Shock Flashcards by MO ROUTH

Shock

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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Compensated shock

normal blood pressure with inadequate perfusion

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

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Uncompensated shock

hypotension and inability to maintain normal perfusion

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Decreased circulatory volume

hypovolemic shock

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Impaired heart pump function

cardiogenic shock

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Pathologic peripheral blood vessel vasodilation

distributive shock

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Non-cardiac obstruction to blood flow

obstructive shock

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most common shock

hypovolemic shock

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Pulmonary embolus, tension pneumothorax, tamponade

obstructive shock

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shock index

heart rate divided by systolic blood pressure

A normal index ranges from 0.5-0.7

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Acute coronary syndrome, valve failure, dysrhythmias

cardiogenic shock

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Hemorrhage or fluid loss

hypovolemic shock

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

hypovolemic shock

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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.

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

anaphylactic (distributive) shock

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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

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

normal or even elevated blood pressure, and normal heart rate

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Hypoperfused patients often exhibit?

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

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Sepsis, anaphylaxis, neurogenic

distributive shock

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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!