TYPES OF SHOCKS !!

Question 1

Hypovolemic Shock

Answer 1

Causes: Dehydrations, bleeding, burns
S/s: increased HR, decreased BP, restless, anxious
Decreased- CO/CVP/PAWP/HgB w/ bleed
Increased- SVR (compensatory)/ Lactate/ NA (hypernatermia)

Treatment: NS fluids ( 3 for 1), blood products

Nursing Care: Hemodynamic monitoring, monitor lung sounds, monitor UO

Question 2

Cardiogenic Shock

Answer 2

Causes: L ventricular MI, Trauma
S/S: similar to HF, crackles, JVD, increased HR, decreased BP, weak pulses (abrupt !)

Increased- CVP/ PAWP/ SVR
Decreased- CO/SV

Treatment: ionotropics, vasopressors, diuretics, antidysrhythmics, IABP, VAD, ECHMO (last resort)
Nurse Management: limit oxygen demand, contin ECG, BP, CVP, vasopressors, provide comfort, maintaining surveillance for complications

impellla small heart pump

Question 3

IABP

Answer 3

Used if drugs not working to fix shock state, temporary measure to decrease Myocardial workload by improving supply & DECREASE demand. it improves coronary artery perfusion and reduces left ventricular afterload

inflates during diastole, deflates during systole

Question 4

VAD

Ventricular Assist Device

Answer 4

mechanical pump that supports heart function and blood flow in people with a weak heart. takes blood from lower chamber of the heart, helps pumps it to the body to vital organs

Question 5

Distributive shock: vessel prob: lack tone

Anaphylactic Shock

Answer 5

Causes: antigen/ aggressor
S/S: massive vasodilations + bronchcontriction, rash, laryngeal edema, stridor, wheezing, decreased LOC, N/V/D, decreased BP/CO/CVP/PAWP/SVR, increased HR

Treatment: Remove antigen, Epi, benadryl, corticosteroids, fluids, ionotropes, vasopressor, tylenol
Nursing Care: Monitor BG

Question 6

IgE mediated

Answer 6

initial contact (primary immune response)
Next time antigen enter body and the IgE antibody reacts (secondary immune response)

Question 7

Non IgE mediated

Answer 7

Direct reaction of mast cells to release biochemical mediators

Question 8

Distributive shock: vessel prob: lack tone

Neurogenic Shock

Answer 8

Causes: T6 increases injury, drugs, improper spinal anesthesia
* Parasympathetic system runs unopposed -> loss of sympathetic tone -> inability to tighten up

S/s: bradycardia, hypoTN, hypothermia
Decreased CO/CVP/PAWP/SVR

Treatment: DVT prophylaxis, fluids ( SBP < 90, UO < 30) , vasopressors (vasocontrict) , atropine, pacemakers, pt warming

parasym remains uncheck, vasodilate no resistance

Question 9

Distributive shock: vessel prob: lack tone

Septic Shock

Answer 9

Sepsis: Tachycardia, Tachypnea, PaCO2 < 32, temp > 38 < 36
* interventions, successful

Septic Shock: Sepsis w/ hypoTN despite fluid (3rd spacing) resuscitation
* no response to interventions
**Microorganism -> SIRS -> activation of coagulation cascade -> organ death
**
Diagnostics: Left shift leukocytosis (bandemia), blood cultures ( -> broad spectrum), increased CRP, coag abnormalities, increased Lactase

S/S: increase HF, TEMP, PaCo2 ( first a decrease), decrease BP,LOC, UO, RR (late), SVR, CVP, PAWP
widened pulse pressure, bounding pulse, warm skin, crackles w/ lung infections

Treatment: trend lactate, blood cultures x2, pan cultures, broad anx -> narrow NS fluids, vasopressors (epi drip), maintain CO+ BG

Question 10

sepsis

Answer 10

1. measure serum lactate
2. blood cultures
3. broad spectrum ABX
4. crystalloid for decrease BP + lactate > 4
5. Vasopressors
6. Persistent arterial hypotension
   * target CVP > 8, CV O2 > 70

Question 11

sepsis

Answer 11

1. low dose steriods
2. glucose control
3. resp. management

Question 12

Obstructive Shock

Answer 12

Causes: cancer/tumor blocking organ blood flow, recent long bone fracture ( fat globules escapes
Risk factors: Cardica Tamponade, Pulmonary Embolism, Pneumothorax