Week 12: Medical Emergencies Flashcards by Ajok Deng Derry

What is shock?

A life threatening condition where the circulatory’s system is not able to deliver adequate oxygen and nurtrients to the body

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What are the 3 main categories of shock?

Cardiogenic
Hypovolemic
Vasogenic (distributive)

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What are the 4 causes of shock?

Hypovolemic Shock: Severe fluid or blood loss (e.g., trauma, burns, dehydration).

Cardiogenic Shock: Heart pump failure (e.g., heart attack, arrhythmias).

Obstructive Shock: Blocked blood flow (e.g., pulmonary embolism, pneumothorax).

Distributive Shock: Widespread vessel dilation (e.g., sepsis, anaphylaxis, drug reactions).

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What is the underlying issue in all types of shock?

Inadequate blood supply of oxygen and nutrients

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What problems will cause inadequate oxygen and nutrients in shock?

Heart pump failure
Inadequate blood volume
Compromised circulatory system

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What can untreated shock lead to?

Cellular starvation, organ dysfunction, and organ death

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How does shock begin at the cellular level before affecting vital signs?

Shock starts with cellular hypoxia due to lack of oxygen and nutrients, leading to anaerobic metabolism.

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What are the effects of anaerobic metabolism during shock?

It produces less ATP and leads to lactic acid buildup, which causes cellular swelling.

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How does increased capillary permeability occur during shock, and what does it cause?

Histamine and bradykinin increase permeability, causing fluid to leak from vessels into tissues.

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What causes electrolyte imbalance in shock, and what happens as a result?

Dysfunction of the sodium-potassium pump leads to electrolyte and fluid shifts within cells.

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What are the 3 stages of shock?

Compensatory
Progressive
Irreversible

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What happens in the compensatory stage of shock?

The body activates neural and hormonal mechanisms to maintain BP and blood volume

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What happens in the progressive stage of shock?

The compensatory mechanisms fail leading to changes in vital signs and inadequate organ perfusion

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What happens in irreversible stage of shock?

The extent of organ damage is irreversible, and the patient’s condition cannot be improved despite medical intervention.

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How does the body try to compensate in the compensatory stage?

Vasoconstriction to maintain BP

Increased HR to maintain cardiac output

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What is the primary goal when treating shock?

To target the underlying problem and provide rapid treatment

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What is third spacing in hypovolemic shock?

When fluid leaks from the intravascular space into the interstitial space

Can happen 2 or 3 day post op

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What are the body’s compensatory mechanisms in response to hypovolemic shock?

Vasoconstriction, fluid retention, and blood shunting to vital organs (heart, lungs, brain).

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What physiological responses occur due to decreased circulating volume in hypovolemic shock?

Decreased cardiac output and blood pressure

Increased heart rate

Release of adrenaline and noradrenaline.

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How does the renin-angiotensin system help during hypovolemic shock?

It conserves fluid and increases blood pressure by releasing aldosterone and ADH.

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What are key signs and symptoms of hypovolemic shock?

Reduced blood volume, increased respiratory and heart rate, altered consciousness, cold/clammy skin, weak peripheral pulses, tachycardia, tachypnea, and confusion.

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What are some examples of injuries that can cause significant blood loss?

Fractured femur: ~1000 mL
Fractured pelvis: ~300 mL
Ruptured spleen: ~2000 mL

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At what point does hypovolemic shock typically develop?

After approximately 15% blood volume loss or around 750 mL.

What is the nurses role in shock?

Recognizing patterns and signs of shock

Implementing appropriate interventions

Communicating patient status to the healthcare team

What is included in the initial treatment of hypvolemic shock?

Prioritizing ABCs Optimizing ventilation/oxygen Restoring intravascular volume

How can you optimize ventilation/oxygen in a patient with hypovolemic shock?

Administer oxygen (O2 above 94%) Collaborate with Respiratory therapist

How can you maintain vascular access when treating hypovolemic shock?

Do it early as the vasoconstriction will make it harder later Insert 2 large bore IVs, in the actecubital Central line may be necessary as well for large volume infusions

What is the first-line fluid for resuscitation in hypovolemic shock?

Crystalloids (e.g., normal saline or Ringer’s lactate).

What is a safe method for administering fluids to avoid overload in hypovolemic shock?

Give small boluses (e.g., 250 mL) and auscultate the chest between boluses.

