Shock and Resuscitation Flashcards

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1
Q

Hypovolemic Shock

A

Tachycardia, orthostatic HOTN progresses to supine HOTN w/ severe

Extremities cold and clammy with sluggish cap refill

Narrowed pulse pressure due to low BP and increased SVR

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2
Q

Triad of Death

A

Coagulopathy

Metabolic acidosis

Hypothermia

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3
Q

Shock and Lactic Acidosis

A

Used to determine if tissues are undergoing anaerobic respiration

Anion gap metabolic acidosis if so

High return CO2 to the heart - abnormal value

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4
Q

Cardiogenic Shock

A

Heart failure causing ischemia of tissues

High SVR and filling pressures with low CO -> narrow pulse pressures

Chest pain, orthopnea/PND, JVD, peripheral/pulmonary edema

S3 gallop heart on auscultation

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5
Q

Distributive Shock

A

Commonly septic shock

Decrease in SVR causing loss of fluid into 3rd space - widened pulse pressures (high CO, at least initially)

Can also be caused by anaphylactic shock or adrenal crisis (give steroids)

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6
Q

Obstructive Shock

A

Impaired cardiac filling - tamponade, pericarditis, tension pneumo, PE

High filling pressures and SVR, low CO - narrowed pulse pressures

Pulsus paradoxus, friction rub

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7
Q

Beck’s Triad

A

Indicates acute cardiac tamponade

Low arterial BP

Distended neck veins (JVD)

Distant, muffled heart sound

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8
Q

Catecholamine Receptors

A

Beta 1 - 1 heart: increases cardiac contractility

Beta 2 - 2 lungs: induces smooth muscle vasodilation

Alpha 1: arterial vascular smooth muscle contraction

D1/D2: vasodilation of renal/splanchnic vasculature

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9
Q

Transfusion parameters

A

Goal of hgb >7 unless cardiac ischemia

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10
Q

Frank-Starling Law

A

SV increases in response to an increase in the volume of blood filling the heart

-Increased stretch increases contractility

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11
Q

Norepinephrine (Levophed)

A

Primarily an alpha-1 agonist

Causes vasoconstriction w/o impacting CO or HR

First line for septic shock

May be toxic to cardiac myocytes - cause apoptosis

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12
Q

Vasopressin (Pitressin)

A

Anti-diuretic hormone (ADH)

Acts on V1 (vasculature) - cause smooth muscle contraction

Acts on V2 (renal) - increase water resorption at collecting ducts

Increase sensitivity to NE

No affected by acidosis or hypoxia

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13
Q

Dopamine

A

Natural NE precursor

Dose determine which receptors affected

  • 3-10 ug/kg/min - B1 (NE release)
  • 10-20 ug/kg/min - alpha 1 (vasoconstriction)

Higher risk of tachyarrhythmias

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14
Q

Dobutamine

A

Beta 1 and Beta 2 (3:1) receptor agonist

Also binds alpha 1 - mild vasodilation

Used for cardiogenic shock and sepsis-induced cardiogenic dysfunction

Increases myocardial oxygen demand

May be pro-arrhythmic

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15
Q

Epinephrine (Adrenalin)

A

Affinity for beta 1&2 and alpha 1 receptors

-beta @ low dose, alpha @ high dose

Used for cardiac arrest - “atomic bomb” of vasoconstriction

Improves coronary blood flow

Can cause cardiac toxicity

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16
Q

Infusion Rate

A

Directly proportional to catheter length

-peripheral short catheters are preferred for shock resuscitation due to short, fat length

17
Q

Central Access and When to Place

A

Internal Jugular

Subclavian

Femoral vein

Place when you need:

  • rapid med delivery
  • peripheral veins inadequate
  • need to monitor CVP/ScVO2