Week 2 - Shock Flashcards
Define Shock
state of inadequate tissue perfusion leading to impaired cell metablosim and function
if untreated organ failure > irreversible > death
4 stages of shock
- initial
- compensatory
- progressive
- refractory/ irreversible
initial stage characteristics (2)
- imbalance between demand and supply
- hypoperfusion begins
compensatory stage characteristics (3)
- compensatory mechansims activated
- decreased cardiac output results in release of adrenaline and noradrenaline > increased heart rate
- blood flow to heart, lungs and brain maintained (blood flow to kidneys reduced)
compensatory stage signs and symptoms (7)
- decreased consciousness
- increased RR
- increased HR
- decreased BP
- decreased UO
- increased BGL
- cool clammy skin
progressive stage characteristics (5)
- compensatory mechandims fail
- GIT devoid of blood > increased risk of gastric ulcers and bleeding
- decreased CO leads to myocardial ischeamia
- failure of the Na+ and K+ pump > peripheral oedema
- aggressive management needed to prevent MODS
progressive stage (signs and symptoms) *(9)
- increased RR
- increased WOB
- crackles (APO)
- increased HR
- decreased blood pressure
- weak peripheral pulses
- peripheral oedema (failure of the Na+ and K+ pump)
- decreased UO
- delirum
refractory stage characteristics (4)
- death of the cells
- build up of toxins
- MODS
- recovery is unlikely
refractory stage signs and symptoms (3)
- coagulation altered
- anuria
- respiratory failure
septic shock (I am remembering this well) just go to book and make sure I remember all the main things
good
cardiogenic shock
is an inability of the heart to pump blood resulting in decreased CO and BP and leading to tissue hypoperfusion
occurs in 6 - 10% of people post AMI with ST elevation
only 2% without ST elevation
48 hours post AMI
60 - 80% mortality rate despite appropriate treatment
cardiogenic shock causes
- know 5
- AMI
- arrythimas
- complications of cardiac surgery
- cardiac arrest
- electrolyte imbalance
- infections
- electrolyte imabalances
cardiogenic shock signs and symptoms (12)
- increased RR, WOB, HR, BP
- crackles (due to APO) as there is tissue hypoperfusion
- weak thready pulses
- cyanosed extremeties
- increaded CVP (hypoperfused)
- distended neck viens
- peripheral oedema
- increased cap refill
- decreased UO
management of cardiogenic shock
increase CO and decrease workload of the heart
cardiogenic shock (main interventions and assessments)
- pathology (cardiac enzymes, FBE, U&E)
- ABG > insert arterial line
- IV access (cautious fluid administration as haven’t lost any fluid so don’t want to overwork the heart)
- CVC (to monitor CVP as will be increased)
- IDC
- INOTROPES (dopamine or adrenaline) if decreased BP
Complications of cardiogenic shock (6)
- cardiopulmonary arrest
- dysthrthmia (VT)
- renal failure
- MODS
- stroke
- death
Distrubutive shock
- what is it?
- 3 types?
intravascular volume is displaced
- decreased venous return due to alteration in blood vessel tone
1) septic shock
2) anaphalytic shock
3) neurogenic shock
Define Septic shock
infection induced hypotension despite adequate fluid resuscitation with the presence of perfusion abnormalities including lactic acodosis, oliguria and acute alteration in mental status.
septic shock risk factors (5)
- age
- malnutrition
- chronic medical conditions (COPD, diabities)
- splenectomy
- major trauma
septic shock clinical manifestations 2 stages (6) & (8)
Early (warm) Phase:
- increased RR
- decreased BP
- increased HR
- thready pulse
- febrile
- anxious
Late (cold) phase:
- lethargic > coma
- increased RR
- decreased BP
- increased HR
- cool pale skin
- anuria
- decreased CVP
- decreased body temp
septic shock management (5)
- find source of sepsis
- iv fluids
- IVAB
- Inotropes
- BGL control (if too high insulin)
septic shock (main interventions) *(6)
- ECG
- CVP
- pathology (U&E, FBE)
- ABG
- blood, urine and sputum sample
- inotropes
Anaphylactic shock
systemic hypersensitivity reaction
(antigen - antibody response)
- sudden, severe and systemic
- can progress to death within 3 minutes if no treatment, however can take upto 4 hours
causes of anaphylactic shock (6)
- bites and stings
- foods
medications:
- antibiotics (penicillin)
- asprin and NSAIDS
- vitamins (thiamine and folic acid)
blood products
anaphylactic shock predisposing factors
- asthma
- eczma
- previous ANA shock
anaphylactic shock main interventions
- iv access
- fluid resus stat 1l
- inotropes
- antihistamines (controversial)
- systemic corticosteroids
neurogenic shock define
imbalance between parasympathetic and sympathetic vascular smooth muscle > resulting in massive systemic vasolidilation
neurogenic shock cause
- trauma to spinal cord
- head injury
- depressive drugs
- anastheitic drugs
