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CPR Exam 1 > Shock > Flashcards

Shock Flashcards

1
Q

what is shock?

A

inadequate tissue perfusion to meet metabolic demand and tissue oxygenation

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2
Q

what are the physiological categories of shock?

A

cardiogenic
hypovolemic
distributive
obstructive

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3
Q

what are the stages of shock?

A

compensated
decompensated
irreversible

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4
Q

what is compensated shock?

A

reflex compensatory mechanisms activated and perfusion to vital organs is maintained

*increased HR and BP

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5
Q

what is decompensated shock?

A

tissue hypoperfusion and onset of worsening circulatory and metabolic derangement

  • hypotension
  • lactic acidosis
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6
Q

what is irreversible shock?

A

organ and tissue injury is so severe that even if hemodynamic effects are corrected, survival is not possible

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7
Q

what are the subtypes of distributive shock?

A

septic

non-septic (inflammatory, anaphylactic, neurogenic)

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8
Q

what are the subtypes of cardiogenic shock?

A

cardiomyopathic
arrhythmogenic
mechanical

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9
Q

what are the subtypes of hypovolemic shock?

A

hemorrhagic

non-hemorrhagic (fluid loss)

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10
Q

what are the subtypes of obstructive shock?

A

pulmonary vascular

mechanical

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11
Q

what are the hemodynamic changes of cardiogenic shock?

A

decreased CO
increased SVR
increased CVP/PCWP

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12
Q

what are the hemodynamic changes of hypovolemic shock?

A

decreased CO
increased SVR
decreased CVP/PCWP

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13
Q

what are the hemodynamic changes of septic and anaphylactic shock?

A

increased CO
decreased SVR
decreased CVP/PCWP

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14
Q

what are the hemodynamic changes of neurogenic shock?

A

decreased CO
decreased SVR
decreased CVP/PCWP

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15
Q

what are the hemodynamic changes of obstructive shock?

A

decreased CO
increased SVR
variable CVP/PCWP

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16
Q

what are signs of shock?

A 
hypotension
tachycardia
oliguria
AMS
tachypnea
cold, cyanotic skin
metabolic acidosis
elevated lactate
17
Q

what’s the most important thing to remember with an unstable patient?

A 
Airway
Breathing
Circulation
Disability
Exposure
18
Q

how do you treat shock?

A

IVFs
vasopressors
US evaluation (RUSH protocol)
broad-spectrum abx (if sepsis suspected)

19
Q

Equation to determine BP

A

CO x TPR

20
Q

Where is BP the highest?

A

Proximal Aorta

  • hits about 30 mmHg at capillaries
  • almost 0 in the RA
21
Q

64% of blood is held where in circulation?

A

Veins
- SNS decreases venous compliance, shifting blood to the heart and to arterial circulation

  • Also a mechanism by which Nitrates work to decrease O2 demand by the cardiac myocytes. Shift the blood more into the veins to decrease preload
22
Q

Possible outcomes of anoxic cells

A
  1. Thrombosis
  2. Hemorrhage
  3. Edema

Release of inflammatory cytokines IL-1 and TNF

23
Q

2 phases of distributive septic shock

A
  1. Warm shock- High CO but low TPR causing edema. Treat with Fluid resuscitation
  2. Cold shock- low CO, high TPR causing hypo perfusion. Skin is cold and petechiae form.
24
Q

What is the mainstay treatment for hypotension in the absence of cariogenic shock (aka pump failure)

A

Give IVF to raise JVP!

25
Q

Review Anaphylactic Shock

A
  1. IgE-mediated (type I hypersensitivity)
  2. Mast cell degranulation (Histamine, Leukotrienes, PGe’s)
  3. Vasodilation, bronchoconstriction
  4. Can cause ACS

Tx: Epi +/- Antihistamine +/- Albuterol

26
Q

At what stage of hypovolemic shock do you typically start to give blood products instead of just saline?

A

Class III aka >30% blood loss

- Drugs typically not needed

27
Q

Typical inotropes/Vasopressers to give in shock

A
  1. Dobutamine (B1 agonist)
  2. Epi (all receptors)
  3. NE (all - B2)
  4. DA
  5. Phenylephrine
  6. Vasopressin (want V1 receptor activation in vasculature, not V2 in kidney where ADH acts)
28
Q

Common causes of cardiogenic shock aka pump failure

A

MI
Arrhythmias
Valvular Dz

29
Q

Describe how Systolic dysfunction progresses to failure and death

A
  1. Decreased CO (reduced EF)
  2. Decreased perfusion of coronary and peripheral vessels
  3. Compensatory vasoconstriction
  4. Progressive failure
30
Q

Describe how diastolic dysfunction progresses to failure and death

A
  1. Increased LVEDP (Left Ventricle End Diastolic Pressure)
  2. Pulmonary Congestion due to back up
  3. Hypoxemia
  4. Ischemia
  5. Progressive failure
31
Q

Primary drug for cardiogenic shock

A

NE

- Dobutamine can be used when decreased CO in presence of adequate filling

32
Q

Review signs of sepsis

A
  1. Hypotensive
  2. Tachycardic
  3. Tachypnic
  4. edema
  5. AMS
  6. Fever
33
Q

First choice vasopressor for septic shock

A

NE +/- Epi
Vasopressin can be added
Dobutamine if needed

34
Q

What other hormone is necessary to survive critical illness and is elicited by corticosteroid dosage in shock?

A

Cortisol

CPR Exam 1 (19 decks)

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