Shock Flashcards
Define: Shock
Inadequate tissue perfusion –> decreased O2 delivery –> hypoxia & metabolic malfxn
- Compensatory mechanisms are overwhelmed
What can shock result in?
- Cell death
- End organ damage
- Death
What is the equation for systemic tissue perfusion?
MAP = CO x SVR
What is SVR influenced by?
- Vessel length & diameter
- Blood viscosity
What determines etiology of shock?
CO & SVR
What are the 3 stages of shock?
- Pre-shock
- Shock
- End-organ damage
Describe pre-shock (including S/S)
- Warm or compensated shock
- Tachy, peripheral vasoconstriction, decreased BP
What are S/S of shock?
S/S of organ dysfunction appear
- Tachy
- Dyspnea
- Metabolic acidosis
- Oliguria
- Confusion
- Cool, clammy skin
Describe end-organ dysfxn
- Progressive
- Irreversible organ damage, coma, death
What are the 5 categories of shock?
- Distributive
- Hypovolemic
- Cardiogenic
- Neurogenic
- Obstructive
What types of lines can you use for resuscitation?
- Arterial
- Central
- Swan-Ganz catheter
Where can you place an arterial line?
- Radial a.
- Brachial a.
- Femoral a.
Describe the fxn of an arterial line
Monitor arterial BP
*NOT used for administering meds
Describe the fxn of a central line
- Deliver caustic/critical meds
- Measure CVP
Define: CVP
Central venous pressure
- Pressure near RA
What does CVP correlate to?
Preload or overall volume status
What is a normal CVP value?
5-15
Define: PCWP
Pulmonary capillary wedge pressure
- LA pressure
What is a normal PCWP value?
5-15
PCWP over 20mmHg indicates…
fluid overload
What is a normal CO value?
4-8
What is a normal SVR?
1000-1500
What type of line is most appropriate in cardiogenic shock?
Swan-Ganz catheter
What is the classic presentation of shock? What are the exceptions?
- Hypotension (SBP <90, or acute decrease in SBP of > 40)
- Tachy (*Exception: Neurogenic shock = decreased HR)
- Oliguria
- Mental status changes
- Cool clammy skin (*Exception: early distributive & neurogenic = flushed, warm)
- Multi-organ failure, coagulopathy
