SHOCK CRITICAL CARE Flashcards
arterial O2 equal
CaO2
1.39 times hemoglobin saturation 02+ (PaO2 x0.0031)
Central venous pressure measured where/normal value
right ventricular end-diastolic pressure
5-10
left atrial pressure measured where/ normal value; What adversely affects the
left ventricular end-diastolic pressure
5-15
mitral valve disease
pulmonary capillary wedge pressure measured where, normal value, what effect IT
rough equal left atrial pressure
5-15
height PEEP/pulmonary disease/mitral valve stenosis
mean arterial pressure calculation
map equals diastolic pressure +1/3 (systolic pressure minus diastolic pressure)
80-90
cardiac index
cardiac output divided by meter squared
2.5-3.5
systemic vascular resistance
SVR = (MAP - CVP) x 80/CO
1000-1500 dyne
pulmonary resistance
100-400 dyne
mixed venous oxygen content
CVO2
75%
15 cc O2 in 100 cc
O2 delivery
cardiac output times arterial arch and content x10
900-1200
02 consumption
250 mL/min
clinical determinant of preload
venous return (central venous pressure)
clinical determine of afterload
systemic resistance
general equation of her cardiac output
systemic resistance x heart rate
lift things that cause improvement of Frank Starling curve with ventricular dysfunction
#1 diuretics #2 inotrope #3 vasodilator
how does dopamine compared to norepinephrine
dopamine and baby nor epinephrine
trade name for norepinephrine
levophed
class I hemorrhagic shock
10% blood volume
Class II hemorrhagic shock
20% blood volume
over 1000 mL
NARROW PULSE PRESSURE
TACHYCARDIA
Class III hemorrhagic shock
30% blood volume
HYPOTENSION
Class IV hemorrhagic shock
40% blood volume
DECREASED MENTATION
Immediate treatment for myocardial infarction
Morphine Oxygen Aspirin/ACE inhibitor nitroglycerin Angioplasty
The reduce preload for cardiogenic shock
Nitroglycerin Calcium channel blocker Narcotic Diuretic Venous dilatation
Reduce afterload cardiogenic shock
Nitroprusside
Antihypertensive
Diuretic
Necrotic
Gen. mechanism dopamine: Heart rate, contractility, preload, afterload
heart rate increased
contractility Increased
preload decreased
Increase/normal
Gen. mechanism dobutamine:Heart rate, contractility, preload, afterload
Heart rate INCREASE
Contractility INCREASE the
Preload decrease
Normal decrease
general mechanism isoproterenol Heart rate, contractility, preload, afterload
heart rate INCREASE
Contractility INCREASE
Preload decrease
After the decrease
Gen. mechanism nitroprusside andHeart rate, contractility, preload, afterload
heart rate no change
Contractility no change
Preload decrease
Afterload DECREASE
Gen. mechanism nitroglycerin Heart rate, contractility, preload, afterload
heart rate no change
Contractility no change
Preload DECREASE
Afterload decrease
Intracellular changes with shock
increased intracellular sodium
Increase interest calcium
how is pediatric Parkland formula modified
Parkland PLUS maintenance
Kidney D5 and a little K.
(approximately 15% above Parkland)
rough oxygen saturation curve
PaO2 40 Saturation 70 PaO2 50 Saturation 80 PaO2 60 Saturation 90 40/50 60/70 80/90
initiating event of shock
cellular energy deficit
Does not equal hypoxia
factors at initiate afferent impulse to CNS neuroendocrine responsive shock
#1 bottle circulating blood volume #2 hypoxemia #3 hypercarbia #4 acidosis #5 infection #6 temperature fluctuation #7 emotional arousal #8 hypoglycemia
what arterial receptors give initial physiologic response to hypovolemic shock on arteriols
ACTIVATION of her adrenergic receptors arterials
Primary affective ADH
Pituitary origin
“vasopressin”
Released from barrel receptors left atrial stretch
Stimulated by:
Epinephrine
Angiotensin II
Pain
Hyperglycemia
Acts on distal tibial and collecting duct INCREASES water permeability-decrease his water and sodium losses
Mesenteric vasoconstriction the
Increases hepatic gluconeogenesis last glycol cyst
for cytokine signal released after major injury
tumor necrosis factor alpha
Anti-inflammatory cytokine
interleukin-10
weather hemodynamic changes seen with neurogenic shock
Increased cardiac index
Unchanged venous capacitance
Percentage of blood line and splanchnic circulation
20%
indirect estimate of oxygen debt withbasic labs value
base deficit
Class I hemorrhagic shock
Less than15% blood volume
700 mL
Class II hemorrhagic shock
15-30% blood volume 750-1500 cc Widened pulse pressure Tachycardia orthostatic Tachycardia
Class III hemorrhagic shock
30-40%
1500-2000 cc
HYPOTENSION
Tachycardia to the 120s
Class IV hemorrhagic shock
Greater than 40%
Greater than2,000 cc
Tachycardia 140s
OBTUNDED
Trauma definition of systolic hypotension
110
Classify severity of base deficit
Mild: -3 to -5
Moderate: -6 to -9
Severe: Greater than -10
Mortality and percentage the patient with a base deficit of -6
25% and trauma related
And INR 1.5 on arrival to ICU as what percent mortality
30%
Transfuse FFP
What type of shock is seen with carbon monoxide poisoning
Vasodilatory shock
This common causes of vasodilatory shock
MOST common SEPTIC Pancreatitis Burns Anaphylaxis Acute adrenal insufficiency Hypotension: Hemorrhagic, cardiogenic, cardiopulmonary bypass Lactic acidosis Carbon monoxide
resistant cardiogenic shock medications are wet and have what potential side effects
Phosphodiesterase inhibitors: Amrinone Milrinone Thrombocytopenia Hypotension Reserve for unresponsive
Acute MI post 12 hours in cardiogenic shock best treatment
Angiogram stent
Do not way to stabilize patient on inotropic support
Classic neurogenic shock findings
Decreased blood pressure
Rate cardia
Warm extremities
Motor/sensory disturbance
