Shock Flashcards
Stage 1. Initiation
No observable clinical indications
Stage 2. Compensatory
^ HR Narrowed pulse pressure Rapid deep respiration's causing alkalosis Thirst, cool moist skin diminished bowel sounds, RAAS Hyperglycemia Restless progressing to confusion
Stage 3. Progressive
Dysrhythmias Deceased BP Tachypnea Absent bowel sounds lethargy progressing to coma Hyperglycemia ^ BUN, creatinine, potassium Respiratory and metabolic acidosis
Stage 4. Refractory
MODS, SIRS Life threatening dysrhythmias ACIDOSIS ARDS DIC Kidney failure MI
SIRS
Release of mediators
causes Hypovolemia
Hypovolemic Shock LABS
^ HR Normal to low Low CO Low CI Low RAP Low PAWP
Cardiogenic Shock LABS
^HR Low CO Low CI ^ RAP ^PAWP
Obstructive Shock LABS
^ HR
Low CO
Low CI
Septic Shock LABS
^ HR
High then low CO
High then low CI
Hypovolemic Shock Causes
External loss of blood Diarrhea Burns Hemothorax ascites
Hypovolemic Shock Clinical presentation
^ HR ↓ BP Tachypnea Flat neck veins Cool pale, skin ↓ CO, CI, RAP, PAP, PAWP ^SVR ↓ HCT
Hypovolemic Shock management
Eliminate and treat cause
Replace lost volume with fluid
Cardiogenic Shock causes
MI
HF
Dyshrythmias
Cardiogenic Shock Clinical presentation
^ HR Dysrthymias ↓ BP Chest pain ↓ CO, CI, SVO2 ^RAP,PAP,PAWP,SVR
Cardiogenic Shock managment
Improve CONTRACTILITY with inotropic meds
Mechanically ventilate
Emergency Revascularization
Neurogenic Shock Causes
General or Spinal anesthesia
Epidural block
Cervical spinal cord injury
meds: barbituates
Neurogenic Shock Clinical presenation
↓ HR, BP
Hypothermia
Warm, dry flushed skin
EVERYTHING LOW
Neurogenic Shock Management
Eliminate and treat cause
Maintain MAP
VTE Propholaxis
Septic Shock Causes
Extreme Age
Malnutrition
Immunosuppresive therapy
BACTERIA
Septic Shock EARLY
^HR Normal to ↓ BP Widened pulse pressure Skin warm Oliguria Confusion ^CO, CI, SVR
Septic ShocK LATE
^HR ↓ BP ↓ Pulse pressure, LOC Skin COOL ↓ CO, CI, SVR
Hypovolemia Fluids
- Isotonic Crystalloids, NS is typically used first
May use blood first IF pt is bleeding - 3-for-1 rule.
Infusion of 300 Ml of fluid for every 100 ml of blood
lost
Cardiogenic Shock also includes
Left sided HF, S3 Heart sound, crackles, dyspnea
R sided HF, Vein distention, edema
Cardiogenic Shock, you should
PCI or stent placement
Fibrolynics when PCI is not available
Beta-blockers
Oxygen administration
Cardiogenic MEDS
Diuretics and Vasodilators, Morphine, nitroglycerin
Dobutamine
For pts receiving Spinal Blocks
Elevate the HOB
Dopamine
norepi
