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Critical Care GBC > W9 D3-4 - Shock > Flashcards

W9 D3-4 - Shock Flashcards

1
Q
A
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2
Q

What are 3 main signs of shock?

A

Low BP, Low CO, hypoxia

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3
Q

Summarize the phases of shock

A

Initial

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4
Q

How much blood must be lost during hypovolemic shock?

A

20% of their total volume

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5
Q

What defines cardiogenic shock?

A

Heart pump problem
* inefficient contractility
* coronary / non-coronary
* decreases FOC, CO, tissue perfusion

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6
Q

Coronary vs non-coronary cardiogenic shock

A

Coronary
* most common
* MI, cell death

Non-coronary
* myocardial dysfunction, myocarditis

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7
Q

What are the 3 main coronary arteries?

A

Circumflex
RCA
LAD

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8
Q

What are the 3 possible types of dysfunction in cardiogenic shock?

A

LV systolic dysfunction - impaired contractility
LV diastolic dysfunction - impaired filling
Right ventricular failure - LVfailure, increased pulmonary afterload

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9
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10
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11
Q

What are the goals of treatment for cardiogenic shock?

A

LVF
* improve pump function - dobutamine / milrinone
* tissue perfusion - restore MAP
* prevent pulmonary edema - ventilated

RVF - hard to treat
* increase RV pump function - optimize preload
* improve forward flow of blood

VVV

Pharmacological agents
* inotropes to increase FOC; dobutamine, milrinone, epinephrine
* pulmonary vasodilators to V pulmonary hypertension

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12
Q

What is an intra aortic balloon pump? IABP

A
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13
Q

Compare shocks

A

Hypovolemia - low volume
Cardiogenic - pump problem
Disruptive - vasodilation

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14
Q

Explain neurogenic shock

A

SNS is suppressed causing vasodilation
On its own, PSNS decreases in HR

often caused by spinal cord injuries

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15
Q

What can cause neurogenic shock? How?

A

Total Injuries above T6 causes a loss of sympathetic tone in the blood vessels (chronic issue)
* pacemaker needed

Spinal cord cervical and thoracic edema above T6 causes as TEMPORARY loss of SNS innervation to blood vessels

Vasomotor center dysfunctions
* from compression via ^ ICP, herniation, barbiturates
* messages cannot be sent down to the muscles

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16
Q

What happens with a loss of SNS tone? in neurogenic shock

A

1. Decreased CO
2. Decreased tissue perfusion

Cause by…
* bradycardia
* peripheral vasodilation = arterial vasodilation (= V afterload) & = venous vasodilation (= V preload) = V BP
* impaired thermoregulation = room temp

17
Q

What are the goals of treatment for neurogenic shock?

A

1. Prevent cardiovascular instability
* fluid resus.
* vasoconstrictor: norepinephrine
* atropine, dopamine, epi, pacing

2. Prevent CNS instability
* spinal cord injury care, log roll
* caution with suctioning, vagal nerve stimulation, have atropine

3. Improve tissue perfusion
* caution turning, watch hypo/hypertension as no SNS compensation
* atropine

4. Maintain normothermia
* warming/cooling blanket
* prevent DVT d/t vasodilation
* anticoagulation, compression device

18
Q

Explain the patho of anaphalactic shock

A

Histamine is released from mast cells
1. histamine 1 receptors
* vasodilation leaky capillaries
* smooth muscle constriction
* both cause respiratory constriction & cardiovascular decrease (BP, SVR, preload) tachycardia = decreased CO and tissue perfusion
* skin: rashes, hives, itchy

2. histamine 2 receptors
* increase in stomach acid
* causes vomiting, cramping, abdominal pain

19
Q

Treatment goals for anaphalactic shock

A
20
Q

Define septic shock

A

Systemic inflammatory response syndrome (SIRS) (to tissue injury)
* temperature high or low
* HR above 90
* RR above 20
* WBC above 12000, less than 4000

Sepsis:
* organ dysfunction d/t dysregulation response to infection

Progressing to shock
* profound circulatory, cellular, metabolic abnormalities including hypotension, serum lactate above 2

21
Q

Explain the patho of septic shock

A

Too many or not enough inflammatory mediators
1. ^ inflammation
2. ^ coagulation
3. V fibrinolytic activity / V clot breakdown
4. high metabolic rate (febrile)

22
Q
A
23
Q

What are the goals of treatment for septic shock?

A

1 hour bundle - initiate uprecognition of sepsis
1. Lactate level
2. Obtain blood cultures
3. Administer broad spectrum antibiotics (piptazo, vanco)
4. Rapid admin of 30 mL/kg crystalloid (NS/ringers) for hypotension / lactate above 4
5. Vasopressors to maintain MAP > 65

Critical Care GBC (33 decks)

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