What’s the difference between crystalloids and colloids in fluid resuscitation in hypovolemic shock?

Crystalloids: Small molecules (e.g., sodium chloride). Colloids: Large molecules (e.g., albumin) that draw fluid into the intravascular space.

What should be monitored to prevent fluid overload during resuscitation in hypovolemic shock?

Lung sounds Blood pressure, pulse, respiratory rate Jugular venous distension (JVD)

Why should IV fluids be warmed during resuscitation in hypovolemic shock?

To prevent hypothermia, which can cause vasoconstriction and impair platelet function.

How fast can rapid transfusers deliver blood, and what should they include for hypovolemic shock?

About 1 unit in 2 minutes with a pressure bag; use devices with warming capabilities.

What is a critical step alongside fluid resuscitation in treating hypovolemic shock?

Identifying and addressing the underlying cause (e.g., GI bleed, C. difficile).

When are vasopressors used in fluid resuscitation for hypovolemic shock?

When blood pressure remains low despite adequate fluid administration.

What are examples of vasopressors used in hypovolemic shock?

Epinephrine and dopamine.

What airway considerations are important in shock patients?

Assess level of consciousness (Glasgow Coma Scale) Ensure airway protection Intubate if needed Provide supplemental oxygen

What intake/output monitoring is recommended?

Monitor I&O carefully Insert a Foley catheter (especially in burn patients)

What is the preferred fluid for up to 1500 mL blood loss?

Crystalloids, with Ringer's lactate often preferred over normal saline.

What are possible complications of massive transfusion?

TRALI (Transfusion-Related Acute Lung Injury) Pulmonary edema/fluid overload Urticaria Transfusion reactions (e.g., rash)

What is a special consideration when giving fluids to elderly patients?

Use caution to avoid fluid overload due to reduced physiological reserve.

What is cardiogenic shock, and what commonly causes it?

Cardiogenic shock is due to the heart's failure to pump effectively, most commonly after an MI—especially an anterior MI involving the LAD artery.

What is the mortality rate of cardiogenic shock, even with treatment?

Around 80%, making it one of the most fatal types of shock.

How can the body’s compensatory mechanisms worsen cardiogenic shock?

Increased heart rate and workload raise oxygen demand, further stressing the already failing heart.

What degree of left ventricular damage leads to cardiogenic shock?

Greater than 40% damage to the left ventricle.

What are other causes of cardiogenic shock besides MI?

End-stage cardiomyopathy Severe valve dysfunction (e.g., ruptured papillary muscle) Ventricular aneurysm

What is the pathophysiology behind cardiogenic shock?

Decreased cardiac output activates compensatory mechanisms, increasing workload and oxygen demand, but the heart fails to meet the body's needs, impairing cellular metabolism.

Who is most at risk for developing cardiogenic shock?

Older adults Females Diabetics Individuals with a history of MI, especially anterior wall infarction

What are early signs and symptoms of cardiogenic shock?

Restlessness/confusion Mental status changes Increased heart rate Narrowing pulse pressure Oliguria Overwhelming fatigue

What are late signs and symptoms of cardiogenic shock?

BP less than 90 mmHg Cold, clammy, mottled skin Central & peripheral cyanosis Dyspnea (from pulmonary edema) Nausea, vomiting Chest pain Dysrhythmias Diaphoresis Elevated glucose (from liver glycogen release)

What are the main goals in managing cardiogenic shock?

Optimize oxygenation, support cardiac function, treat underlying causes, and monitor closely.

How is oxygenation managed in cardiogenic shock?

Provide supplemental oxygen to maintain SpO₂ of 94–95%. Obtain ABGs for guidance. Intubation and mechanical ventilation may be needed to reduce cardiac workload.

What are key monitoring strategies in cardiogenic shock?

Frequent vital signs Neurological and chest assessments Hourly urine output Abdominal assessment for bowel ischemia

What symptoms should be managed in cardiogenic shock?

Pain and anxiety Dysrhythmias (treated with antiarrhythmics) Hyperglycemia (managed with insulin, even in non-diabetics)

How is hemodynamic stability achieved in cardiogenic shock?

Use inotropes like digoxin to increase cardiac contraction Digoxin also helps delay AV node conduction Administer high-dose diuretics (e.g., Lasix) to relieve fluid overload