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Foundations > Shock > Flashcards

Shock Flashcards

1
Q

MAP equation

A

MAP=CO x SVR

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2
Q

SVR determinants

A

Vessel length, diameter.

Blood viscosity.

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3
Q

Stage of shock

A
  1. Pre-shock: (compensated/warm) Hypotension, Peripheral vasoconstriction, Tachycardia.
  2. Shock: Overwhelmed compensatory mechanism.
    S/S end organ dysfxn-Tachycardia, dyspnea, metabolic acidosis, oliguria, confusion, cool clammy skin
  3. End-organ dysfxn: Progressive dysfxn. Irreversibe damage-Coma-Death.
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4
Q

Shock types (5)

A
  1. Hypovolemic
  2. Cardiogenic
  3. Obstructive
  4. Neurogenic (injury loss of SNS)
  5. Distributive (Sepsis, etc. Decreases TVR)
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5
Q

PCWP

A

Estimates L atrial pressure
Increased: Cardiogenic
Decreased: Hypovolemic & Neurogenic (or normal)

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6
Q

CO

A

Increased: Early septic (hyperdynamic response)
Decreased: All else (may be normal in neurogenic)

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7
Q

SVR

A

Increased: Cardiogenic, Hypovolemic, Late Septic (vasodilation)
Decreased: Early septic (vasodilation), Neurogenic

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8
Q

Hypovolumic etiology

A
  1. Blood loss (Post-surgical, GI bleed, trauma)

2. Fluid loss (Dehydration, Burns, Acute pancreatitis)

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9
Q

Hypovolumic Pathophysiology

A

Decreased: blood vol, preload, SV, CO, BP, tissue perfusion
Compensate: Increase SNS, SVR. Blood shunted to vital organs.
Anaerobic metabolism builds Lactate up.

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10
Q

Hypovolumic parameters

A
  1. CO decreased
  2. PCWP/CVR decreased
  3. TVR increased
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11
Q

Hypovolumic clinical sx

A
  1. Greater loss at higher rate=poorly tolerated
  2. Sx depend on cause
    Hematemesis/Melena/Hematochezia
    N/V/D
    Abdominal pain
    Post-op
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12
Q

Hypovolumic PE signs

A

Dry mucosa
Extremities: cool, clammy, decreased tugor
Decreased BP/JVP/CVP
Increased heart rate
Decreased urine output
Confused mental status
Post-op bleeding-Abdominal pain & distention

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13
Q

Hypovolumic diagnostic tests

A
  1. CBC (h&h), CMP, PT/INR (bleeding)
  2. Lactate (increase assoc with mortality)
  3. ABG
  4. Other: CXR, AXR
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14
Q

Hypovolemic treatment

A
  1. Treat issue
  2. Replace volume
    Crystalloid/Colloid/Blood (PRBC, FFP, Plts)
  3. Monitor urine, perfusion, mentation

Vasopressor only if SBP<70, dire situation.
(Already vasoconstrict as compensatory)

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15
Q

Cardiogenic/Obstructive etiology

A
  1. Ischemia (MI, CM)
  2. Valve ds (Severe AS, ruptured chordae tendinae/septum)
  3. Arrhythmia (Vtach/Vfib/Complete heart block)

Obstructive: PE, tamponade, tension pneumothorax

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16
Q

Cardiogenic pathophysiology

A

Decrease CO, BP,
Decrease renal perfusion-Increase Na/H2O retention
Increase CVP/PCWP-fluid back up in lungs (caution fluids)
Compensatory: Increase SNS, SVR

17
Q

Cardiogenic parameters

A
  1. CO decrease
  2. CVP/PCWP increase
  3. TVR increase
18
Q

Cardiogenic clinical presentation

A

CP, Dyspnea, Fatigue, Palpitations

19
Q

Cardiogenic PE signs

A 
Increased JVP, crackles, tachypnea (fluid in lungs)
Muffled heart sounds (tamponade)
Deviated trachea (tension pneumo)
New murmur
Cool, clammy extremities
20
Q

Cardiogenic Dx studies

A

Same as hypovolumic plus…
Cardiac enzymes (nonspecific)
Echocardiogram
CXR:
Tamponade-enlarged cardiac silhouette
Pneumo-lost vascularity, deviated trachea

21
Q

Cardiogenic treatment

A
  1. Treat issue (cath, ACLS, decompression, pericardiocent)
  2. Cardio consult
  3. Caution with fluids (back up into lungs)
  4. Meds: Inotropes-Dobutamine (increase contractility)
    Anti-arrhythmics, diuretics, vasopressors, HF meds.
    Last line: LVAD, ECMO, transplant
22
Q

Distributive etiology

A 
Sepsis
Adrenal insufficiency
Liver disease
Anaphylaxis
Drugs/Meds
23
Q

Septic pathophysiology

A

Increased O2 demand & Endotoxins

Inadequate perfusion & cell hypoxia

24
Q

Early septic patho

A

Vasodilation & hyperdynamic heart

Decreased SVR, BP. Increased CO. Compensates well, but short.

25
Q

Late septic patho

A

Vasoconstriction.
Due to hypovolumia (leaking) & decreased BP.
Increased SNS, HR, SVR.
Increased SVR decreases perfusion further.

26
Q

Sepsis clinical presentation

A

Increased HR, temp, fever
Decreased BP.
Early-warm. Late-cool.
Confused.

27
Q

Sepsis Parameters

A

A) Early

  1. CO increased
  2. SVR decreased
  3. CVR decreased (due to SVR decreasing)

B)

  1. CO (+/-) usually decreased
  2. CVR usually decreased (plasma leaking)
  3. SVR increased
28
Q

Septic dx studies

A

Same (including lactate)

+ Blood cultures

29
Q

Septic treatment

A
  1. Goal-directed therapies
  2. ID problem (culture before AB, Empiric based on likely)
  3. Fluid
  4. Vasopressors (NE)
  5. Ventilator if needed
30
Q

Septic mortality rate

A

35-60% 1 mo.

31
Q

Neurogenic etiology

A
  1. Spinal cord injury

2. Brainstem injury (closed head trauma)

32
Q

Neurogenic pathophysiology

A
  1. Unopposed PNS, disrupted SNS
  2. Decreased HR & SVR (Vasodilation)
  3. SNS normally released NE/Epi from TL SC
33
Q

Neurogenic PE signs

A
  1. Warm extremities (vasodilations)
  2. Anal sphincter: decreased tone
  3. LOC change, Para/quad, DTR increased or gone
  4. HR normal or gone (ONLY one normal or decrease HR)
  5. BP decreased
34
Q

Neurogenic parameters

A
  1. CO normal or decreased
  2. CVR decreased
  3. TVR decreased
35
Q

Neurogenic dx studies

A
  1. same
  2. Spinal CT/MRI
  3. Head CT/MRI
  4. XR
36
Q

Neurogenic treatment

A

Neuro consult!

Address issues, volume replacement.

Foundations (7 decks)

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