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Neo Pathophys 2 > Shock > Flashcards

Shock Flashcards

1
Q

What is shock?

A

Complex circulatory dysfunction—>insufficient O2 and nutrient delivery to satisfy tissue requirements

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2
Q

Name the 2 classifications of Shock

A
  1. Compensated (normal b/p & decreased flow to non-essential organs)
  2. Uncompensated (decreased blood flow to all organs)
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3
Q

Name the 2 subtypes of Uncompensated Shock

A
  1. Reversible

2. Irreversible

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4
Q

With Compensated Shock, which 3 organs get preferential perfusion?

A
  1. Heart
  2. Brain
  3. Adrenals
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5
Q

What happens when Compensation is used up?

A

Anaerobic Metabolism–>Increased Glucose Metabolism–>Metabolic Acidosis & Cellular Dysfunction–>Release of Chemical Mediators–>Further Decreased Tissue Perfusion–>Capillary Leak–>Sluggish Blood Flow–>DIC–>Death

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6
Q

Capillary leak is seen especially w/what type of shock?

A

Septic Shock

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7
Q

Recite the shock pathway starting with Inadequate tissue perfusion to 1 or more organs.

A

Inadequate tissue perfusion to 1 or more organs–>Decreased O2 & Nutrients–>Inadequate Delivery to meet Metabolic needs of tissues (lactic acid met.& dec. pH)–>Cellular dysfunction–>Possible cellular death

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8
Q

What is the formula for CO?

A

CO = HR x SV

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9
Q

SV is the volume of blood ejected in _____ ______.

A

Heart Beat (from Ventricle)

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10
Q

CO is the amount of blood ejected in each _______.

A

Minute

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11
Q

What is the only way infants can effect CO?

A

By altering HR. They can not change SV (like an adult can).

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12
Q

What can be the earliest sign of shock?

A

Altered HR

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13
Q

What are the factors that negatively affect CO?

A

Decreased Preload
Increased Afterload (Increased SVR)
Decreased Myocardial Contractility (less blood w/each beat)
Electrolyte, Mineral or Energy Imbalances

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14
Q

Name the 3 types of shock

A
  1. Hypovolemic
  2. Cardiogenic
  3. Septic
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15
Q

What is the most prevalent type of shock in NICU?

A

Hypovolemic

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16
Q

What does Hypovolemic shock result from?

A

Low circulating Blood Volume

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17
Q

When does Cardiogenic shock happen?

A

When the Heart Muscle functions poorly

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18
Q

True/False: Septic shock includes parts of Hypovolemic and Cardiogenic Shock?

A

True.

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19
Q

Name the 4 causes of Hypovolemic Shock

A
  1. Acute blood loss during Intrapartum Period.
  2. Postnatal Hemorrhage
  3. Obstructive (Pneumopericardium, etc)
  4. Other non-hemorragic causes (cord accidents, dehydration, capillary leak)
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20
Q

What is the estimated blood loss in Compensated Hypovolemic Shock?

How much Replacement volume would you give?

A

~25%

20 mL/kg

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21
Q

What is the estimated blood loss in Uncompensated, Reversible Hypovolemic Shock?

How much Replacement volume would you give?

A

~25-40%

20-30 mL/kg

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22
Q

What is the estimated blood loss in Uncompensated, Irreversible Hypovolemic Shock?

How much Replacement volume would you give?

A

> 40%

> 30 mL/kg

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23
Q

Name causes of Cardiogenic shock

A 
Intrapartum/Postpartum Asphyxia
Hypoxia/Metabolic Acidosis
Bacterial/Viral Infection
Severe RDS
Severe Hypoglycemia
Severe Metabolic/Elelctrolyte Imbalances (esp Hyperkalemic Crisis--effects Heart pumping)
Arrythmias (SVT)
CHD's (esp a/w hypoxemia or obstruction of systemic circulation--i.e. Hypoplastic L. H.)
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24
Q

Septic Shock is caused by?

A

Severe Infection–Viral OR Bacterial.

Usually Gram- Cocci, but can be Gram+

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25
Q

True/False: W/a bacterial infection, many complicated systemic reactions occur that result in circulatory insufficiency

A

True

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26
Q

In Septic Shock, what allows fluid to leak out of the blood vessels and into the tissue spaces?

A

Loss of Vascular Integrity

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27
Q

In Septic Shock, Poor Myocardial Contractility leads to…..

A

Poor tissue Perfusion and Oxygenation

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28
Q

With poor Myocardial Contractility, _____ _________ is a high risk.

A

Organ Failure

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29
Q

What is the Hallmark of Septic Shock?

A

They do not respond to Fluid Resuscitation

30
Q

What are the Altered Areas affected by Shock in Clinical presentation?

A 
Respiratory effort
Pulses
Peripheral perfusion
Color
Heart Rate
Heart-itself
B/P
Neuro Exam
U.O.
31
Q

What would you see w/altered Respiratory Effort?

A
  1. Increased WOB
  2. Tachypnea
  3. Apnea
  4. Gasping
32
Q

What is Gasping?

What would you do to tx?

