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Shock, C26 P164-170 Flashcards

1
Q

What is the definition of shock?

P164

A

Inadequate tissue perfusion

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2
Q

What are the different types (5)?

P164

A 
Hypovolemic
Septic
Cardiogenic
Neurogenic
Anaphylactic
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3
Q

What are the signs of shock?

P165

A 
Pale, diaphoretic, cool skin
Hypotension, tachycardia, tachypnea
↓ mental status and pulse pressure
Poor capillary refill
Poor urine output
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4
Q

What are the best indicators of tissue perfusion?

P165

A

Urine output, mental status

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5
Q

What lab tests help assess tissue perfusion?

P165

A

Lactic acid (elevated with inadequate tissue perfusion), base deficit, pH from ABG (acidosis associated with inadequate tissue perfusion)

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6
Q

HYPOVOLEMIC SHOCK
What is the definition?
P165

A

Decreased intravascular volume

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7
Q

HYPOVOLEMIC SHOCK
What are the common causes?
P165

A 
Hemorrhage
Burns
Bowel obstruction
Crush injury
Pancreatitis
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8
Q

HYPOVOLEMIC SHOCK
What are the signs?
P165

A

Early—Orthostatic hypotension, mild
tachycardia, anxiety, diaphoresis,
vasoconstriction (decreased pulse pressure
with increased diastolic pressure)
Late—Changed mental status, decreased BP,
marked tachycardia

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9
Q

HYPOVOLEMIC SHOCK
What are the signs/ symptoms with:
Class I hemorrhage (

A

Mild anxiety, normal vital signs

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10
Q

HYPOVOLEMIC SHOCK
What are the signs/ symptoms with:
Class II hemorrhage (15%–30% or 750–1500 cc blood loss)?
P165

A

Normal systolic BP with decreased pulse

pressure, tachycardia, tachypnea, anxiety

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11
Q

HYPOVOLEMIC SHOCK
What are the signs/ symptoms with:
Class III hemorrhage (30%–40% or 1500–2000 cc blood loss)?
P165

A

Tachycardia (heart rate >120), tachypnea
(respiratory rate >30), decreased
systolic BP, decreased pulse pressure,
confusion

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12
Q 
HYPOVOLEMIC SHOCK
What are the signs/ symptoms with:
Class IV hemorrhage ( >40% or >2000 cc
blood loss)?
P166
A

Decreased systolic BP, tachycardia (heart
rate >140), tachypnea (respiratory rate >35), decreased pulse pressure, confused
and lethargic, no urine output

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13
Q

HYPOVOLEMIC SHOCK
What is the treatment?
P166

A
  1. Stop the bleeding
  2. Volume: IVF (isotonic LR) then blood
    products as needed
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14
Q

HYPOVOLEMIC SHOCK
How is the effectiveness of treatment evaluated:
Bedside indicator?
P166

A

Urine output, BP, heart rate, mental status, extremity warmth, capillary refill, body temperature

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15
Q

HYPOVOLEMIC SHOCK
How is the effectiveness of treatment evaluated:
Labs?
P166

A

pH, base deficit, and lactate level

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16
Q

HYPOVOLEMIC SHOCK
What usually causes failure of resuscitation?
P166

A

Persistent massive hemorrhage, requiring

emergent surgical procedure

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17
Q

HYPOVOLEMIC SHOCK
Why does decreased pulse pressure occur with early hypovolemic shock?
P166

A

Pulse pressure (systolic–diastolic BP) decreases because of vasoconstriction, resulting in an elevated diastolic BP

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18
Q

HYPOVOLEMIC SHOCK
What is the most common vital sign change associated with early hypovolemic shock?
P166

A

Tachycardia

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19
Q

HYPOVOLEMIC SHOCK
What type of patient does not mount a normal
tachycardiac response to hypovolemic shock?
P166

A

Patients on ℬ-blockers, spinal shock

(loss of sympathetic tone), endurance athletes

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20
Q

HYPOVOLEMIC SHOCK
Should vasopressors be used to treat hypovolemic shock?
P166

A

No

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21
Q

HYPOVOLEMIC SHOCK
Should patients with hypovolemic shock be put
into the Trendelenburg position?
P166

22
Q

SEPTIC SHOCK
What is the definition?
P167

A

Documented infection and hypotension

23
Q

SEPTIC SHOCK
What is the specific etiology?
P167

A

Most common—gram-negative septicemia
Less common—gram-positive septicemia,
fungus

24
Q

SEPTIC SHOCK
What factors increase the susceptibility to septic
shock?
P167

A

Any mechanism that increases susceptibility to infection (e.g., trauma, immunosuppression, corticosteroids, hematologic disease, diabetes)

