Shock - Pfeiffer Flashcards
Hemorrhagic vs. neurogenic shock
H = Vascular system blood volume
Hemorrhagic vs. neurogenic shock
H = Vascular system blood volume
4 elements to tissue perfusion
- Vascular system
- Fluid volume
- Air exchange (lungs)
- Pump (heart)
4 basics of shock management
- Maintain airway
- Maintain oxygenation/ventilation
- Control bleeding
- Maintain circulation (HR, volume, perfusion pressure)
How to estimate systolic blood pressure via pulses
- Carotid present = 60s
- Femoral present = 70s
- Radial present = 80s
- Tibial present = 90+
Describe cycle of shock progression
RBCs decreased –> inadequate perfusion –> anaerobic process –> hypoxia/acidosis –> catecholamines –> cell death –> RBCs decreased
3 populations that CANNOT tolerate hypotension
Old, hypertensive, head injury
Many acute symptoms in shock are due to ____
Catecholamine release
Symptoms of COMPENSATED shock
Weak, light-headed, thirsty, pale, tachycardic, sweaty, tachypnic, decreased urination, weakened pulses
Signs of progression to UNCOMPENSATED shock
- Acute RISE in BP (catecholamines)
- Acute narrowing of pulse pressure (diastolic increased)
- Weak, thin pulse - Lactic acidosis (hypoxia)
- CRASH (loss of catecholamine production)
Populations prone to QUICK compensated to uncompensated crash
Very young, very old, those on HTN meds
Warning about HTN patients and shock
A “normal” BP might be TOO LOW for them
Signs of HYPOVOLEMIC shock decompensation
HYPOTENSION, altered mental status (decreased cerebral perfusion, acidosis, hypoxia), weak pulse, cardiac arrest
Tachycardia and shock
Sustained > 100 pulse = hemorrhage
Systained > 120 pulse = shock
Exhaled CO2 level that indicates circulatory collapse/shock
Exhaled CO2 level that indicates circulatory collapse/shock
4 elements to tissue perfusion
- Vascular system
- Fluid volume
- Air exchange (lungs)
- Pump (heart)
What is mechanical shock?
Obstructed blood flow to or through the heart
How to estimate systolic blood pressure via pulses
- Carotid present = 60s
- Femoral present = 70s
- Radial present = 80s
- Tibial present = 90+
Describe cycle of shock progression
RBCs decreased –> inadequate perfusion –> anaerobic process –> hypoxia/acidosis –> catecholamines –> cell death –> RBCs decreased
Types of cardiogenic mechanical shock (2)
- Myocardial contusion
- Myocardial infarction
Many acute symptoms in shock are due to ____
Catecholamine release
Symptoms of COMPENSATED shock
Weak, light-headed, thirsty, pale, tachycardic, sweaty, tachypnic, decreased urination, weakened pulses
Signs of progression to UNCOMPENSATED shock
- Acute RISE in BP (catecholamines)
- Acute narrowing of pulse pressure (diastolic increased)
- Weak, thin pulse - Lactic acidosis (hypoxia)
- CRASH (loss of catecholamine production)
Populations prone to QUICK compensated to uncompensated crash
Very young, very old, those on HTN meds
Warning about HTN patients and shock
A “normal” BP might be TOO LOW for them
Signs of HYPOVOLEMIC shock decompensation
HYPOTENSION, altered mental status (decreased cerebral perfusion, acidosis, hypoxia), weak pulse, cardiac arrest
Tachycardia and shock
Sustained > 100 pulse = hemorrhage
Systained > 120 pulse = shock
If a patient is not tachycardic, is shock ruled out?
NO - could be neurogenic, on beta-blockers, etc.
Exhaled CO2 level that indicates circulatory collapse/shock
Types of high-space shock
- Neurogenic, vasovagal syncope, sepsis, drug OD
What is vasovagal syncope?
Sudden vagal sympathetic loss –> rapid drop in BP –> faint
What is mechanical shock?
Heart can’t physically pump or perfuse appropriately
2 groups of mechanical shock
- Obstructive
- Cardiogenic
Types of obstructive mechanical shock (3)
- Cardiac tamponade (fluid into pericardium)
- Tension pneumothorax
- Pulmonary embolism
Types of cardiogenic mechanical shock (2)
- Myocardial contusion
- Myocardial infarction
Thready pulse, tachycardia, pale, flat neck veins
Hypovolemia
Relative hypovolemia
Vasodilatory shock - loss of SNS or excess vasodilation
Causes of vasodilatory shock
Sepsis, drug OD, spinal cord injury (neurogenic)
Hypotension, slow/normal heart rate, warm dry skin, diaphragmatic paralysis/deficit
Neurogenic high-space shock
Hypotension, tachycardia, pale/flushed
Drug OD or sepsis – high space shock
Distended neck veins, cyanosis, pallor, tachycardia, sweating
Mechanical shock (decreased blood flow to/through heart)
Why is it important to get an IV line inserted EARLY in shock?
Hard to do it once compensatory vasoconstriction occurs
Management of controllable hemorrhage
- Control bleeding
- High-flow oxygen
- IV acess
- Fluid bolus (repeated)
- Cardiac, O2, CO2 monitors
- Ongoing exam
Management of uncontrollable external hemorrhage
- Same as controllable hemorhage EXCEPT caution with fluid administration
Fluid administration in uncontrollable hemorrhage
- DON’T give much fluids - dilutes clotting factors, can’t carry O2
- DO give blood transfusion (carries O2)
- 1 to 1 FFP/platelets ratio
Management of uncontrollable internal hemorrhage
- Surgical assessment
- SAME as external
Special management part to high-space shock
VASOPRESSORS
Hypovolemic shock + severe head injury - management
- Glasgow coma score of less than 8 - SEVERE
- Fluid administration to BP 120 so cerebral perfusion pressure is at least 60
Management of nonhemorrhagic hypovolemic shock
- Same as controllable
- Fluid replacement
Tension pneumothorax - describe
Vena cava collapses –> prevents venous return –> decreased cardiac output
Tension pneumothorax - presentation
- Tracheal deviation away from affected side
- Decreased pulse
- Decreased breath sounds
- Distended neck veins
Tension pneumothorax - management
- Chest decompression (needle) of pleural pressure
Penetrating cardiac injury –> ______
Cardiac tamponade
Presentation of cardiac tamponade
“Beck’s triad”
- Shock, muffled heart tones, distended neck veins
Management of cardiac tamponade
- Pericardiocentesis
- Fluid administration (MAYBE)
Management of myocardial contusion
Treat arrhythmias
