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Surgical Recall > SR 26 - Shock > Flashcards

SR 26 - Shock Flashcards

1
Q

What are the signs of shock?

A 
Pale, diaphoretic, cool skin
Hypotension, tachycardia, tachypnea
Decreased mental status and pulse pressure
Poor capillary refill
Poor urine output
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2
Q

What are the best indicators of tissue perfusion?

A

Urine output

Mental status

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3
Q

What lab tests help assess tissue perfusion?

A 
Lactic acid (elevated with inadequate tissue perfusion)
Base deficit
pH from ABG (acidosis associated with inadequate tissue perfusion)
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4
Q

What is the definition of hypovolemic shock?

A

Decreased intravascular volume

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5
Q

What are common causes of hypovolemic shock?

A

Hemorrhage, burns, bowel obstruction, crush injury, pancreatitis

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6
Q

What are the early signs of hypovolemic shock?

A

Orthostatic hypotension, mild tachycardia, anxiety, diaphoresis, vasocontriction (decreased pulse pressure with increased diastolic pressure)

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7
Q

What are the late signs of hypovolemic shock?

A

Changed mental status, decreased BP, marked tachycardia

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8
Q

Amount of blood loss and signs/symptoms with Class I hemorrhage

A
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9
Q

Amount of blood loss and signs/symptoms with Class II hemorrhage

A

15-30% or 750-1500cc of blood

Normal systolic BP with decreased pulse pressure, tachcyardia, tachypnea, anxiety

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10
Q

Amount of blood loss and signs/symptoms with Class III hemorrhage

A

30-40% or 1500-2000cc of blood

Tachycardia (>120), tachypnea (>30), decreased SBP, decreased pulse pressure, confusion

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11
Q

Amount of blood loss and signs/symptoms with Class IV hemorrhage

A

> 40% or >2000cc of blood

Decreased SBP, tachycardia (>140), tachypnea (>35), decreased pulse pressure, confused and lethargic, no urine output

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12
Q

What is the treatment of hypovolemic shock?

A

Stop any bleeding

IVF (isotonic LR) then blood products, as needed

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13
Q

How do you evaluate the effectiveness of treatment for hypovolemic shock?

A

Urine output, BP, HR, mental status, extremity warmth, capillary refill, body temperature
pH, base deficit, lactate level

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14
Q

What usually causes failure of ressucitative treatment of hypovolemic shock?

A

Persistent massive hemorrhage, requiring emergent surgical procedure

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15
Q

What does decreased pulse pressure occur with early hypovolemic shock?

A

Vasocontriction leads to an elevated DBP

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16
Q

What is the most common vital sign change associated with earl hypovolemic shock?

A

Tachycardia

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17
Q

What type of pateint does not mount a normal tachycardiac response to hypovolemic shock?

A

Patients on B-blockers
Spinal shock (loss of sympathetic tone)
Endurance athletes

18
Q

What is the definition of septic shock?

A

Documented infection and hypotension

19
Q

What is the etiology of septic shock?

A

Most common - G- septicemia

Less common - G+ septicemia, fungus

20
Q

Major complications of septic shock?

A

Multiple organ failure, DIC, death

21
Q

Signs and symptoms of septic shock?

A

Initial - vasodilation, resulting in warm skin and full pulses, normal urine output
Delayed - vasoconstriction and poor urine output, mental status changes, hypotension
Associated - fever, hyperventilation, tachycardia

22
Q

Associated lab findings in septic shock?

A

Early - hyperglycemia/glycosuria, respiratory alkalosis, hemoconcentration, leukopenia
Late - leukocytosis, acidosis, elevated lactic acid

23
Q

What is the treatment of septic shock?

A 
Volume - IVF
Antibiotics - empiric, then narrowed by cultures
Drainage of infection
Pressors PRN
Zygris PRN
24
Q

What is Zygris?

A

Activated protein C, shown to decrease mortality in septic shock and multiple organ failure

25
Q

Define cardiogenic shock

A

Cardiac insufficiency

Impaired cardiac output results in inadequate tissue perfusion

26
Q

Causes of cardiogenic shock?

A

MI, papillary muscle dysfunction, massive cardiac contusion, cardiac tamponade, tension pneumothorax, cardiac valve failure

27
Q

What are signs/symptoms of cardiogenic shock on exam?

A

Dyspnea, rales, pulsus alternans (increased pulse with greater filling following a weak pulse), loud pulmonic component of S2, gallop rhythm

28
Q

What are the vital sign changes seen with cardiogenic shock?

A

Hypotension, decreased CO, elevated CVP/wedge pressure, decreased urine output, tachycardia

29
Q

What are the signs seen on CXR in cardiogenic shock?

A

Pulmonary edema

30
Q

What is the treatment of cardiogenic shock?

A

Based on diagnosis/mechanism
CHF - diuretics and afterload reduction (i.e. ACEI), +/- pressors
LVF (MI) - pressors, afterload reduction

31
Q

What are the last resort support mechanisms in cardiogenic shock?

A

Intra-aortic ballon pump (IABP)

Ventricular assist device (VAD)

32
Q

What is the definition of neurogenic shock?

A

Inadequate tissue perfusion from loss of sympathetic vasoconstrictive tone

33
Q

What are the common causes of neurogenic shock?

A

Spinal cord injury:

  • Complete transection of spinal cord
  • Partial cord injury with spinal shock
  • Spinal anesthesia
34
Q

Signs and symptoms of neurogenic shock?

A

Hypotension and bradycardia

Neurologic deficit

35
Q

Why are heart rate and BP decreased in neurogenic shock?

A

Loss of sympathetic tone

But you need to rule out hypovolemia and hemorrhagic shock

36
Q

What is the treatment for neurogenic shock?

A

IV fluids

Vasopressors - only for hypotension refractory to fluid resuscitation

37
Q

What is spinal shock?

A

Complete flaccid paralysis immediately following spinal cord injury
May or may not be associted with circulatory shock

38
Q

What is the lowest reflex available to the examiner?

A

Bulbocavernous reflex

Contract of the anal spincter upon compression of the glands penis or clitoris

39
Q

What ist eh lowest level voluntary muscle?

A

External anal sphincter

40
Q

What are the classic findings associated with spinal cord shock?

A

Hypotension

Bradycardia or lack of compensatory tachycardia

41
Q

What are the treatment options for anaphylactic shock?

A

BASE

  • Benadryl
  • Aminophylline
  • Steroids
  • Epinephrine

Surgical Recall (32 decks)

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