25
SEPTIC SHOCK What complications are major risks in septic shock? P167
Multiple organ failure, DIC, death
26
SEPTIC SHOCK What are the signs/symptoms? P167
Initial—vasodilation, resulting in warm skin and full pulses; normal urine output Delayed—vasoconstriction and poor urine output; mental status changes; hypotension
27
SEPTIC SHOCK What percentage of blood cultures is positive in patients with bacterial septic shock? P167
Only about 50%!
28
SEPTIC SHOCK What are the associated findings? P167
Fever, hyperventilation, tachycardia
29
SEPTIC SHOCK What are the associated lab findings? P167
Early—hyperglycemia/glycosuria, respiratory alkalosis, hemoconcentration, leukopenia Late—leukocytosis, acidosis, elevated lactic acid (Note: Identifying organism is important to direct treatment/antibiotics)
30
SEPTIC SHOCK What is the treatment? P167
1. Volume (IVF) 2. Antibiotics (empiric, then by cultures) 3. Drainage of infection 4. Pressors PRN 5. Zygris® PRN
31
SEPTIC SHOCK What is Zygris®? P168
Activated protein C, shown to decrease mortality in septic shock and multiple organ failure
32
CARDIOGENIC SHOCK What is the definition? P168
Cardiac insufficiency; left ventricular failure (usually), resulting in inadequate tissue perfusion
33
CARDIOGENIC SHOCK What are the causes? P168
MI, papillary muscle dysfunction, massive cardiac contusion, cardiac tamponade, tension pneumothorax, cardiac valve failure
34
CARDIOGENIC SHOCK What are the signs/symptoms on exam? P168
``` Dyspnea Rales Pulsus alternans (increased pulse with greater filling following a weak pulse) Loud pulmonic component of S(2) Gallop rhythm ```
35
CARDIOGENIC SHOCK What are the associated vital signs/parameters? P168
Hypotension, decreased cardiac output, elevated CVP/wedge pressure, decreased urine output (low renal blood flow), tachycardia (possibly)
36
CARDIOGENIC SHOCK What are the signs on CXR? P168
Pulmonary edema
37
CARDIOGENIC SHOCK What is the treatment? P168
Based on diagnosis/mechanism: 1. CHF: diuretics and afterload reduction (e.g., ACE inhibitors), with or without pressors 2. Left ventricular failure (MI): pressors, afterload reduction
38
CARDIOGENIC SHOCK What are the last resort support mechanisms? P168
Intra-aortic balloon pump (IABP), | ventricular assist device (VAD)
39
NEUROGENIC SHOCK What is the definition? P168
Inadequate tissue perfusion from loss of | sympathetic vasoconstrictive tone
40
NEUROGENIC SHOCK What are the common causes? P168
Spinal cord injury: - Complete transection of spinal cord - Partial cord injury with spinal shock - Spinal anesthesia
41
NEUROGENIC SHOCK What are the signs/symptoms? P169
Hypotension and bradycardia, neurologic deficit
42
NEUROGENIC SHOCK Why are heart rate and BP decreased? P169
Loss of sympathetic tone (but hypovolemia [e.g., hemoperitoneum] must be ruled out)
43
NEUROGENIC SHOCK What are the associated findings? P169
Neurologic deficits suggesting cord injury
44
NEUROGENIC SHOCK What MUST be ruled out in any patient where spinal shock is suspected? P169
Hemorrhagic shock!
45
NEUROGENIC SHOCK What is the treatment? P169
IV fluids (vasopressors reserved for hypotension refractory to fluid resuscitation)
46
NEUROGENIC SHOCK What percentage of patients with hypotension and spinal neurologic deficits have hypotension of purely neurogenic origin? P169
About 67% (two thirds) of patients
47
NEUROGENIC SHOCK What is spinal shock? P169
Complete flaccid paralysis immediately following spinal cord injury; may or may not be associated with circulatory shock
48
NEUROGENIC SHOCK What is the lowest reflex available to the examiner? P169
Bulbocavernous reflex: checking for contraction of the anal sphincter upon compression of the glans penis or clitoris
49
NEUROGENIC SHOCK What is the lowest level voluntary muscle? P169
External anal sphincter
50
NEUROGENIC SHOCK What are the classic findings associated with spinal cord shock? P169
Hypotension Bradycardia or lack of compensatory tachycardia
51
MISCELLANEOUS What is the acronym for treatment options for anaphylactic shock? P169
``` “BASE”: Benadryl Aminophylline Steroids Epinephrine ```

Surgery 🤓 (29 decks)

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