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Med Surg > Shock > Flashcards

Shock Flashcards

1
Q

What is shock

A

insuff tissue perfusion causing impaired cellular metabolism

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2
Q

What shock relates to low blood flow

A

Cardiogenic

Hypovolemic

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3
Q

What shock relates to the distribution of blood

A

Septic
Anaphylactic
Neurogenic

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4
Q

Can edema be a cause of hypovolemia

A

yes with massive edema

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5
Q

What are the causes of cardiogenic shock

A

things that cause heart failure

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6
Q

So if cardiogenic shock is caused from HF then what would be a diagnositic test to assess for HF

A

using a swans gans cath in the pulmonary artery

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7
Q

How much fluid needs to be lost for hypovolemic shock to kick in

A

more than 30%

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8
Q

What are some causes of relative hypovolemia

A

Sepsis, burns, bowel obstruction

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9
Q

What happens in neurogenic shock

A

SNS is turned off so no more vasoconstriciton, increased HR, RR, etc.

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10
Q

What are some causes of neurogenic shock

A

spinal injury
spinal anesthesia
opioids
benzodiazepines

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11
Q

If the SNS is turned off in neurogenic shock then what takes over

A

the parasympathetic

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12
Q

So then if the parasymp has taken over in neurogenic shock then what manifestations would we likely see

A

bradycardia

hypotension

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13
Q

What is a big difference with the heart rate between hypovolemic/cardiogenic and neurogenic shock

A

the first two will increase HR while neuro decreases it

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14
Q

What happens in anaphylactic shock

A

massive vasodilation from histamine release so permeability increases

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15
Q

What is a distinctive mani of anaphylactic shock

A

angioedema

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16
Q

What happens in septic shock

A

vasodilation from infection

17
Q

What is indicative symptoms of septic shock

A

warm flushed skin

18
Q

What is obstructive shock

A

Occurs when blood flow is restricted by decreased cardiac output
so everything works you just have something cause a restriction

19
Q

What are some causes of obstructive shock

A

Tamponade. Pneumothorax, abdominal compartment syndrome

RV thrombi, PE

20
Q

What indicative symptom might be seen in obstructive shock

A

JVD and pulsus paradoxus

21
Q

What do we see in the initial stage of shock

A

not much

little lactic acid build up from anaerobic meta from lack of perfusion

22
Q

What happens in the compesatory stage of shock

A

start seeing the body compensate like SNS kicking in, ADH prod, RAAS
Start seeing BP drop from less CO

With ↓ CO  baroreceptors stimulate SNS  vasoconstriction (epinephrine & norepinephrine) and blood to vital organs is maintained but is cut off to non-vital (kidneys, GI, skin, lungs, etc.)
With ↓ flow to kidneys  RAAS system is initiated  vasoconstriction of veins and arteries  ↑ return to the heart and ↑ BP
At the same time the adrenal cortex is stimulated  ADH  increased reabsorption of water and sodium at kidneys  increases circulating volume and ↑BP and ↑CO.
↓ blood to GI  ↓ GI motility (potential paralytic ileus)
↓ blood to skin  cool & clammy (septic patient will be warm)
↓ blood to lungs means there will be decreased chance for oxygenation at the same time that the heart has begun to work harder (↑ oxygen demand)  compensatory ↑rate and ↑ depth of respirations  remember VQ mismatch from the respiratory lecture
Coronary arteries dilate, heart speeds up, increases output and all is well. If we can correct the insult at this point there will probably be a full recovery . . . . . And if not . . . . The progressive stage

23
Q

What are some manifestations during the compensatory stage

A

the signs of compensation

24
Q

What happens as you enter the progreessive stage

A

metabolic acidosis after the compensatory mechs have failed

25
Q

What are other manifestations of the progressive stage

A

organs start to fail
systemic interstitial edema
anasarca

26
Q

What happens in the refractory stage

A

interventions are a lot less responsive

27
Q

What are the interventions for shock

A

oxygenate
give fluids
give a blanket (from cold fluids entering the vessels)
blood transfusions
vasoconstrictors like epi
vasodilators for cardiogenic shock
parenteral feeding for first 24 hrs if shock was stabalized

28
Q

What ratio do we give fluids when replacing it during hypovolemic shock

A

3:1

29
Q

What is one of the last things to go in the nervous system

A

pain response

Med Surg (35 decks)

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