Shock & Fluids Flashcards
What is fluid maintenance based on?
patient weight
How is total fluid intake calculated?
(100ml x 10kg) + (50ml x 10kg) + (20ml x Xkg)
how do you calculate total maintenance fluid rate?
TFI/ 24hrs
why may we want to increase fluids?
dehydration
shock
why may we want to decrease fluids?
hypertension
edema
increase in intercranial pressure
what is the acceptable range for urine output?
1-2 ml/kg/hr
when should you notify the physician for urine output?
<1 or > 5 ml/kg/hr
How do you calculate urine output?
urine output/ patient weight / how many hours for that amount of output
ml/kg/hr
how much and how do you deliver a bolus
10-20ml/kg through IV or intra osseous (into bone marrow)
Define shock
when the organs and tissues of the body are not receiving adequate flow of blood which in turn deprives tissues and organs of oxygen
what does shock lead to?
decreased intravascular volume
How does shock lead to decreased intravascular volume?
- decreases CO and SV due to vasodilation and 3rd spacing
- hypoxia and acidosis develops
- adrenergic and renal compensations
What are the compensatory mechanisms for shock?
- increase in HR and BP
- increase in respirations
- increase in catecholamine and cortisol
- renin > angiotensin > aldosterone
- ADH > H2O and Na retention
what is decompensation of shock? and what may present?
continued intravascular volume depletion
- can present with: DIC, hypotension, cellular death, multi-organ death, cardiac or resp arrest
What are the 4 main causes (etiology) of shock?
- distributive
- hypovolemic
- cardiogenic
- obstructive
what do each of the causes of shock have in common?
one or more of the physiologic principles that govern oxygen delivery or consumption is disturbed
What happens in the early/compensated stages of shock?
Vital organ function is sustained by intrinsic compensatory mechanisms
What happens in the decompensated stage of shock?
circulatory failure overcomes compensatory efforts: results in tissue hypoxia, metabolic acidosis, leading to multi-organ dysfunction
What happens in the profound shock stage?
Imminent cardiac and/or respiratory arrest
Irreversible organ damage due to prolonged ischemia
What is this stage of stock with the cardiac system?
Mild tachycardia, weak distal pulses strong central pulses
early
What is this stage of stock with the cardiac system?
Moderate tachycardia, thready distal, weak central pulses, decreasing BP
Decompensated
What is this stage of stock with the cardiac system?
Hypotention, severe tachycardia or bradycardia, absent distal, thready central
irreversible
What does the respiratory system look like in the stages of shock?
early: mild tachypnea
demcomp: moderate tachypnea
irreversible: severe tachypnea
What does the neuro system look like in EARLY stage of shock?
Normal, restless, anxious
what does neuro system look like in DECOMPENSATED stage of shock?
Confusion, agitation, lethargy, decreased pain response
What is this stage of shock in neuro system?
comatose state
irreversible
What is the skin like in the EARLY stage of shock?
Flushed, mottled, decreased cap refill, cool clammy extremities
What is the skin like in the DECOMPENSATED stage of shock?
Pallor, cap refill > 3 sec, cold dry extremities, sunken eyes
What is the skin like in IRREVERSIBLE stage of shock?
Pale, cold skin, cyanosis ,cap refill > 5 sec
What happens in the renal system during the stages of shock?
Early: decreased urine output, increased specific gravity
Decomp: Oliguria, increased specific gravity
Irreversible: Anuria, No urine output
What are the types of distributive shock?
septic
anaphylactic
neurogenic
what does distributive shock result in?
- peripheral vasodilation
- decreased systemic vascular resistance (SVR)
- with venous pooling and inadequate arterial tissue perfusion to meet metabolic demands
How does septic shock occur?
- infection (UTI, pneumonia, meningitis, appendicitis)
What is bacteremia?
presence of viable bacteria in blood cultures
what are some clinical signs of septic shock?
tachycardia, tachypnea, hyperthermia/hypothermia, leucopenia
What are the signs of warm shock? and what type of shock is this?
- septic shock
signs:
Tachycardia
Tachypnea
Fever
Bounding pulses
BP normal or slightly increased
Wide pulse pressure 3040 mmHg
Fussy/irritable/unable to console
Flushed , mottled
Normal urine output 1-2 cc/kg/hr
What are the signs of cold shock? and what type of shock is this?
- septic shock
-signs:
Severe tachycardia to bradycardia
Increase WOB > resp depression
Hypothermia
Weak peripheral pulses
Hypotension
Narrow pulse pressure 10-20 mmHg
Lethargic altered LOC
Decreased cap refill 3-5 sec, cool to cold pale extremities
Low urine output < 1cc/kg/hr
What is severe sepsis
Systemic Inflammatory Response Syndrome (SIRS)
What may you see in severe sepsis/SIRS?
- Core temp>38.5°C (high temp), significant increased HR and Resp. for age, increased Leukocyte counts, positive cultures or strongly suspected
- disseminated intravascular coagulation
- O2 therapy and fluid replacement given without pt. Improvement
what occurs in anaphylactic shock?
- due to massive hypersensitivity response (Type I)
- Loss of vascular tone due to vasodilatation
- Capillaries begin to leak fluids with mast cells initiating hypersensitivity cascade (Blood is where it is not supposed to be)
What are the signs of anaphylactic shock? (FAST)
Face: swelling, changes to skin texture
Airway: wheezes, airway compromise
Stomach: nausea and vomiting
Total body: hives
T or F: anaphylactic shock can be life-threatening in a child with respiratory issues? (ex. asthma)
True
what occurs in neurogenic shock?
severe central nervous system trauma (i.e. spinal cord injury) causes a rapid loss in sympathetic stimulation
Loss of sympathetic and parasympathetic control results in massive vasodilation and a decrease in peripheral vascular resistance causing blood to pool in the venous system
What is the treatment for neurogenic shock?
- First line of treatment is fluid resuscitation
- O2 is still first line too
What occurs in hypovolemic shock?
- decreased cardiac filling
- lower end-diastolic volume
- decreased stroke volume
- decreased cardiac output
What is hypovolemic shock caused by?
- blood loss due to significant injury/trauma or surgery
- Plasma loss due to burns, nephrotic syndrome, or sepsis
- Fluid and electrolyte loss associated with dehydration, diabetic ketoacidosis, diabetes insipidus, heat stroke, gastroenteritis (bug causing vomiting and diarrhea)
What is obstructive shock?
- Physical (and/or mechanical) impediment of blood flow
- Impairs cardiac output
- ex. pneumothorax
What is cardiogenic shock?
Inability of heart to maintain CO and tissue perfusion
T or F: cardiogenic shock resembles hypovolemic shock
True
what are some examples of how cardiogenic shock may occur?
- Hypoplastic left heart syndrome: born with underdeveloped heart
- Cardiomyopathy
- Myocarditis
- Severe electrolyte imbalance
- Severe acid-base imbalance
