Shock States Flashcards
Shock States
Shock is a clinical syndrome of systemic hypertension, acidemia, and impairment of vital organ function resulting from tissue hypo perfusion
Hypovolemic Lab/Diagnostics
CO/CI: low CVP: low PCWP: low **SVR: high SV 02: low
Cardiogenic Lab/Diagnostics
CO/CI: low **CVP: High **PCWP: high SVR: high SV 02: low
Distributive shock
Three forms of shot characterized by vasodilation, decrease intravascular volume, reduced peripheral vascular resistance, and loss of capillary integrity. Distributive shock maybe
Septic
Anaphylactic
Neurogenic
Septic Lab/Diagnostics
CO/CI: high than low CVP: low than high PCWP: low than high SPR: low SP 02: low than high
Anaphylactic Lab/Diagnostics
CO/CI: low CVP: low PCWP: low SVR: low SVO2: low
Neurogenic Lab/Diagnostic
CO/CI: low CVP: low PCWP: low SVR: low SVO2: low
Obstructive Lab/Diagnostics
CO/CI: low CVP: high PCWP: normal/low SVR: high SVO2: high
Hypovolemic Shock
Results from a loss of greater than 20% of circulating blood volume
Hypovolemic shock causes
Internal/external bleeding
Burns
DKA
Severe dehydration
Hypovolemic shock management
Fluid resuscitation is the mainstay of treatment
Vasopressor supports
Packed red blood cells when indicated by hemoglobin/hematocrit
Cardiogenic Shock
A loss of effective contract tile function results in impaired cardiac output, impaired oxygen delivery, and reduced tissue perfusion
Cardiogenic shock causes
Acute am I: most common causes Ventricular aneurysm Dysrhythmia Pericardial tamponade Hypoxemia Pulmonary edema Acute valvular regurgitation Acute ventricular septal defect
Cardiogenic Shock Management
Initial, careful administration of IV fluids
Vasopressor support
Septic Shock
Caused by infective organisms which invade the bloodstream and alter vascular tone; hypovolemia develops as a result of blood pooling in the micro circulation
QSOFA
Used to identify patients with suspected infection who are at greater risk for a poor outcome
Assign one point for each criterion met; the presence of two or more points near the onset of infection is associated with a greater risk of death or prolonged intensive care stay
Low blood pressure less than or equal to 100
High respiratory rate greater than or equal to 22
Altered mentation Glasgow coma scale less than 15
Septic shock Management
Fluid resuscitation is main state of treatment (Crystal Lloyd)
Upon diagnosis of sepsis, initiate antibiotics within one hour
Vasopressor agents
Anaphylactic Shock
IGE mediated reactions that occur shortly after exposure to Allergan
Anaphylactic Management
Maintain airway Crystalloids for volume expansion Diphenhydramine 25–75 mg IV or I am Eppinette friend 0.3–0.5 mg sub Q or I am for respiratory distress, strider, wheezing IV glucocorticoids as needed Consider H2 antagonist Inhaled beta agonist for bronco spasm
Neurogenic Shock
Loss of peripheral vasomotor tone as a result of spinal cord injury, regional anesthesia
Neurogenic shock Management
Maintain airway
Crystalloids for volume expansion
Vasopressor agents
Obstructive shock
In adequate cardiac output as a result of impaired ventricular filling
Obstructive shock causes
**Massive pulmonary embolus, most common causes Tension pneumothorax Acute cardiac Tampa nod Obstructive valvular disease Disease of pulmonary vasculature
Obstructive shock management
Maintain blood pressure while initiating treatment of underlying causes Fluid administration Vasopressors Mechanical ventilation as indicated Anticoagulation as indicated
