Week 5- hypovolemic, distributive Flashcards
most common type of shock see in practice
hypovolemic
why hip fracture a concern
highly vascularized and can bleed
diagnostics for hypovolemia
6
- ABGs
- CBC
- Lytes
- type and cross match
- lactate
- coags
types of hypovolemia
relative
absolute
risk factors for hypovolemia
3
- Age >65 (cant compensate as well, more at risk for dehydration, nutrition)
- diseases (renal, cardiac, liver)
- decreased body mass (break down fat when body needs energy)
pathophysiology
hypovolemic shock
decrease circulating volume
decrease venous return
decrease stroke volume
decrease output
decrease oxygen supply
tissue perfusion
impaired cellular metabolism
examples of absolute and relative
shock
A: external blood loss (gun shot wound)
body fluid loss (diuresis)
R: third spacing (ie, burns)
internal blood loss (ie. ruptured spleen)
complications for hemorrhage
3
hypoperfusion
lethal triad
Electrolyte imbalance
lethal triad
Hypothermia
Acidosis
Coagulopathy
hypovolemia treatment
treat the cause
- stop loss
- replace loss (PRBC, IV fluids)
improve CO
- increase O2 supply (preload, contractility & afterload)
- decrease O2 demand
Hypovolemia treatment
hemorrhage
2
- whole blood
- 4 units of RBC
- 4 units of plasma
- 1 platelets (4 donors)
Ratio is 1 1 1
- Tranexamic acid (TXA)
hypovolemia non hemorrhage treatment
colloids
crystalloids
whole blood helps with
volume and clotting vs RBC alone
colloids contain
where do they go
what they do
require
watch for
examples
- large molecules
- remain in intravascular compartment
- expand plasma by drawing fluid from the extravascular space (oncotic pressure)
- require less volume than crystalloids
- fld volume overload
- FFP, Albumin, Hetastarch, pentastarch
colloids can be good if patient is already
fluid overloaded but need to increase pressure
crystalloids are (3)
Isotonic: osmolality matched plasma
hypertonic: higher concentration of electrolytes
hypotonic: lower concentration of electrolytes
examples of isotonic fluids
watch for
0.9% NS
ringers lactate
hypervolemia
examples of hypertonic fluids
watch for (2)
3% NS D10W D50
intravascular overload
pulmonary edema
examples of hypotonic
watch for (2)
0.45% S, D5W once dextrose has been metabolized
changes in LOC/shock
fluid we most commonly use
NS but RL is the closest to blood composition but expensive
some tests done in ICU to see if interventions are working
5
- CVP
- Arterial pressure
- PCWP
- SVR
- CO/cardiac index
5 things to remember if interventions are working
- increase BP
- HR decrease (RR will also decrease)
- Increased UO
- increased skin perfusion (decrease in Peripheral edema)
- improved mental status
distributive shock what happens
tank gets bigger
- vessels dilate
- increased vessel capacity
- not enough fluid in the tank
hypovolemia vs septic shock
Signs
type of problem
H= preload problem, decrease in volume
S= afterload problem, vessel is getting bigger
septic= temperature increase, confirmed or suspected infection, flushed, warm
hypo= slight drop in temperature
Septic shock differs from hypovolemia shock in that it is frequently manifested by:
fever and flushed face
elevated blood pressure
increased urinary output
slow bounding pulse
a
who is at risk for septic shock
3
CAN
- Age (babies and elderly
- comorbidities
- nutrition/hydration
lactic acid is
natural byproduct of cellular metabolism and is produced when body breaks down CHO for energy in low O2 conditions (impaired cellular metabolism)
the produces and uses ____ not _____
lactate nt lactic acid
key features of sepsis
- source of infection
- S/S of infection (increase HR >90, RR >20)
- temp >38 or less than 36
- increase WBC (>12 or less than 4)
- SBP >90
- altered mental status
sepsis screening tool
2 f the following
- HR > 90
- RR >20
- Temp greater than or equal to 38 or less than 36
- WBC > 12 or less than 4
- altered mental status
AND
confirmed of suspected source of infection or any of the symptoms below
- cough/sputum/CP/SOB
- Abdo pain, distension, vomiting, diarrhea
- dysuria/frequency/indwelling cath
- skin or joint (pain, swelling, redness)
- Central line present
- mottled skin, cold extremities
diagnostics for sepsis
lactate
ABGs
CBC
Lytes
Coags
septic shock treatment
- fluids
- abx #1
- improve CO
increase O2 supply (preload, contractility & afterload) - decrease 02 demand
o2 intubation
Septic shock S&S
- temp dysregulation
- increased WBC
- hypoperfusion
tachycardia
tachypnea/hyperventilation
hypotension
↓ UO
Altered neuro
GI dysfunction
ARDS:
DIC
What is the difference between anaphylaxis & anaphylactic SHOCK????
shock is more systemic, there is vasodilation
onset of anaphylaxis is
immediate and life threatening
anaphylactic shock is a
result of an immediate hypersensitivity reaction
antigen/antibody response
- massive histamine, chemical mediator release, vasoactive substances causing vasodilation
S&S of anaphylactic shock
- stridor (airway swelling)
- rash
- swelling
- hypoperfusion
Tachycardia
Tachypnea/hyperventilation
Hypotension
↓ urine output
Altered neurological status
GI dysfunction
ARDS: Acute respiratory distress syndrome
DIC: Disseminated Intravascular Coagulation
tx anaphylactic shock
- remove the cause
- treat the cause
improve CO
increase O2 supply
- afterload
- preload
- contractility
Decrease O2 demand
- intubation
how do we treat the cause
anaphylaxis
- Stop the vasodilation
- stop bronchoconstriction
- stop histamine
Epinephrine
Antihistamine (Benadryl)
Ranitidine (also an antihistamine)
Alpha
B1
B2
vasoconstriction
increase HR, BP
bronchodilation, increase RR
signs of anaphylactic shock
3
bronchoconstriction
hives or edema
hypotension
neurogenic shock results of loss or suppresion
- of sympathetic tone
- rare
- SCI
results in major vasodilation
- drop and become super bradycardia
Neurogenic shock S&S
- bradycardia
- dry, warm skin
hypoperfusion
Tachypnea/hyperventilation
Hypotension
↓ urine output
Altered neurological status
GI dysfunction
ARDS: Acute respiratory distress syndrome
DIC: Disseminated Intravascular Coagulation
treatment of neurogenic shock
treat cause but if cant then maintain normal HR: atropine
maintain normothermia
increase O2 supply and decrease demand
take away for shock
neurogenic
anaphylaxis
septic
signs
- hypoperfusion
septic= high temp, warm, flushed
neurogenic= badycardic warm then cool
ana= stridor, rash, swelling
