Shock Lecture Powerpoint Flashcards
Shock definition
Clinical condition characterized by signs and symptoms which arise when cardiac output is insufficient to fill the arterial tree with blood under sufficient pressure to provide organs and tissues with adequate blood flow - a failure of perfusion
Mean arterial pressure MAP =
CO x PVR (peripheral vascular resistance)
Cardiac output CO=
HRxSV
SV (EDV x contractility)
Most common type of distributive shock
-Sepsis (sepsis is the next step of SIRS -systemic inflammatory response phenomenon)
Nonhemorrhagic hypovolemic shock is most often due to ___ losses
Gastrointestinal
Third space losses
A type of nonhemorrhagic hypovolemic shock where fluid in a potential space sees filling due to capillary leakage (think peritoneum or pleura) and this depletes intravascular volume overall
4 classes of hemorrhage
I - Small amount of blood loss (10-19%), BP, HR, RR, and U/O remain the same
II - Decreased pulse pressure (20-29%), HR >100, RR increase, U/O decrease
III - (30-39%)decreased BP, HR >120, RR >30, U/O oligouric
IV - up to 40-50% blood loss, BP very low, >140HR, RR>40, aneuric
Massive transfusion protocol
1:1:1 of packed RBC (first choice O neg, Op pos and type specific are alternatives), plasma, and platelets
Neurogenic shock pathophysiology
Dilation of the arterial and some degree of the venous side of the systemic circulation
Examples of obstructive shock (5)
(this is the least common type)
- PE
- tension pneumothorax
- pericardial tamponade
- constrictive pericarditis
- abdominal compartment syndrome
Low pulse pressure or decreased cardiac output indicates what type of shock origin? (2)
- cardiogenic
- hypovolemic
Mixed venous O2
A measure of the oxygenation of the venous blood entering the pulmonary artery with a catheter (the least oxygenated blood in the body), should normally be 65-75% saturated, if lower then indicates worse condition of shock than if higher because that implies inadequate perfusion of the tissue at the periphery which therefore draws out more oxygen
Swan ganz catheterization of the right heart to obtain pulmonary capillary wedge pressure gives a measure of ___
left atrium
6 things that can be manipulated in the treatment of shock to help preserve pressure
- systemic arterial pressure (MAP)
- cardiac preload
- blood o2 carrying capacity
- treat the underlying cause
- expansion of intravascular space with warm fluids***
- monitor response to intervention
Hemorrhagic shock treatment (3)
- 2 large bore IV’s
- normal saline and lactated ringer crystalloid (class I-II)
- blood/plasma/platelet/hypertonic saline (3% - draws out stores in interstitial space) (class III-IV hemorrhages)
Blood delivery to the heart occurs during what phase of the cardiac cycle?
Diastole
Cardiogenic shock diagnosis (2)
- pumonary artery catheterization
- echocardiogram of left ventricle
How is cardiogenic shock treated? (3)
- balloon pump catheterization
- norepi
- thrombolytic drugs
SIRS criteria (4)
- temp >38 or <36C
- HR >90bpm
- RR >20 or PaCO2 <32 (respiratory alkalosis)
- WBC count >12000 or <4000 or >10% immature bands
qSOFA criteria for sepsis (3)
- RR >22
- SBP <100
- altered mental status (due to suspected infection)
Predisposing risk factors for sepsis (6)
- underlying disease
- increasing age
- antibiotic use
- immunosuppresion
- malignancy
- hospitalization or indwelling catheter/ventilator
Sepsis treatment options (3)
- administer broad spectrum antibiotics piperacillin, ampicillin
- steroids that mute the immune response (leukotriene storm)
- initiate pressors as needed (norepi)
Goal directed therapy for sepsis (4)
Meet the following criteria:
- Central venous o2 sat of > or =70
- central venous pressure > or =8-12
- mean arterial pressure > or = 65
- urine output > or = .5cc/kg/hr
Neurogenic shock etiologies (4)
- spinal anesthesia
- vagal stimulation
- cord transection
- NOT head trauma
Widened pulse pressure might indicate what sources of shock? (2)
- neurogenic
- vasodilatory shock
Neurogenic shock treatment options (3)
- trendelenberg position
- IV fluids
- Pressors
Why don’t you use antihistamines for anaphylaxis?
Because most mast cells have already degranulated at the point of anaphylaxis presence
