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Surgical Recall > Shock, C26 P164-170 > Flashcards

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 (<15% or 750 cc blood loss)?P165

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

A

No

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
Q

SEPTIC SHOCK
What complications are major risks in septic shock?
P167

A

Multiple organ failure, DIC, death

26
Q

SEPTIC SHOCK
What are the signs/symptoms?
P167

A

Initial—vasodilation, resulting in warm skin and
full pulses; normal urine output
Delayed—vasoconstriction and poor urine
output; mental status changes; hypotension

27
Q

SEPTIC SHOCK
What percentage of blood cultures is positive in
patients with bacterial septic shock?
P167

A

Only about 50%!

28
Q

SEPTIC SHOCK
What are the associated findings?
P167

A

Fever, hyperventilation, tachycardia

29
Q

SEPTIC SHOCK
What are the associated lab findings?
P167

A

Early—hyperglycemia/glycosuria, respiratory
alkalosis, hemoconcentration, leukopenia
Late—leukocytosis, acidosis, elevated lactic acid
(Note: Identifying organism is important
to direct treatment/antibiotics)

30
Q

SEPTIC SHOCK
What is the treatment?
P167

A
  1. Volume (IVF)
  2. Antibiotics (empiric, then by cultures)
  3. Drainage of infection
  4. Pressors PRN
  5. Zygris® PRN
31
Q

SEPTIC SHOCK
What is Zygris®?
P168

A

Activated protein C, shown to decrease mortality in septic shock and multiple organ failure

32
Q

CARDIOGENIC SHOCK
What is the definition?
P168

A

Cardiac insufficiency; left ventricular failure (usually), resulting in inadequate tissue perfusion

33
Q

CARDIOGENIC SHOCK
What are the causes?
P168

A

MI, papillary muscle dysfunction, massive cardiac contusion, cardiac tamponade,
tension pneumothorax, cardiac valve failure

34
Q

CARDIOGENIC SHOCK
What are the signs/symptoms on exam?
P168

A 
Dyspnea
Rales
Pulsus alternans (increased pulse with greater
  filling following a weak pulse)
Loud pulmonic component of S(2)
Gallop rhythm
35
Q

CARDIOGENIC SHOCK
What are the associated vital signs/parameters?
P168

A

Hypotension, decreased cardiac output,
elevated CVP/wedge pressure, decreased
urine output (low renal blood flow), tachycardia (possibly)

36
Q

CARDIOGENIC SHOCK
What are the signs on CXR?
P168

A

Pulmonary edema

37
Q

CARDIOGENIC SHOCK
What is the treatment?
P168

A

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
Q

CARDIOGENIC SHOCK
What are the last resort support mechanisms?
P168

A

Intra-aortic balloon pump (IABP),

ventricular assist device (VAD)

39
Q

NEUROGENIC SHOCK
What is the definition?
P168

A

Inadequate tissue perfusion from loss of

sympathetic vasoconstrictive tone

40
Q

NEUROGENIC SHOCK
What are the common causes?
P168

A

Spinal cord injury:

  • Complete transection of spinal cord
  • Partial cord injury with spinal shock
  • Spinal anesthesia
41
Q

NEUROGENIC SHOCK
What are the signs/symptoms?
P169

A

Hypotension and bradycardia, neurologic deficit

42
Q

NEUROGENIC SHOCK
Why are heart rate and BP decreased?
P169

A

Loss of sympathetic tone
(but hypovolemia [e.g., hemoperitoneum]
must be ruled out)

43
Q

NEUROGENIC SHOCK
What are the associated findings?
P169

A

Neurologic deficits suggesting cord injury

44
Q

NEUROGENIC SHOCK
What MUST be ruled out in any patient where spinal shock is suspected?
P169

A

Hemorrhagic shock!

45
Q

NEUROGENIC SHOCK
What is the treatment?
P169

A

IV fluids (vasopressors reserved for hypotension refractory to fluid resuscitation)

46
Q

NEUROGENIC SHOCK
What percentage of patients with hypotension and spinal neurologic deficits have hypotension of purely neurogenic origin?
P169

A

About 67% (two thirds) of patients

47
Q

NEUROGENIC SHOCK
What is spinal shock?
P169

A

Complete flaccid paralysis immediately
following spinal cord injury; may or may
not be associated with circulatory shock

48
Q

NEUROGENIC SHOCK
What is the lowest reflex available to the examiner?
P169

A

Bulbocavernous reflex: checking for
contraction of the anal sphincter upon
compression of the glans penis or clitoris

49
Q

NEUROGENIC SHOCK
What is the lowest level voluntary muscle?
P169

A

External anal sphincter

50
Q

NEUROGENIC SHOCK
What are the classic findings associated with spinal cord shock?
P169

A

Hypotension
Bradycardia or lack of compensatory
tachycardia

51
Q

MISCELLANEOUS
What is the acronym for treatment options for
anaphylactic shock?
P169

A 
“BASE”:
   Benadryl
   Aminophylline
   Steroids
   Epinephrine

Surgical Recall (33 decks)

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