Shock II Flashcards
What is shock?
State of inadequate tissue perfusion leading to hypoxia and cell death
What causes septic shock?
Infection –> Bacteremia –> SIRS/sepsis –> shock
Infection: Inflammatory response to microorganisms or invasion of sterile host tissue
Bacteremia: Viable bacteria in the blood
SIRS/Sepsis: Systemic inflammatory response to infection (and other insults)
Shock: Hypoperfusion causing hypoxia and cell death
What are the SIRS/Sepsis criteria?
T > 38degC
RR > 20
HR > 90
WBC > 12
–> easy to have these SIRS criteria for other reasons, so context is key
What is the mortality of septic shock?
20-80% mortality
–> highly lethal
Who is at risk of septic shock?
Anyone can get it
Most at risk: Immunocompromised
DM
Medicated (transplant/RA)
IVDA
Hospitalized
Asplenic
ESRD
Extremes of Ages
What is the treatment for septic shock?
1. ANTIBIOTICS!
as well as Early goal directed therapy
–> Goals are to treat and normalize:
Central venous pressure with fluids
Mean Arterial Pressure with vasoactive agents
ScvO2 with transfusion of RBCs until HCT > 30%
–> in that order
Who is at risk of hemorrhagic Shock?
Anyone can get it
Young are more at risk due to high-risk behavior
Traumatic and Atraumatic causes
What is the treatment for hemorrhagic shock?
Treatment Basics:
Find the bleeding
Stop the bleeding
Reverse coagulopathies (ASA, warfarin)
Replace blood and support patients
Hypotensive resuscitation for traumas
What are the most common causes of anaphylaxis?
Antibiotics (esp. B-lactam)
Insects (hymenoptera)
Food (shellfish, nuts)
What is anaphylaxis?
Severe systemic hypersensitivity that may include hypotension or airway compromise
–> IgE-dependent mast cell, basophil release
What is an anaphylactoid response?
Non-IgE mediated
- Same final common pathway as anaphylaxis
- No sensitizing exposure required
What are clinical features of anaphylaxis?
Angioedema
Diffuse Urticaria
Others: abdominal pain, N/V/D, Bronchospasm, rhinorrhea, conjunctivitis
Hypotension
What is the immediate treatment of anaphylaxis?
Epinephrine
–> NO absolute contraindications
What are long-term treatments for anaphylaxis (after epi)?
- Airway - intubate sooner than later
- Fluid resuscitation for hypotension
- Steroids
- Antihistamines (H1 & H2)
- Tx bronchospasm
- Glucagon (if on B-blockers because they prevent epi from working well)
What causes neurogenic shock?
- *- Disruption of sympathetic outlfow**
- -> blunt trauma - usually C-spine
- -> Sympathetic roots T1-L2
- -> Unopposed vagal tone
Leads to Hypotension, bradycardia
- Not spinal shock (total loss of spinal reflex activitiy at/below injury level)
