Shock + syncope Flashcards
What is the first thing you do with a patient with shock?
ABCs + establish monitoring
Cardiac monitor w/ BP cuff
ABGs repeated
Central cath/swan-ganz for detailed monitor
VIP treatment – evaluate whether you need to:
Ventilate (O2)
Infuse (IV fluid resuscitation)
Pump (vasoactive agents)
______ often initial DOC in cardiogenic, septic, + hypovolemic shock
norepinephrine
_____ first line in cardiogenic shock with low CO and maintained BP
dobutamine. It’s an inotrope
Do you give fluids to cardiogenic shock patients?
Yes, but in small increments. If they are overloaded, they will not benefit
If your patient has cardiogenic shock from an MI, consider –
immediate percutaneous coronary revascularization when MI is recognized
Balloon pump/ECMO for BP support
Blood circulatory devices
Transcutaneous/transvenous pacemaker
Urgent hemodialysis/filtration for kidney injury
Medications for shock include
Vasoactive therapy
Steroids
Antibiotics
Sodium bicarbonate
How do you treat septic shock?
fluids + broad antibiotics
If fluids don’t fix HOTN, vasopressors (norepinephrine)
If a patient remains HOTN with fluids in septic shock, you should
give norepinephrine may be indicated to raise MAP
How do you treat anaphylactic shock
airway + epinephrine + antihistamines
How do you treat neurogenic shock?
fluids + pressors + steroids
How do you treat hemorrhagic shock?
blood + fluids (crystalloids)
How do you treat non-hemorrhagic shock?
fluids
Vasopressors indicated in shock if:
Continued HOTN
Preserved CO
After adequate fluid resuscitation
like epinephrine, norepinephrine, dopamine, vasopressin, phenylephrine, dobutamine
Inotropes indicates in shock if
Low CO
High filling pressure
How do you treat obstructive shock
Relieve obstruction + stabilize patient → oxygen + fluids + vasopressors
How do you treat syncope?
Treat cause + prodromal symptoms – counterpressure maneuvers like leg crossing, lower body muscle tensing, hand grip, arm tensing
Immediate response: assist patient, lay supine, assess VS, observe other signs, call for assistance, attempt to arouse patient
