States of Shock Flashcards
What is the MAIN problem of hypovolemic shock?
- decreased preload (less volume the heart is pumping)
Signs and symptoms hypovolemic shock
- cool and clamped down vasculature
- tachycardia (to get any little vol around the body)
- low urine output (not enough vol or pressure and kidneys wont work do to not enough circulating volume)
- dry mucous membranes
- narrowed pulse/BP
cause and characteristics of hypovolemic shock
- dehydration ( diarrhea, burns, salt-wasting)
- fluid loss
- dilated veins
- hemorrhage (blood loss) with trauma or bleedings
- increased afterload (veins constrict to increase vascular resistance to get blood and oxygen to where it needs to be)
- decreased cardiac output (not enough to pump)
- low volume circulation
What is hypovolemic Shock?
volume depletion
intravascular volume down
distributive shock: preload, afterload, contractility, BP, HR
- low preloads (venous dilation and 3rd spacing so not in vasculature)
- low afterload due to massive arterial dilation
- increase contractility initially and decrease in late-stage
- low BP (vasodilation)
- increase HR
cardiogenic shock: what happens to Preload, afterload, contractility, BP, HR
- increase preload (high fluid retention and vasoconstriction)
- increase afterload to compensate by vasoconstriction
- decreased contractility (pump failure)
- low BP (not pump as efficiently)
- high to low depends on the cause
hypovolemic: what happens to Preload, afterload, contractility, BP, HR
decreased preload
increased afterload (vasoconstrictor to shunt blood to vital organs)
contractility decrease (less preload = less stretch myocytes)
decreased or normal BP
increase HR (to get more vol around body)
the goal of treatment and types of treatment for distributive shock
- move fluid into vasculature so the heart has something to pump
- Fill large empty space in the vasculature (correct 3rd spacing and fill with fluid)
- normal saline and L.R.
- with infection treat the cause with antibiotics ➡ maintain BP
- consider vasopressor and inotropes (epi) increase flight or fight to slam close vasculature
- isotonic fluids
Signs and symptoms of distributive shock
- flushed
- peripherally dilated
- tachycardia
- concentrated urine
- hypotensive
- high temp
- warm skin
Anaphylaxis: edema, flushed and warm
Septic: depends on the presentation
Types of distributive shock (3) and their characteristics:
- Septic shock (infectious): massive inflammatory response leading to massive vasodilation
- Anaphylactic (autoimmune): mass inflammatory response, immune system
- Neurogenic (spinal trauma): loss of sympathetic NS simulations lead to an inability to vascoconstrict
Characteristics of distributive shock
- decreased preload (fluid not where it needs to be (dilated veins and 3rd spacing)
- decreased afterload due to dilated arterie
- decreased contractility
- cardiac output is high (heart pumping into nothing),
- leaky blood vessels
- inability to maintain vascular tone (vasodilation)
What is distributive shock and what is the main problem?
- change in fluid distribution
- decreased afterload (due to dilated arteries)
Cardiogenic shock treatment and reason for this treatment
- Decrease the workload of the heart and increase contractility (squeeze)
- decrease preload (less volume pumping)
- decrease work of heart with fluid removal Lasix
- decrease afterload (dilate arteries)
- increase contractility with inotropes
- get rid of built-up fluid, albumin pull fluid back into circulation
Signs and symptoms of cardiogenic shock
- cool and clamped down vasculature
- mottled skin
- crackles in lung
- peripheral edema
- perfusion problem
- contractility issues
Characteristics of cardiogenic shock
- decreased cardiac output (not working pumps)
- decreased blood pressure
- decreased tissue perfusion
- increased catecholamine release
- RAAS activation (hold on to Na+ and H2O, blood shunting to vital organs, not circulating as efficiently
- increased afterload (pump what it can with less efficient pumping mechanism with same volume as before )
