

43
Q

Obstructive shock due to PE often requires ________ treatment

A

anticoagulation or thrombolysis

44
Q

cardiac tamponade treatment

A

emergent drainage of the pericardial fluid may be necessary.

45
Q

Resuscitation of a shock state is thought to be successful when the following occurs

A
  • 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
46
Q

shock lactate goal

A

-lactate decreases by 1/2 in the first couple of hours

47
Q

shock acid base goal

A

-resolution of acidosis / return to normal metabolic parameters

48
Q

Despite proper treatment, the mortality rates from shock can exceed ?

A

50 percent

49
Q

Treatment pearl for shock

A

Do not wait until labs and/or studies return to begin resuscitation; remember the ABCs!

aaa EM Exam (27 decks)

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