Therapeutics - Shock Flashcards
a syndrome of impaired tissue perfusion is known as
shock
when a tissue is underperfused it leads to
ischemia
endogenous inflammatory cytokines
oxygen radicals
what may lead to decreased perfusion
cellular dysfunction
organ damage
SIRS describes
an acute dysregulation of inflammatory response regadless of teh cause
what is the hallmark of septic shock
SIRS
what are the characteristics of SIRS
profound vasodilation
increased capillary permeability
SIRS has greater that atleast 2 of the following abnormalities
temperature
heart rate
respiration
WBC
what is the main determiant of tissue perfusion
MAP
MAP is a function of
CO x SVR
what is the general treatment goal of shock
to regain hemodynamic control and identify and reverse causes, halt organ dysfunction and minimize adverse effects
the goal of treatment of hypovolemic shock is
to restore tissue perfusion and oxygenation by resotring volum and to avoid fluid overload
what type of interventions are used for hypovolemic shock
infusion of IV fluids - crystalloids, colloids, and blood
what should be checked for when giving hypovolemic treatment
pulmonary edema
colloid iv infusions should be avoided in persons with hypersensitivity to
albumin
what is first line for hypovolemic shock
crystalloids
require more to replete less volume
inexpensive
what is the general approach with crystalloids
give 1-2 L as fast as possible and monitor to see if goal is achieved
normal saline, lactated ringers, D5W
what are examples of colloid solutions for hypovolemic shock
albumin
dextrans
starches
what are the adverse effects of blood transfusions for hypovolemic shock
electrolyte abnormalities
hypo hyperkalemia
hemolysis
infectious disease
coagulopathies
imunnosuppression
acute lung injury
what is the general approach with blood for hypovolemia
administer units of PRBCs about 200 ml to increase hg to 1 g/dl and hematocrit to 3%
what should be monitored when administering blood for hypovolemic shock
ptt platelets electrolytes
what are the goals of treating cardiogenic shock
restore tissue perfusion and oxygenation by improving cardiac function
what are the three interventions for cardiogenic shock
fluid challenge
inotropes
vasodialators
if the patient is in both hypovolemic and cardiogenic shock what should you tret first
hypovolemic shock
otherwise can cause adverse effects
what is the direct effect of fluid challenge
increases PCWP
what is the general approach for fluid challenge in cardiogenic shock
give small amoutn of fluid 100 ml normal saline and reevaluate CO , if it doesnt improve unliekl to benefit from more
what is the effect of treating cardogenic shock with inotropic agents
increase HR, contractility, ventricular wall tension should increase CO
increases map by increasing cardiac performance , increase myocardial o2 consumption
what is the general approach for inotropic agents of cardiogenic shock
titrate by 1-2 mcg/kg/min q10 minutes to lowest effective dose that ahcieves goal and avoids adverse effects - tachy
given IV only via central line
what are the goals of inotropic support of cardiogenic shock
MPA 75 - 80 mmHg
HR less than 110 beats/min
PCWP 12-18 mmHg
Cl greater than 2.5L
what are the inotropic agents
dopamine
dobutamine
epinephrine
what is the effect of vasodilator agents
decrease PCWP and SVR
what is the general approach of vasodilators for cardiogenic shock
give only if sbp is greater than 90 mmHg which can decreases BP initially
titrate q5 mins to lowest effective dose that acheives goal and avoids adverse effects
when should map stop increasing during treatment
if mmHg decreases 5-10, worsening tachy
what is the goal of vasodilators
Map greater than 70 mmHg
