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Cardiovascular 2 > Shock - Pfeiffer > Flashcards

Shock - Pfeiffer Flashcards

1
Q

Hemorrhagic vs. neurogenic shock

A

H = Vascular system blood volume

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2
Q

Hemorrhagic vs. neurogenic shock

A

H = Vascular system blood volume

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3
Q

4 elements to tissue perfusion

A
  • Vascular system
  • Fluid volume
  • Air exchange (lungs)
  • Pump (heart)
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4
Q

4 basics of shock management

A
  • Maintain airway
  • Maintain oxygenation/ventilation
  • Control bleeding
  • Maintain circulation (HR, volume, perfusion pressure)
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5
Q

How to estimate systolic blood pressure via pulses

A
  • Carotid present = 60s
  • Femoral present = 70s
  • Radial present = 80s
  • Tibial present = 90+
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6
Q

Describe cycle of shock progression

A

RBCs decreased –> inadequate perfusion –> anaerobic process –> hypoxia/acidosis –> catecholamines –> cell death –> RBCs decreased

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7
Q

3 populations that CANNOT tolerate hypotension

A

Old, hypertensive, head injury

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8
Q

Many acute symptoms in shock are due to ____

A

Catecholamine release

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9
Q

Symptoms of COMPENSATED shock

A

Weak, light-headed, thirsty, pale, tachycardic, sweaty, tachypnic, decreased urination, weakened pulses

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10
Q

Signs of progression to UNCOMPENSATED shock

A
  • Acute RISE in BP (catecholamines)
  • Acute narrowing of pulse pressure (diastolic increased)
    - Weak, thin pulse
  • Lactic acidosis (hypoxia)
  • CRASH (loss of catecholamine production)
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11
Q

Populations prone to QUICK compensated to uncompensated crash

A

Very young, very old, those on HTN meds

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12
Q

Warning about HTN patients and shock

A

A “normal” BP might be TOO LOW for them

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13
Q

Signs of HYPOVOLEMIC shock decompensation

A

HYPOTENSION, altered mental status (decreased cerebral perfusion, acidosis, hypoxia), weak pulse, cardiac arrest

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14
Q

Tachycardia and shock

A

Sustained > 100 pulse = hemorrhage

Systained > 120 pulse = shock

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15
Q

Exhaled CO2 level that indicates circulatory collapse/shock

A
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16
Q

Exhaled CO2 level that indicates circulatory collapse/shock

A
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17
Q

4 elements to tissue perfusion

A
  • Vascular system
  • Fluid volume
  • Air exchange (lungs)
  • Pump (heart)
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18
Q

What is mechanical shock?

A

Obstructed blood flow to or through the heart

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19
Q

How to estimate systolic blood pressure via pulses

A
  • Carotid present = 60s
  • Femoral present = 70s
  • Radial present = 80s
  • Tibial present = 90+
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20
Q

Describe cycle of shock progression

A

RBCs decreased –> inadequate perfusion –> anaerobic process –> hypoxia/acidosis –> catecholamines –> cell death –> RBCs decreased

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21
Q

Types of cardiogenic mechanical shock (2)

A
  • Myocardial contusion

- Myocardial infarction

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22
Q

Many acute symptoms in shock are due to ____

A

Catecholamine release

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23
Q

Symptoms of COMPENSATED shock

A

Weak, light-headed, thirsty, pale, tachycardic, sweaty, tachypnic, decreased urination, weakened pulses

24
Q

Signs of progression to UNCOMPENSATED shock

A
  • Acute RISE in BP (catecholamines)
  • Acute narrowing of pulse pressure (diastolic increased)
    - Weak, thin pulse
  • Lactic acidosis (hypoxia)
  • CRASH (loss of catecholamine production)
25
Q

Populations prone to QUICK compensated to uncompensated crash

A

Very young, very old, those on HTN meds

26
Q

Warning about HTN patients and shock

A

A “normal” BP might be TOO LOW for them

27
Q

Signs of HYPOVOLEMIC shock decompensation

A

HYPOTENSION, altered mental status (decreased cerebral perfusion, acidosis, hypoxia), weak pulse, cardiac arrest

28
Q

Tachycardia and shock

A

Sustained > 100 pulse = hemorrhage

Systained > 120 pulse = shock

29
Q

If a patient is not tachycardic, is shock ruled out?

