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ICM Block I > Shock and Eye stuff > Flashcards

Shock and Eye stuff Flashcards

1
Q

What is the definition of shock?

A

Failure to deliver and/or adequately use oxygen

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2
Q

What are the four classifications of shock?

A

Hypovolemic, septic/inflammatory, cardiogenic, neurogenic

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3
Q

Describe the following in shock: 1. Blood Pressure 2. Heart Rate 3. Respiratory Rate 4. Urine output 5. Metabolism 6. O2 sat

A
  1. BP: under 110 sys. “brachial”
  2. sinus tachycardia - over 90 bpm
  3. RR: Under 7 or over 29
  4. UO: less than 1/2 cc/kg/hr
  5. metabolic acidemia
  6. O2 sat - under 90 if under 50, 80 for 51-70, 70 for over 70
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4
Q

What occurs with preload for hypovolemic shock?

A

decreased pre-load, which leads to inadequate CO

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5
Q

What are some causes of hypovolemic shock?

A

Bleeding, vomiting and diarrhea, adrenal insufficiency, diabetes insipidus, dehydration,

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6
Q

What are the classic signs of hypovolemic shock?

A

hypotension, tachycardia, MS change, oliguria, diminished pulses, narrowed pulse pressure

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7
Q

How do you treat hypovolemic shock?

A

ABCs, IVF (crystalloid 20mL/kg) then colloiod in a 3:1 ratio

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8
Q

Which patients don’t have a typical spike in HR with hypovolemic shock?

A

Patients on Beta blockers, those with spinal shock, athletes

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9
Q

How much blood is lost in each of the 4 stages of hypovolemic shock?

A

Stage 1 - 750 mL (15%)
Stage 2 - 750 - 1500 mL (15-30%)
Stage 3 - 1500 - 2000 mL (30-40%)
Stage 4 - above 2000 mL (above 40%)

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10
Q

What stage of hypovolemic shock does blood pressure change?

A

Stage 3 - systolic blood pressure drops to below 100 mmHg.

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11
Q

How do the ABCs change with trauma?

A

Go to CABs, see if there is any hemorrhage, check cap refill, etc.

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12
Q

Describe Stage 2 of hypovolemic shock

A 
750-1500 mL blood loss
CO can no longer be maintained by vasoconstriction
Tachycardia (over 100 bpm)
Tachypnea
Narrowed pulse pressure 
Delayed cap refiill 
UO reduced to 20 - 30 mL/hour
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13
Q

Describe Stage 3 of hypovolemic shock

A 
1500 - 2000 mL blood loss
First major change in BP, sys. falls to below 100
Tachycardia of 120 bpm
Alteration in mental status
Sweating with pale skin
UO - 20 mL/hr
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14
Q

What is GCS?

A

Eyes: 1) Closed 2) open in response to pain 3) open in response to voice 4) spontaneously open
Verbal: 1) No speaking 2) gurgling 3) Inappropriate words 4) Disoriented, confused 5) Speaking clearly
Movement: 1) No Movement 2) extension in response to pain 3) flexion in response to pain 4) pull away from painful stimuli 5) localizes painful stimuli 6) obeys commands

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15
Q

The clues of Stage 1 of shock include:

A

750 mL loss of blood, change in pallor of skin with compensated vasoconstriction, blood pressure maintained. Slight anxiety.

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16
Q

A patient is making gurgling noises, eyes closed, flexion to pain. What is their GCS?

A

6

17
Q

What causes septic shock/inflammatory shock?

A

releases of inflammatory mediators. Leads to sequestering of blood in cutaneous venules and small veins

18
Q

What do you see in Early and Late septic/inflammatory shock

A

Early- warm with vasodilation, tachypneic

Late - vasoconstriction, hyptotension, oliguria

19
Q

What is the treatment change between hypovolemic shock and septic shock?

A

In septic shock, you still want to do the ABCs, IVF, but also want to give antibiotic in addition to your pressor.

20
Q

Stage 4 of shock includes:

A

Profound tachycardia (over 140), hypotension (under 70), tachypnea, loss of 40% of blood or more, decreased LOC, absent cap refill and urinary output.

21
Q

What are the 4 different kinds of cardiogenic shock?

A

cardiomyopathies, mechanical issues, arrythmias, obstructive disorders like a pulmonary embolism or tension pneumothorax

22
Q

What are the primary findings with cardiogenic shock?

A

high preload (CVP), low CO, low BP, dyspnea

23
Q

What is Beck’s Triad?

A

3 signs associated with acute cardiac tamponade? muffled heart sounds, JVD, hypotension. This causes obstructive cardiogenic shock

24
Q

What are 4 causes of neurogenic shock?

A

Spinal cord injury, anesthesia, Drugs, Neurological disorders

25
Q

Which type of shock has an increased CO?

A

Inflammatory/septic shock

26
Q

Which types of shock have SVR (peripheral resistance - no lungs)

A

Hypovolemic and Cardiogenic

27
Q

What medications should you use to treat shock?

A

Pressors:
Dobutamine = ionotrope (increased contractility)
Epi/Norepi/dobutamine = increase in shock

28
Q

What is glaucoma?

A

Glaucoma is caused by increased ocular pressure. The two types are closed angle (which can come on suddenly) and open angle (chronic).

29
Q

What is the normal flow of aqueous humor out of the eye, starting with the posterior chamber>

A

Aqueous humor flows through the pupil from the posterior chamber to the anterior chamber. It then flows through the trabecular meshwork and the canal of schlemm to enter the blood stream.

30
Q

What is open angle vs. closed angle glaucoma?

A

Open angle occurs when aqueous humor cannot be evacuated through the trabecular meshwork and causes a chronic, painless buildup of AH over time. Closed angle is acute and caused by a closing of the iris/corneal angle, resulting in rapid build up of pressure and is painful.

31
Q

What is clinical presentation of glaucoma?

A

If it is acute, the vessels dilate, and cornea can be clouded. If chronic, there may be no visible appearance until you examine the back of the eye. Severe eye cupping

32
Q

What is Cup to Disk ratio?

A

Ratio of the physiological cup of optic nerve to overall diameter of nerve (disk). She look like a donut with a very tiny hole. Record horizontal, then verical. 0.4/0.3

33
Q

What is papilledema

A

optic swelling due to increased ICP

34
Q

What is hypertensive retinopathy?

A

damage to the retina due to hypertension. Normal Artery:Vein ratio is 4/5 to 2/3 but if artery is half the size of vein = hypertensive.

35
Q

What do you see in diabetic retinopathy?

A

Early Macular Edema with Hard Yellow Exudates and Retinal Hemorrhages; Cotton Wool Spots and Flame Shaped Hemorrhages. See angiogenesis and hemorrhaging. Advance stage is retinal detachment.

36
Q

What are the 4 types of hemorrhages in the eye?

A
  1. pre-retinal - diabetes
  2. dot and blot - diabtetes
  3. flame - hypertension
  4. sub-retinal - age related macular degeneration

ICM Block I (5 decks)

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