Shock Flashcards
MAP
SBP+ 2DBP/3
Inadequate __________ perfusion
TISSUE
Common cellular changes in shock
Decreased energy production Deterioration of cellular function Excess production of lactic acid Eruption of intracellular lysosome Cell death
Classifications of Shock
- Distributive: Neurogenic, Anaphylactic, Septic
- Hypovolemic
- Cardiogenic
- Obstructive
Distributive Shock
Decreased vascular tone
- Neurogenic
- Anaphylactic
- Septic
Hypovolemic Shock
Body fluid depletion
Cardiogenic Shock
Pump failure
Obstructive Shock
Blood flow obstruction that leads to decreased CO
Shock Focus of care
- Identify pts at risk
- Integration of pts hx and PA to make dx
- Tx and eliminate cause
- Monitor tissue perfusion
- Protect target organs from dysfunction
- Multisystem support care
Pts at risk for shock
autoimmune, elderly, young, trauma pt.
Management:
O2>90% IV access to maintain BP and CO Drug therapy Nutritional therapy Pulses perfusion
Stages of Shock
Initial
Compensatory/Non-progressive
Progressive
Refractory “Does not respond to tx”
Neurogenic Shock Causes:
Pain Anesthesia Stress SCI Head Trauma
Neurogenic Management
Airway
TREAT HYPOTENSION AND BRADYCARDIA (with vasopressor and Atropine)
Fluids
Temp control
Anaphylactic Managament
Prevention CPR and emergency respiratory mangement Identify and remove agent Epi Fluids Benadryl/solumedrol Neb bronchodilator
SIRS
If >2 = SIRS Temp <36 (96.8) or >38 (100.4) HR >90 RR>20 or PaCO2 <32 WBC <4000 or >12000 OR >10% bands
Sepsis =
SIRS+ infection
Sepsis 3 hr bundle
Lactate
Blood cultures
Broad spectrum abx
crystalloid for hypotension or lactate >4
Sepsis 6 hr bundle
Vasopressors to keep MAP >65
For persistent hypotension:
COnsider NICOM-use passive leg raise to determine fluid response
Hypovolemic Shock sx
Tachy
Dec LOC
Dec UO
Dec labs
Hypovolemic monitoring
ABP, PAP, CVP, UO, Labs
Hypovolemic Management
Treat cause; restore volume
Ensure a patent airway
2 IVs
Crystalloids: replace 3cc for every 1 cc of EBL
When fluids is not successful in hypovolemic shock:
VASOCONSTRICTORS (Vasopressors) To raise BP Dopamine Epi Norepi Phenylenephrine
Cardiogenic shock + isotropes to enhance contractility
DEN
Dieuretics: Decrease preload
Beta Blockers
IABP
LVAD