A

NO - could be neurogenic, on beta-blockers, etc.

30
Q

Exhaled CO2 level that indicates circulatory collapse/shock

A
31
Q

Types of high-space shock

A
  • Neurogenic, vasovagal syncope, sepsis, drug OD
32
Q

What is vasovagal syncope?

A

Sudden vagal sympathetic loss –> rapid drop in BP –> faint

33
Q

What is mechanical shock?

A

Heart can’t physically pump or perfuse appropriately

34
Q

2 groups of mechanical shock

A
  • Obstructive

- Cardiogenic

35
Q

Types of obstructive mechanical shock (3)

A
  • Cardiac tamponade (fluid into pericardium)
  • Tension pneumothorax
  • Pulmonary embolism
36
Q

Types of cardiogenic mechanical shock (2)

A
  • Myocardial contusion

- Myocardial infarction

37
Q

Thready pulse, tachycardia, pale, flat neck veins

A

Hypovolemia

38
Q

Relative hypovolemia

A

Vasodilatory shock - loss of SNS or excess vasodilation

39
Q

Causes of vasodilatory shock

A

Sepsis, drug OD, spinal cord injury (neurogenic)

40
Q

Hypotension, slow/normal heart rate, warm dry skin, diaphragmatic paralysis/deficit

A

Neurogenic high-space shock

41
Q

Hypotension, tachycardia, pale/flushed

A

Drug OD or sepsis – high space shock

42
Q

Distended neck veins, cyanosis, pallor, tachycardia, sweating

A

Mechanical shock (decreased blood flow to/through heart)

43
Q

Why is it important to get an IV line inserted EARLY in shock?

A

Hard to do it once compensatory vasoconstriction occurs

44
Q

Management of controllable hemorrhage

A
  • Control bleeding
  • High-flow oxygen
  • IV acess
  • Fluid bolus (repeated)
  • Cardiac, O2, CO2 monitors
  • Ongoing exam
45
Q

Management of uncontrollable external hemorrhage

A
  • Same as controllable hemorhage EXCEPT caution with fluid administration
46
Q

Fluid administration in uncontrollable hemorrhage

A
  • DON’T give much fluids - dilutes clotting factors, can’t carry O2
  • DO give blood transfusion (carries O2)
  • 1 to 1 FFP/platelets ratio
47
Q

Management of uncontrollable internal hemorrhage

A
  • Surgical assessment

- SAME as external

48
Q

Special management part to high-space shock

A

VASOPRESSORS

49
Q

Hypovolemic shock + severe head injury - management

A
  • Glasgow coma score of less than 8 - SEVERE

- Fluid administration to BP 120 so cerebral perfusion pressure is at least 60

50
Q

Management of nonhemorrhagic hypovolemic shock

A
  • Same as controllable

- Fluid replacement

51
Q

Tension pneumothorax - describe

A

Vena cava collapses –> prevents venous return –> decreased cardiac output

52
Q

Tension pneumothorax - presentation

A
  • Tracheal deviation away from affected side
  • Decreased pulse
  • Decreased breath sounds
  • Distended neck veins
53
Q

Tension pneumothorax - management

A
  • Chest decompression (needle) of pleural pressure
54
Q

Penetrating cardiac injury –> ______

A

Cardiac tamponade

55
Q

Presentation of cardiac tamponade

A

“Beck’s triad”

- Shock, muffled heart tones, distended neck veins

56
Q

Management of cardiac tamponade

A
  • Pericardiocentesis

- Fluid administration (MAYBE)

57
Q

Management of myocardial contusion

A

Treat arrhythmias

Cardiovascular 2 (20 decks)

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