Alteration In Hemodynamic Health: Shock

Front 1

What is shock?

Back 1

failure of the circulatory system to deliver oxygen to the cell and to remove the waste products of cellular metabolism

hypotension with associated hypo-perfusion (inadequate organ blood flow) abnormalities or impaired cell oxygen utilization

Front 2

Tissue perfusion is related to what?

Back 2

MAP: mean arterial pressure

Front 3

What factors influence the MAP?

Back 3

cardiac output (pump)

total blood volume (tank)

size of the vascular bed (pipes)

Front 4

MAP is directly proportional to what two things?

Back 4

blood volume

CO

Front 5

MAP is inversely proportional to what?

Back 5

the size of the vascular bed

Front 6

What compensatory mechanism leads to the manifestation of shock?

Back 6

The body's ability to shunt blood flow from less vital areas to maintain blood flow and oxygen delivery to vital areas.

Front 7

How is shock classified?

Back 7

according to the initial event

Front 8

Hypovolemic shock clinical manifestations?

Back 8

restlessness

increased heart rate and respiratory rates

cool, clammy skin

decreased urine output, due to compensatory vasoconstriction

B/P may be normal or low in the early phase

Front 9

Hypovolemic shock hemodynamic findings?

Back 9

decreased cardiac output

decreased left ventricle filling pressure

increased SVR

Front 10

Hypovolemic shock is due to what?

Back 10

decreased intravascular volume

Front 11

Hypovolemic shock usually occurs when?

Back 11

when there is a deficit of at least 15%-20% or total blood volume

Front 12

Hypovolemic shock is the most common cause of ____ in ____ patients, especially in the ____ phase.

Back 12

Hypovolemic shock is the most common cause of hypotension in critically ill patients, especially in the post-op phase.

Front 13

Causes of absolute hypovolemia

Back 13

fluid lost through:

hemorrhage

GI loss

diabetes insipidus

hyperglycemia

diuresis

Front 14

Causes of relative hypovolemia

Back 14

fluid out from vascular spare into the extravascular space "third spacing"

burns

Front 15

How can the hypovolemic shock state be reversed?

Back 15

if the fluid volume is replaced quickly

Front 16

If low pressure persists for ____ minutes, it may be irreversible.

Back 16

60

Front 17

What are the clinical manifestations of hypovolemic shock?

Back 17

restlessness

increased heart and respiratory rates

cool, clammy skin

decreased urine output, due to compensatory vasoconstriction

B/P may be normal or low in the early phase

Front 18

What are the hemodynamic findings of hypovolemic shock?

Back 18

decreased cardiac output

decreased left ventricular filling pressure

increased SVR

Front 19

What is cardiogenic shock?

Back 19

anything which affects the heart as a pump

forward blood flow is inadequate because of a primary defect in cardiac function

Front 20

What is the most common cause of cardiogenic shock?

Back 20

myocardial infarction, when more than 40% of the ventricle is damaged

Front 21

What are some other causes of cardiogenic shock?

Back 21

end-stage cardiomyopathy

valvular heart disease

cardiac tamponade

Front 22

What are the clinical manifestations of cardiogenic shock?

Back 22

tachypnea

crackles

cyanosis

pallor, cool, and clammy skin

decreased capillary refill

Front 23

What are the hemodynamic findings of cardiogenic shock?

Back 23

decreased cardiac output

high left ventricle filling pressures

increased SVR

decreased left ventricular stroke work

Front 24

What is the primary goal of treating cardiogenic shock?

Back 24

to treat the oxygenation needs of the heart muscle

NOT to limit further myocardial damage

Front 25

What is obstructive shock?

Back 25

impedance of adequate cardiac filling

Front 26

What are the forms of obstructive shock?

Back 26

tension pneumothorax

massive pulmonary embolus

cardiac tamponade

Front 27

What are the hemodynamic findings of obstructive shock?

Back 27

decreased cardiac output

increased SVR

variable left ventricular filling pressures (depending on etiology)

Front 28

What is the treatment for obstructive shock?

Back 28

relief of the obstruction

cardiac tamponade: pericardiocentesis may be lifesaving

maintenance of intravascular volume with all forms of obstructive shock

Front 29

What are the types of vasogenic shock?

Back 29

septic: massive vasodilation from endotoxins

anaphylactic: massive vasodilation from an allergic reaction

neurogenic: seen in patients with spinal cord injuries

Front 30

What are the results of vasogenic or distributive shock?

Back 30

massive vasodilation

circulating volume is lost in venous pooling

increased capillary permeability and third spacing of fluids

Front 31

What will happen is intravascular volume is not replaced?

Back 31

hypovolemia

Front 32

What are the extremities in vasogenic shock?

Back 32

they're warm

Front 33

The most common form of vasogenic shock?

Back 33

sepsis

Front 34

Sepsis is related to the release of what?

Back 34

bacterial endotoxins in a gram-negative bacterial infection

Front 35

What groups of patients are susceptible to sepsis?

Back 35

elderly

immunosuppressed

patients with indwelling catheters

patients with UTIs

patients who have undergone invasive procedures

Front 36

Mortality in sepsis is around 50% due to what factors?

Back 36

microbial resistance to antibiotics

rapidly changing microbial profile

Front 37

What are the early hemodynamic changes in sepsis?

Back 37

cardial output, stroke volume, and heart rate are increased

systemic vascular resistance (SVR) and CVP are decreased

the patient is warm, dry, and flushed

B/P is normal

Front 38

What are the late hemodynamic changes in sepsis?

Back 38

the continued increase in capillary permeability will potentiate hypovolemia to the point that the process will convert to a cold phase of septic shock:

SVR increases

cardiac output decreases

patient is cold, pale and clammy

Front 39

What are some other factors that can cause vasogenic shock?

Back 39

anaphylactic reactions from drugs, insect bites, and food allergies

involves an antigen-antibody interaction that provokes the release of the likes of histamine; histamine works on the vascular membranes and the smooth muscles

causes the arterioles to dilate, cardiac output and arterial pressure decreases

histamine also increases capillary permeability and subsequent volume depletion

the immediate S&S from the patient are pharyngeal and laryngeal edema and bronchoconstriction

Front 40

When does neurogenic shock occur?

Back 40

when a disturbance in the nervous system affects the vasomotor center

Front 41

What are some qualities of neurogenic shock?

Back 41

The sympathetic nerve impulses are interrupted and as a result there is vasodilatation andincreased vascular space and therefore decreased peripheral vascular resistance

this results in peripheral pooling and a decrease in venous return

result is drop in cardiac output and tissue hypoxia

Front 42

What are the stages of shock?

Back 42

compensatory

progressive

irreversible