Week 7b: Circulatory Shock Flashcards
an acute failure of the circulatory system to supply the peripheral tissues and organs of the body with an adequate blood supply, resulting in tissue hypoxia
circulatory shock
which type of shock involves:
- loss of blood
- loss of plasma
- loss of extracellular fluid
hypovolemic
which type of shock involves:
- inability of the heart to fill properly
- obstruction of outflow of the heart
obstructive
which type of shock involves:
- loss of sympathetic motor tone
- presence of a vasodilation substance in the blood
- presence of inflammatory mediators
distributive
which type of shock is caused by an alteration in cardiac function
cardiogenic shock
which type of shock: hypotension, tachycardia, weak thready pulse, cool pale moist skin, decreased urine output, decreased cardiac output and increased SVR?
hypovolemic
which type of shock: hypotension, tachycardia, cool pale moist skin, urine output less than 30ml/h, crackles and tachypnea, decreased CO and increased SVR?
cardiogenic
which type of shock involves hypotension, warm dry skin, bradycardia, decreased CO, venous and arterial dilation, and loss of sympathetic tone?
neurogenic
which type of shock: hypotension, tachycardia, cough, dyspnea, pruritus, urticaria, restlessness, decreased LOC, decreased CO and decreased SVR?
anaphylactic
which type of shock: hypotension, tachycardia, full bounding pulse, tachypnea, pink warm flushed skin, decreased urine output, fever, decreased CO and decreased SVR?
septic
what are some complications of shock?
- acute respiratory distress syndrome
- acute renal failure
- gastrointestinal complications
- DIC
- multiple organ dysfunction system
treatment of shock
- sustain CO
- reduce workload and oxygen needs of the myocardium
- increase coronary perfusion
- affect peripheral vascular resistance
- monitor volume
what is the first priority in the management of shock?
basic life support
what is second priority in the management of shock?
maintaining blood pressure, airway and breathing
what are the other signs and symptoms of cariogenic shock?
- restlessness
- confusion
- pale cold sweaty skin
- peripheral/central cyanosis
- rapid weak pulse
- low SAP and MAP
- drowsiness and coma
- decreased urinary output
What are 2 very important signs/symptoms of shock?
- shallow, rapid breathing
- increased CVP and pulmonary artery pressure
medications used to treat cariogenic shock
- nitroprusside
- dobutamine
- milrinone
- epinephrine
- dopamine
Nitroprusside for cariogenic shock
produces arterial and venous dilation, producing a decrease in venous return to the heart and a reduction in arterial resistance against which the left heart must pump
dobutamine for cariogenic shock
a beta adrenergic agonist which has greater inotropic than chronotropic effects
milrinone for cariogenic shock
increases myocardial contractility by letting more calcium into the cell, resulting in decreased after load and increased stroke volume
epinephrine and dopamine (catecholamines) for cariogenic shock
- positive inotropes
- used with caution because of arterial constriction and increased HR
- organ failure due to vasoconstriction
when are vasoconstrictors used to treat shock?
to maintain the BP when fluid replacement has not been effective
why is treatment with vasoconstrictors considered last resort
due to potential organ damage
what are 3 commonly used vasoconstrictors?
- norepinephrine
- isoproterenol
- phenylephrine
inotropic effect is usually generated by stimulating….?
beta1 adrenergic receptors
what are 2 examples of inotropic agents used to treat shock
- dobutamine
- dopamine
what are two important signs/symptoms of hypovolemic shock?
- deep rapid breathing
- low CVP
crystalloids
consists of solutions that are usually isotonic with physiological concentrations of electrolytes. administered IV to replace lost fluids, maintain BP, and promote urine output
therapeutic effects and uses of human serum albumin
- low plasma volume
- hypovolemic shock
- hypoproteinemia
important adverse effects of human serum albumin
- pulmonary congestion
- circulatory overload if too much fluid is drawn into the vasculature
- renal failure can promote fluid overload
causes of distributive or vasodilatory shock
- decrease in sympathetic control of vasomotor tone
- release of excessive vasodilatory substances
- vessel damage from severe or prolonged hypotension due to haemorrhage
what are the 3 types of distributive shock
- neurogenic shock
- anaphylactic shock
- septic shock
decreased sympathetic control of the vessel tone due to a defect in the vasomotor centre
neurogenic shock
severe systemic allergic reaction most commonly mediated by IgE
anaphylactic shock
a life threatening organ dysfunction caused by a dysregulated host response to an infection
sepsis
what are some important manifestations of septic shock
- warm flushed skin
- fever and increased WBC
- elevated lactate/ metabolic acidosis
- decrease in systemic vascular resistance
what is the end result of severe sepsis?
multiple organ dysfunction syndrome
presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention
MODS
which electrolyte is eliminated primarily though the kidneys and is conserved through reabsorption by aldosterone
Sodium
Normal range of sodium
135-145 mEq/L
signs and symptoms of hyponatremia
- nausea and vomiting
- headache
- confusion
- drowsiness/fatigue
- restlessness/ irritability
- muscle weakness, spasm or cramps
- seizures
- coma
what will happen to the cells in hyponatremia?
cells swell because water moves in
signs and symptoms of hypernatremia?
- excessive thirst
- lethargy
- muscle twitching
- seizures
- coma
what will happen to the cells in hypernatremia?
due to to increased osmolality of the ECF, water leaves the cells and the cells shrink
which electrolyte plays an important role in transmission of electrical impulses, particularly in the nerve, heart, skeletal, intestinal and lung tissue?
potassium
what triggers potassium excretion in the urine
aldosterone
what is the most abundant electrolyte in the body?
calcium
what is the normal value of calcium?
2.1-2.5 mmol/L
what is the normal value of ionized calcium ?
1.15-1.35 mmol/L
what are some causes of hypocalcemia?
- decreased ionized Ca
- excess loss
- inadequate intake
- Decreased absorption in GI tract
what are some signs and symptoms of hypocalemia?
- osteoporosis leading to fractures
- tingling and convulsions
- abnormal deposits of calcium in bodily tissues
- muscle spasms and tetany
- dysrhythmias and cardiac arrest
what are two tests used to elicit calcium deficiency?
- trousseaus sign
- Chvosteks sign
causes of hypercalcemia?
- loss from bones
- excess intake
- increase in factors causing mobilization from bone
what are some signs and symptoms of hypercalcemia?
- kidney stones and kidney damage
- decreased tendon reflexes, lethargy and coma
- bone pain, osteoporosis and fractures
- muscle fatigue, hypotonia, decreased GI motility
- dysrhythmias and cardiac arrest
which electrolyte plays a major role in bone formation and metabolic processes?
phosphorus
which electrolyte imbalances are related to starvation/refeeding?
hypophosphatemia
which electrolyte maintains normal intracellular levels of potassium, helps maintain electrical activity in nervous tissue membranes and muscle membranes
magnesium
what is the normal value of magnesium
1.5-2.5 mEq/L
hypomagnesemia can cause?
hypokalemia
high serum calcium results in?
excretion of magnesium by the GI tract
relation between hypomagnesemia and calcium deficit
magnesium inhibits the transport of PTH, decreasing the amount of calcium being released from the bone, resulting in possible calcium deficit
