Shock Evaluation and Management Flashcards
List the 4 vascular system components of perfusion.
Vascular system, air exchange, pump, fluid volume
Equation for BP and CO
BP=COxPVR
CO=HR/SV
How do you easily obtain perfusion pressure?
Approximate peripheral pulses - if extremities are perfused, than organs are perfused.
Peripheral pulse approx:
Carotid 60, Femoral 70, Radial 80, Tibial 90
What is the definition of shock progression?
Begins with injury, spread throughout body, MULTISYSTEM INSULT TO MAJOR ORGANS,
What is the cycle of shock progression?
Inadequate perfusion, anaerobic processes, worsening hypoxia, CATECHOLAMINE release, cell death, RBC decrease
Who cannot tolerate hypotension for even a short period of time?
People who are older, hypertension, and/or HEAD INJURY
What are signs of compensated progression of shock?
How much blood (%) can be lost for this type?
Weakness, thirst, pallor, tachycardia, diaphoresis decreased urine output, weakened peripheral pulses/DELAYED CAP REFILL
15-25% loss of blood volume (1-2units) can be lost.
What signifies progression from compensated to decompensated shock?
Initial rise in BP (cats), initial narrowing of pulse pressure (diastolic, check for a weak pulse), lactic acidosis.
Look for the CRASH.
What age has the worst ability to compensate in hypovolemic shock?
ELDERLY CRASH FAST (atherosclerosis = less cat vasoconstrictive ability; live at higher BP/shock at higher pressures.)
What are signs of decompensated progression of shock?
How much blood (%) can be lost for this type?
HYPOTENSION, weak or no peripheral pulse, PROLONGED CAP REFILL (more than 2sec).
30-45% (6+units) loss of blood volume
What is the first sign of late shock - decompensated shock?
Hypotension.
When looking for early signs of shock, what pulse rates do you look for in (1) suspected hemorrhage and (2) red flag for shock?
1) sustained pulse of more than 100
2) pulse rate of more than 120
Does not having tachycardia rule out shock?
No - neurogenic shock has bradycardia.
1) What does falling ETCO2 indicate?
2) What does ETCO2 less than 20mmHg?
1) hyperventilation or decreased oxygenation
2) Circulatory collapse, warning sign of worsening shock
What are the 3 common shock syndromes?
Low-volume shock, high-space shock, mechanical shock.
What is low volume shock?
Absolute hypovolemia. In severe blood loss cats cannot compensate with enough vasoconstriction.
Clinical presentation of what type of shock?
Thready pulse, tachycardia, pale, flate neck veins.
low volume shock
Neurogenic shock (primarily) or vasodilatory shock. Interruption of SNS with no cat release, so no vasoconstriction = space is “too large”.
What is high-space shock?
Sepsis, drug overdose, neurogenic shock cause what type of shock?
Three causes of high space shock
Describe differences (4) and similarities (1) between the high space shocks.
All - hypotension
Neurogenic - NO CATS, bradycardia, skin warm dry pink, paralysis or deficit (no chest mvmt)
Sepsis and Drug overdose - CATS, tachycardia, pale or flushed, no localized deficit, flat neck veins
What is the most typical cause of neurogenic shock?
Spinal cord injury
What is mechanical shock?
Obstruction of blood flow to or through the heart, slowing venous return and decreasing CO.
Clinical presentation of mechanical shock.
Distended neck veins, cyanosis, catcholamine effects
What are effects of catecholamines?.
Pallor, tachy, diaphoresis
General management of shock state (4).
1) control bleeding
2) administer (Green) high-flow O2
3) maintain perfusion pressure (peripheral pulses)
4) treat the cause
Management of un/controllable hemorrhage similarities (6).
1) Fluid bolus 20ml/kg
2) Cardiac monitor, ETCO2, SpO2
3) **Ongoing exam (physical or diagnostic)
4) High flow oxygen
5) Control bleeding
6) Large-bore IV access
What do you NOT do in management of uncontrollable hemorrhage? Why?
Do not administer IV fluid. May cause increase in BP»_space; lose blood and clotting factors.
What does internal management of uncontrollable hemorrhage consist of?
Trauma surgical intervention
What is the best FFP/platelet ratio to administer in uncrontrollable hemorrhage?
1:1
What is special about large bone fractures? Pelvis?
They are self limited, UNLESS in the pelvis (asymptomatic until 3L lost)
What are the types of internal hemorrhage from blunt trauma? Which of these calls for fluid admin for volume support?
1) large bone fracture - GIVE FLUID
2) internal blood vessel tear, laceration, or avulsion to internal organ - possible fluid, to maintain perfusion, but fluid may increase bleeding/death
What is a special consideration for management of high-space, vasodilatory shock?
VASPORESSORS - for CCB overdose or sepsis
What do you do for someone with severe head injury with hypovolemic shock?
Fluid admin and BP of 120 to maintain cerebral perfusion pressure of at least 60.
What do you do for someone with nonhemorrhagic hypovolemic shock?
Same mgmt as controllable.
Fluid admin for volume replacement.
What kind of shock is tension pneumothoarx and what do you do to treat?
Mechanical Shock.
DECOMPRESSION OF PLEURAL PRESSURE (needle then CT).
Causes of mechanic shock (2)
1) Cardiac tamponade - blood fills potential space, heart cannot fill
2) Myocardial contusion - severe may cause AHF
Management of cardiac tamponade (2).
1) PERICARDIOCENTESIS - cardiac arrest in minutes if not performed.
2) Fluid administration
Management of myocardial contusion.
What do you NOT do for myocardial contusion?
1) cardiac monitoring and treat arrhythmias
2) Do NOT administer fluid.