A

A sign of impending Respiratory Failure

Provide PPV and Possible intubation

33
Q

What would you look for in Pulses w/Septic Shock?

A

Strength of Pulses

Comparison of them

34
Q

What would you see w/Altered Peripheral Perfusion in Shock?

A
  1. Poor Perfusion
  2. Prolonged Cap Refill time
  3. Cool Skin
  4. Mottled Skin
35
Q

What color might you see in shock?

A

Cyanosis (and desaturations)

Pallor (may not have enough RBC’s to even turn cyantoic–Very BAD)

36
Q

What 2 Heart Rate types might you see in Shock?

A

Tachycardia

Bradycardia

37
Q

Which is a more concerning sign, Bradycardia or Tachycardia?

A

Bradycardia

38
Q

Which is often displayed 1st, Tachycardia or Bradycardia?

A

Tachycardia

39
Q

What 3 things lead to Bradycardia?

A
  1. Hypoxemia
  2. Hypotension
  3. Acidosis
40
Q

In terms of the Heart on x-ray, what might you see?

A

Enlarged

Compressed (bilateral pneumo, pneumopericardium)

41
Q

If a mom has SLE, what might baby have?

A

Neonatal Heart block

42
Q

What might you hear on heart exam?

A

Murmur

43
Q

W/shock is B/P high or low?

A

Either high or low

44
Q

B/P alteration is an Early or Late sign of Cardiac Decompensation?

A

LATE

45
Q

Lower extremity B/P’s are usually higher or lower than Upper extremity B/P’s?

A

Higher

Compare lower to upper

46
Q

Too small cuff results in falsely _______ b/p.

A

Elevated

47
Q

In addition to B/P, you also want to evaluate the _____ ________.

A

Pulse Pressure

48
Q

What is the normal PP for a Preemie?

A

15-25

49
Q

What is the normal PP for a Term?

A

25-30

50
Q

What does a Narrow PP mean?

A

Cardiac Compression

51
Q

What does a Widened PP mean/where might you see this?

A

PDA
AV malformations
Truncus

52
Q

How do you measure PP?

A

Systolic b/p -Diastolic b/p

53
Q

What do you examine on Neuro assessment?

A

Lethargy

54
Q

What is a concerning U.O. ?

A

< 1mL/kg/hr OR declining UO in presence of signs of Hypoperfusion

55
Q

What labs would you want to evaluate w/Shock?

A 
Blood gas
Glucose
Electrolytes
iCa
LFT's
Renal Fxn tests
Coags
Blood Lactate
CBC w/d
Blood Cx
Cardiac Enzymes

ECHO (fxn)
ECG (rhythm)
UO
Ammonia (and other metabolic screens)

56
Q

How do you treat Shock?

A

ID the cause

57
Q

What are the Tx Goals of Shock?

A

Increasing CO–>Increases Tissue perfusion–>Increases Tissue oxygenation–>Decreases Anaerobic Metabolism–>Decreases Lactic Acid build-up–>Increases pH = Happy NNP & Baby :-)

58
Q

How do you Tx Hypovolemic Shock?

A
  1. Note Acute blood loss

2. Volume Replacement

59
Q

What type of volume replacement is used?

A
  1. Crystalloid Solutions (NS –usually used 1st, but could be LR)
  2. Colloid Solutions (not used much except w/Hydrops–5% Albumin, Plasminates. They stay in vascular space longer, expensive, allergies dev, are blood derivative)
  3. Blood Products
60
Q

Will infants with Hx of Chronic blood loss in Severe Shock tolerate volume boluses?

A

No. They’ve adapted to the decreased volume.

The boluses are reserved for ACUTE blood loss.

61
Q

What is the emergency blood replacement?

A

O-

Get it released from Blood Bank

62
Q

What is a good test to try to have done before transfusion if possible?

A

NBMS

63
Q

How do you Tx Cardiogenic Shock?

A

Tx underlying problems Negatively affecting Heart Fxn

64
Q

What medications might be used w/Cardiogenic Shock?

A

Volume Expanders
NaHCO3 4.2% (controversial)
Dopamine (most common inotrope used-is renal dosing)
Epinephrine (increasing use esp W/O response to Dopamine)

65
Q

How do you Tx Septic Shock?

A

Combo of Hypovolemic and Cardiogenic Shock therapies

66
Q

Does a baby w/Septic Shock need More or Less fluid boluses than other types of shock?
Why?

A

Usually More

D/T movement of fluid from Intravascular to Interstitial Space

67
Q

W/Septic Shock, Oxygenation and Ventilation must be ________.

A

Maximized

68
Q

What medications may be used to Tx Septic shock?

A

Volume expanders
NaHCO3 4.2%
Dopamine

69
Q

When might NaHCO3 be considered as Tx?

If given, what needs to be considered?

A

Severe Metabolic Acidosis

Adequate Ventilation
Rate of Infusion (linked to IVH in preemies)

70
Q

Dopamine has ______ related effects.
Has ________ solutions.
Monitor ____, _____ & _________ ____

A

Dose-related
Standardized
HR, B/P, & infusion site (PIV site, NEVER in Artery, ONLY IN VEINS)

Neo Pathophys 2 (20 decks)

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