Shock Flashcards
what is the definition of shock?
inadequate tissue perfusion
what are the different types of shock?
- hypovolemic
- septic
- cardiogenic
- neurogenic
- anaphylactic
what are the signs of shock?
- pale, diaphoretic, cool skin
- hypotension, tachycardia, tachypnea
- decreased mental status and pulse pressure
- poor capillary refill
- poor urine output
what are the best indicators of tissue perfusion?
urine output, mental status
what lab tests help assess tissue perfusion?
lactic acid - elevated with inadequate tissue perfusion
base deficit
pH from ABG - acidosis assoc with inadequate tissue perfusion
what is hypovolemic shock?
decreased intravascular volume
what are the common causes of hypovolemic shock?
hemorrhage burns bowel obstruction crush injury pancreatitis
what are the early signs of hypovolemic shock
orthostatic hypotension, mild tachycardia, anxiety, diaphoresis, vasoconstriction (decreased pulse pressure with increased diastolic pressure)
what are the late signs of hypovolemic shock?
changed mental status, decreased BP, marked tachycardia
what is the treatment of hypovolemic shock?
stop the bleeding
volume: IVF (isotonic LR) then blood products PRN
why does decreased pulse pressure occur with early hypovolemic shock?
pulse pressure decreases because of vasoconstriction, resulting in elevated diastolic BP
what is the most common vital sign change associated with early hypovolemic shock?
tachycardia
what type of patient does not mount a normal tachycardia response to hypovolemic shock?
patients on ß blockers, spinal shock, endurance athletes
should vasopressors be used to treat hypovolemic shock?
no
what is septic shock?
documented infection and hypotension
what are the signs/symptoms of septic shock?
initial: - vasodilation, resulting in warm skin and full pulses - normal urine output delayed: - vasoconstriction and poor urine output - mental status changes - hypotension
what are the associated findings with septic shock?
fever, hyperventilation, tachycardia
what is the treatment of septic shock?
- volume (IVF)
- antibiotics (empiric, then by cultures)
- drainage of infection
- pressers PRN
what is cardiogenic shock?
cardiac insufficiency, left ventricular failure (usually), resulting in inadequate tissue perfusion
what are the causes of cardiogenic shock?
MI, papillary muscle dysfunction, massive cardiac contusion, cardiac tamponade, tension pneumothorax, cardiac valve failure
what is neurogenic shock?
inadequate tissue perfusion from loss of sympathetic vasoconstrictive tone
what are the common causes of neurogenic shock?
spinal cord injury:
- complete transection of the spinal cord
- partial cord injury with spinal shock
- spinal anesthesia
what are the signs/symptoms of neurogenic shock?
hypotension and bradycardia, neurologic deficit
why are heart rate and BP decreased?
loss of sympathetic tone (but hypovolemia must be ruled out)
what are the associated findings with neurogenic shock?
neurologic deficits suggesting cord injury
what must be ruled out in any patient where neurogenic shock is suspected?
hemorrhagic shock
what is the treatment of neurogenic shock?
IV fluids
what is spinal shock?
complete flaccid paralysis immediately following spinal cord injury
may or may not be associated with circulatory shock
what is the lowest reflex available to the examiner of neurogenic shock?
bulbocavernous reflex: checking for contraction of the anal sphincter upon compression of the glans penis or clitoris
what is the lowest level voluntary muscle for neurogenic shock?
external anal sphincter
what are the classic findings associated with neurogenic shock?
hypotension, bradycardia or lack of compensatory tachycardia
what is the acronym for treatment options for anaphylactic shock?
BASE
- benadryl
- aminophylline
- steroids
- epinephrine
