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47 Cards in this Set
- Front
- Back
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What is shock?
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State of circulatory failure charac. by inadequate tissue perfusion.
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Correct managment of shock involves what things?
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treating both the underlying cause of shock and physiologic abnormalities associated with the shock state
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Causes of shock can be classified on the basis of what 4 pathophysiologic mechanisms?
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Hypovolemic
Cardiogenic Obstructive Distributive |
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The chief abnromality in obstructive shock is what?
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impediment of filling of the right and left ventricle (decreased preload)
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Obstruction may occur in what two systems?
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systemic circulation
Pulmonary circulation |
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The chief abnormality in distributive shock is what?
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abnl distribution of vascular volume due to change in vascular resistance or permeability
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The derangement of vascular volume characterizing distributive shock may occur as a result of what conditions?
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Sepsis
Anaphylaxis Neurogenic shock |
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What is the systolic BP of and adult or child that is hypotensive?
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>90mmHg
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What is consider mild shock?
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decreased perfustion of nonvital organs and tissue only (skin, fat, muscle and bone)
Mentation unimpaired Normal Urine output |
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What is the initial treatment of shock?
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Pt supine and level or elevated feet
O2 Stop external hemorrhage Gain IV access suspect hypovolemic shock |
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What is a good tool or lab test used to rule out hemorrhagic causes for shock?
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HCT
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If pt presents with sever back or abd pain with hx of HTN should suggest what?
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Aortic dissection
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What are some symptoms a pt could be presented with if suspect of Aortic dissection ?
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Hematuria, Neurologic deficit, or dimished peripheral pulses
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What are some causes of hypovolemic shock that are not so apparent?
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Ruptured Abd aortic aneurysm
aortic dissection Splenic rupture intestinal obstruction peritonitis |
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What is considered a crystalloid solution?
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isotonic .9% or normal saline (LR)
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What are some colloids solutions?
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Blood
Plasma (fresh frozen) Hetastarch |
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What is the fluid of choice for mild Shock?
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Crystalloid sol Strongly perferred. due to low cost , lack of adverse effect .
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During Hemorrhagic shock, what is the fluid of choice, until adequate blood cross matching can be done for 30-40min?
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2-3 liters of crystolloid sol (Normal or RL)
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What is the best indicator of successful resuscitation?
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improved atrial filling presssures and
improved Urine output. Improved Mentation Peripheral perfusion |
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Urine output is good index of visceral blood flow and should be maintained at what?
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.5 ml/kg/h in adults
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During an Emergent care of shock patients what are some important vital to maintain?
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V/S q 5-15 min
Fluids (quantity/type) CVP (30-60 mint) URINE output (q 30-60min) Serial HCT, ABG, Electroyles ect |
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How much blood can be held with Hemithorax?
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2L , quick upright or lateral decubitus chest x-ray important
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How much blood can the thigh hold during hemorrhage?
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3-4 L after major fracture or crush injury
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Cardiogenic shock due to "pump failure" is usually associated with what condition?
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Acute MI
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Cardiogenic shock is a complication of Acute MI in about what Percent of all patients?
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10% (MR >50%)
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What is the hallmark of cardiogenic shock?
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Hypotension (systolic <90mmHg)
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What are some clinical signs of Cardiogenic shock with Hypotension?
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Inc. peripheral vascular resistency (weak thready pulse, cool, clammy skin)
Inadequate organ perfusion (AMS, dec. Urine output) |
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What are some early signs of cardiogenic shock
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tachycardia with dec. pulse pressure
Diaphoresis restlessness aagitation confusion |
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What are some treatment steps for pts that goes in cardiogenic shock?
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O2
Place pt in supine position legs elevated with systolic 70-80mmHg IV If pul. edema present use 5% dextrose in water to keep KVO Labs 12 lead Monitor output hourly search and treat nonmyocardial factors |
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What is the treatment of choice fo tachyarrhythmias?
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cardioversion
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Initial treatment for bardycardia causing hypotension is what?
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atropine .5mg IV q 5 min up to total dose of 2mg
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If pt has no signs of pulmonary edema, what is the rate of infusion of fluids?
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50-100ml increment over 5-10 minutes keep close watch for signs of improvement.
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What could be some signs of tamponade vs a cardiogenic shock?
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JVD, clear lung fields, Pulsus paradoxus,
Pericardial friction rub Low voltage on teh ECG |
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History of what condition could lead you to believe possiblity of pericardial effusion?
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cancer
uremia infectious illness |
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Pulsus paradoxus with fall in how much for systolic pressure or more during inspiration, occur in most case of Cardiac tamponade?
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12mmHg
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What are some signs and exam findings that could lead you to Tamponade?
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distent heart sounds
friction rub enlarged heart silhouette on x-ray |
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What are some sign of pt with massive Pulmonary emboli?
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Pleuritic chest pain, dyspnea, apprehension, cough
hemoptysis or syncope. PO2 does not increase with 100% O2 |
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The causes of distributive shock are diverse and include what types of shock?
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septic
anaphylactic neurogenic |
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Septic shock is usually caused by what ?
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invasion of Gram negative bacteria ("endotoxic ")
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Factors predisposing to development of septic shock include what?
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trauma
diabetes leukemia sever granulocytopenia disease of GI tract Radiation tx |
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What are some systemic signs of shock with infection/
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Rigors
fever petechiae Leukocytopsis leukopenia with shift to the left |
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Localized signs with shock and infection present?
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abd tenderness, perirectal abcess
extensive PNA |
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Typical sites of occult infection include?
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Urinary tract
biliary system Pelvis retroperitoneum perirectal area |
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Pt with GU tract infection had Aerobic gram negative bacilli, what is the antibiotic of choice?
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Ampicllin plus aminoglycoside
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Pt having Respiratory tract infection (Strep pneumonia; Staphy aureus aerobic gram neg bacilli) uses of what antibiotic?
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PEN G or clindamycin
Cefoitin or cefazolin |
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What antibiotic to use for skin, bone or joint infection?
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Nacillin, Oxacillin or methicillin
clindamycin |
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What is the dosage of Epi for anaphylactic reaction?
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.3-.5 mg (.3-.5 ml of 1: 1000) IM
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