Shock Flashcards
shock definition
Inadequate oxygen delivery to meet metabolic demands
Results in global tissue hypoperfusion and metabolic acidosis
what physiologically is activated during shock
sympathetic NS-epi/NE/dopamine cause vasoconstriction and increased CO
RAAS-Na and H2O conservation
Progression of physiologic effects as shock ensues Cardiac depression Respiratory distress Renal failure DIC Result is end organ failure
multiorgan dysfunction syndrome
S/S shock
Patient looks ill Altered mental status Skin cool and mottled or hot and flushed Weak or absent peripheral pulses SBP <110 Tachycardia
what to remember about intubating
intubation can worsen hypotension
Sedatives can lower blood pressure
Positive pressure ventilation decreases preload
goal urine output
0.5 ml/kg/hr (30 ml/hr)
maintain a Hg of
at least 7
goal CVP
MAP
central venous oxygen
8-12 mm/Hg
65 mm/Hg
70%
causes of hypovolemic shock
wounds
burns
diarrhea/vomitting
altered mental status. She is febrile to 39.4, hypotensive with a widened pulse pressure, tachycardic, with warm extremities
septic shock
two or more signs of SIRS can indicate sepsis
Temp > 38 or < 36 C HR > 90 RR > 20 WBC > 12,000 or < 4,000 Plus the presumed existence of infection Blood pressure can be normal!
septic shock
sepsis + refractory hypotension After bolus of 20-40 mL/Kg patient still has one of the following: SBP < 90 mm Hg MAP < 65 mm Hg Decrease of 40 mm Hg from baseline
also can be defined as pressors neeeded to maintain a MAP >65 and lactate >2
how to tx persistent hypotension
If no response after 2-3 L IVF, start a vasopressor (norepinephrine{1st line}, dopamine, etc)
Consider adrenal insufficiency, give hydrocortisone
A 55 yo M with hx of HTN, DM presents with “crushing” substernal CP, diaphoresis, hypotension, tachycardia and cool, clammy extremities
cardiogenic Defined as: SBP < 90 mmHg CI < 2.2 L/m/m2 PCWP > 18 mmHg narrow pulse pressure
A 34 yo F presents to the ER after dining at a restaurant where shortly after eating the first few bites of her meal, became anxious, diaphoretic, began wheezing, noted diffuse pruritic rash, nausea, and a sensation of her “throat closing off”. She is currently hypotensive, tachycardic and ill appearing.
distributive, anaphylactic
IgE mediated
biphasic rxn, symptoms may recur 3-4 hours after initial rxn has cleared
