Shock Flashcards
MAP equation
MAP = CO X SVR
calculating MAP
(DBP x 2) + SBP then divide by 3
CO equation
HR x SV
SV equation
preload x contractility
what is occult shock
MAP and lab value
when a pt usually lives at a higher BP and is now in a lower range than usually
-MAP is over 65 and lactate is elevated
what is the shock index equation and what does it signify
HR/SBP
-if over 1 then + and is has more negative outcome
pt comes in and has increased pulse pressure and is warm, what kind of shock
distributive, low vascular tone
70/20 etc
what are the causes of distributive shock
1) sepsis
2) anaphylaxis
3) spinal shock
4) anesthesia
5) adisons disease
different types of shock from CO
HR: arrythmia
SV: PL;: obst: RV: pericardial tamp and tension pneumo
SV: PL obst: LV: pulmonary embolism
SV: PL: vol down: dehydr, diures, diarrhea, hemorrhage
SV Contractility: CHF and MI
if pt is in shock from decreased PL what should you do first
IVF
treating shock from contractility issues like mi and chf
inotropes
get bnp, troponins, echo, ekg
types of shock (4)
distributive
cardiogenic
obstructive
hypovolemic
what are the go to medications in sepsis
inoconstrictors
norepi (levophed)
dopamine
problem with SVR and not sepsis what drug class
vasoconstrictors
- epinephrine
- phenylephrine (neo)
- vasopressin
chf and shock med class
inodilators
-dobutamine and milrinone
HTN meds
nicardipine (cardine)
possibly esmolol or NO
what receptors are on cardiac muslce
B1
receptors on blood vessels
a1
receptors on muscle vasculature
B2
SIRS criteria
Temp above 38 or below 36
HR above 90
RR above 20
WBC count above 12 and below 4
severity SIRS
2/4 criteria
Sepsis criteria
sirs w/ source
severe sepsis criteria
sepsis with lactate over 2 and or MAP under 65
septic shock criteria and then what do you start
severe sepsis and no response to fluids, get vasopressors
early goal directed therapy in severe sepsis
fluid challenge: 300cc/kg of LR = NS
-check to see if Lactate and MAP normal
ABX
Source control (pull out lines, remove abscess etc.)
what pressors in septic shock and order
norepi (levophed) dopamine vasopressin epinephrine steroids is last resort (addisons)
late goal directed therapy in severe sepsis (next day after admin)
3 main categories
SVR = arterial line = pressors
preload = U/S to look at IVC collapsing
-best is leg lift which will give 300-500 cc bolus, see if arterial line pressure goes up, if so increase fluids
contractility (ScVO2): want over 70%
-if below 70% means that pumping not great and that pooling could be occuring somewhere. if blood pooled then more o2 extracted. May need inotropic support
