Shock/Resuscitation lecture

Question 1

What is shock?

Answer 1

the inadequate perfusion of cells, tissue, and organs with oxygen and other nutrients resulting in cell, tissue, and organ dysfunction. It is also often referred to as hypoperfusion

Question 2

What are the etiologies/cause of shock

Answer 2

Inadequate volume
inadequate pump
inadequate vessel tone

Question 3

What are the 4 main categories of shock?

Answer 3

Hypovolemic
Cardiogenic
Distributive
Obstructive

Question 4

What is the sometimes mentioned 5th category of shock?

Answer 4

metabolic/respiratory

Question 5

What is hypovolemic shock?

Answer 5

Shock caused by low blood volume caused by loss of blood or fluid lost from intravascular space; loss of whole blood

Question 6

What are the categories of hypovolemic shock?

Answer 6

hemorrhagic: loss of whole blood

non hemorrhagic: shift of fluid out of the intravascular space; however, red blood cells and hemoglobin remain within the vessels. It is primarily water, plasma proteins, and electrolytes that are lost; ex: vomit

burn: specific form of nonhemorrhagic hypovolemic shock resulting from a burn injury. Burns can interrupt the integrity of the capillaries and vessels and allow them to leak plasma and plasma proteins.

Question 7

What is distributive shock?

Answer 7

a decrease in intravascular volume caused by massive systemic vasodilation and an increase in capillary permeability

Question 8

what are the types of distributive shock?

Answer 8

anaphylactic, septic, neurogenic

Question 9

What is anaphylactic shock?

Answer 9

Chemical mediators that are released in the anaphylactic reaction cause massive and systemic vasodilation. These chemical mediators also cause the capillaries to become permeable and to leak

Question 10

What is Septic Shock?

Answer 10

results from sepsis, which is an exaggerated inflammatory response to an infection that causes the vessels throughout the body to dilate and become permeable.

Question 11

What is neurogenic shock?

Answer 11

referred to as vasogenic shock, A spinal cord injury may damage the sympathetic nerve fibers that control vessel tone below the level of injury. Loss of sympathetic tone causes the vessels to dilate. If the injury is high in the thoracic spinal cord or in the cervical region, enough vessel tone may be lost to cause a drop in systemic vascular resistance, blood pressure, and perfusion

Question 12

What is sepsis

Answer 12

exaggerated inflammatory response to an infection that overwhelms the body’s defense and regulation systems. disrupts organ and cell function

Question 13

what are the s/s of sepsis

Answer 13

tachycardia
tachypnea
hyperthermia or hypothermia
hypotension

flushed warm skin early on,
mottled/cyanotic in late stages
AMS

Question 14

What is obstructive shock?

Answer 14

a condition that obstructs forward blood flow. The volume is adequate, the heart is not damaged, and the vessels are of a normal size with adequate resistance. However, an obstruction is not allowing the blood to move forward.

Question 15

What is Cardiogenic shock?

Answer 15

caused by ineffective pump function of the heart. The patient has an adequate blood volume and vessel tone; however, hypoperfusion results from the inability of the heart to contract effectively typically due to the left ventricle being damaged

Question 16

What are common causes of cardiogenic shock?

Answer 16

cute myocardial infarction (heart attack), congestive heart failure, abnormal cardiac rhythm, infection, or overdose on drugs that depress the pumping function of the heart such as beta blockers or calcium channel blockers

Question 17

What is metabolic shock?

Answer 17

described as a dysfunction in the ability of oxygen to diffuse into the blood, be carried by hemoglobin, off-load at the cell, or be used effectively by the cell for metabolism.

Question 18

What is the body’s immediate response to shock?

Answer 18

Sympathetic nerve stimulation leading to:
Increase in heart rate
Increase in force of ventricular contraction (stroke volume)
Vasoconstriction
Stimulation of the release of epinephrine and norepinephrine from the adrenal gland

Question 19

What are the stages of shock?

Answer 19

compensatory followed by decompensatory

Question 20

What is compensatory shock?

Answer 20

organ and gland stimulation to maintain normal bp, and perfuse vital organs

Question 21

What is Decompensatory shock?

Answer 21

advanced stage of shock where the body can no longer compensate and maintain blood pressure, or perfusion of the vital organs

Question 22

What are the s/s of compensatory shock

Answer 22

anxiety
normal BP
Mild tachycardia (>100 bpm)
thready pulse in extremities
Slight-to-moderate tachypnea (20–30/minute)
Pale, cool skin; skin is moist

Question 23

what are the s/s of decompensatory shock?

Answer 23

AMS
hypotension
Marked tachycardia ( at 140 and higher, the pt is dire); may progress to bradycardia
pulse is weak/absent
Air hunger (tachypnea/hyperpnea)
progresses to respiratory failure
white waxy cold skin

Question 24

What are the s/s of hypovolemic shock?

Answer 24

decreased bp
narrowing pulse pressure
tachycardia
tachypnea
pale, cool, clammy skin
poor/unobtainable spo2
anxiety
delayed capillary refill
weak/absent peripheral pulse
decreased urine output

Question 25

what are the s/s of cardiogenic shock?

Answer 25

decreased bp
narrowing pulse pressure
tachycardia or bradycardia
tachypnea
pale, cool, clammy skin or cyanotic/mottled
decreased spo2
anxiety
JVD/peripheral edema (Right side failure)
crackle/rales upon auscultation (left side failure)
weak/absent peripheral pulse
decreased urine output

Question 26

What are the s/s of distributive shock?

Answer 26

decreased bp
tachycardia with anaphylaxis/sepsis
bradycardia associated with spinal cord injury
tachypnea associated with anaphylaxis/septic
normal respiratory rate neurogenic
anxiety
weak/absent peripheral pulses

Skin signs:
normal to flushed skin- sepsis
warm flushed skin- neurogenic
warm flushed skin with hives- anaphylaxis
mottled/cyanotic- late stage of shock

Question 27

what are the s/s of obstructive shock?

Answer 27

decreased bp
pulsus paradoxus(tension pneumothorax, paricardial tamponade)
narrow pulse pressure
tachycardia
tachypnea
pale cool clammy skin
decreased spo2 reading
anxiety
jvd (tension pneumothorax, paricardial tamponade)
weak/absent peripheral pulse
decreased urine output

Question 28

what is the normal systolic bp of kids less than 10?

Answer 28

70 mmHg plus two times the age in years is a lower limit of normal.

Question 29

what are the three phases the patient goes through following cardiac arrest that lead to biological death?

Answer 29

electrical phase, circulatory phase, metabolic phase

Question 30

what is the electrical phase?

Answer 30

begins immediately upon cardiac arrest and ends 4 minutes afterward. During this early and initial phase, the heart still has a good supply of oxygen and glucose; therefore, aerobic metabolism is maintained with continued energy production for cell function and prevention of mass production of acid. During this phase, the heart is in a good physiological condition for resuscitation

Question 31

What is the circulatory phase?

Answer 31

begins at 4 minutes following the cardiac arrest and lasts through 10 minutes following the cardiac arrest. During this phase, the oxygen stores are reduced and the myocardial cells shift from aerobic to anaerobic metabolism. This results in very little energy production for cell function, in addition to the production of acid. heart is less prepared for defibrillation and is less prone to restarting

Question 32

What is the metabolic phase?

Answer 32

begins 10 minutes after cardiac arrest. At this point the heart is starved of oxygen and glucose and has a large amount of acid buildup. The tissues are ischemic and may begin to die. The chances of survival drop dramatically during this phase. Because of the lack of glucose and ATP, the sodium/potassium pump fails, allowing sodium to enter and stay within the cell. The sodium attracts water inside the cell.

Question 33

What are the shockable rhythms?

Answer 33

V fib and v tac

Question 34

What is a v fib rhythm?

Answer 34

disorganized cardiac rhythm that produces no pulse or cardiac output

Question 35

what is a v tac rhythm?

Answer 35

a very fast heart rhythm that is generated in the ventricle instead of the sinoatrial node in the atrium. Because the pumping is so rapid, the heart does not refill properly and cardiac output is sharply reduced. This rhythm can easily degenerate into ventricular fibrillation.

Question 36

What are non shockable rhythm?

Answer 36

Asystole and Pulseless electrical activity

Question 37

What is asystole rhythm?

Answer 37

the absence of electrical activity and pumping action in the heart. This often registers on a monitoring screen as a flat or nearly flat line; hence, the term “flatline” is often used for asystole

Question 38

What is Pulseless electrical activity rhythm?

Answer 38

heart has an organized rhythm, but either the heart muscle is so weakened that it fails to pump, or the heart muscle does not respond to the electrical activity, or the circulatory system has lost so much blood that there is nothing to pump

Question 39

What are the three indications for ROSC?

Answer 39

A pulse is felt after the AED indicates a no shock advisory.
Patient regains spontaneous breathing.
The patient begins to move

Question 40

Adult ventilation rate?

Answer 40

10-12/minute
1 every 5-6 sec

Question 41

child/infant ventilation rate?

Answer 41

12-20/minute
1 every 3-5 sec

Question 42

neonatal ventilation rate?

Answer 42

40-60/minute
1 every 1-1.5 sec

Question 43

adult cpr ratio

Answer 43

30/2
100-120 compressions/minute

Question 44

child/infant cpr ratio

Answer 44

30/2 - 1 responder
15/2- 2 responder
100-120 compressions a minute

Question 45

neonatal cpr ratio

Answer 45

3 compressions to 1 ventilations