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23 Cards in this Set

  • Front
  • Back
How is hypovolemic shock diagnosed?
• blood pressure
• cap. refill
• consciousness
• heart rate
• skin
• temperature
• urine output
What is the most common cause of hypovolemic shock?
What are other causes of hypovolemic shock, besides hemorrhage?
• burns
• pancreatitis
• peritonitis
• protracted diarrhea
• vomiting
What are the body's responses to hemorrhagic shock?
• blood flow shifts centrally
• decreased cardiac output
• decreased systemic arterial pressure
• diminished venous return
• fluid shift (from intracellular to extracellular compartment)
• increase ADH, Adrenal Cortical Hormone, & GH
• increased respiratory rate
• shift from aerobic to anaerobic (causing increase in lactic acid)
• supression of insulin (2° to increased catecholamines) causing hyperglycemia
How can you distinguish stage 2 from stage 1 shock?
restlessness in stage 2
What are lab tests to get to determine the degree of hypovolemic shock?
• serum electrolytes
• serum lactic acid
What is the most likely etiology of an increased anion gap in hypovolemic states?
elevated lactic acid
What is the definition of septic shock?
• result of the systemic effects of infection (primarily bacterial or fungal)

• inadequate oxygen delivery (due to supernormal oxygen demand by increased metabolism of septic cells)
What are characteristics of early septic shock?
• aka warm shock
• ABG reveals moderate respiratory alkalosis
• lactate levels are usually normal or only mildly increased initially
• low systolic BP, relative normal pulse pressure, and stroke volume
• normal or high cardiac output
• tachycardia & tachypnea
What are characteristics of late septic shock (aka cold shock)?
• bicarbonate levels fall
• cardiac index usually falls below normal
• depletion of functional extracellular fluid volume
• depressed mental status
• impaired organ function
• intravascular fluid retention
• lactate levels begin to rise rapidly*
• oliguria
• pH becomes acidotic
Most septic shock is caused by what type of bacteria?
gram-negative enteric bacteria
What are some causes of septic shock?
• infected burn wounds
• intra-abdominal abscess
• intravenous cateter infection
• peritonitis
• pneumonia
• wound infection
What is the definition of a surgical fever?
fever > 101 or 101.5°F
What is the treatment for septic shock?
• correct primary process
- antibiotics
- drainage

• resuscitation
- ventilatory support and O2
- fluids
- inotropes
- vasodilators or vasopressors
What are etiologies for cardiogenic shock?
• Ischemic heart disease
• valvular heart disease
• arrhythmias
• trauma
What is the most common cause of cardiogenic shock?
myocardial infarction
What are determinants of myocardial oxygen consumption?
• heart rate
• contractility
• preload
• afterload
What are significant lab and diagnostic findings of cardiogenic shock?
• abnormal EKG, CXR, echo
• elevated central venous pressure or pulmonary capillary wedge pressure
• pulmonary edema, hypoxia, metabolic acidosis
• rising BUN and creatinine levels
• severe reduction in cardiac index
What intervention is mandatory for the treatment of cardiogenic shock?
pulmonary artery catheter
What does a pulmonary artery catheter measure in the treatment of cardiogenic shock?
• arterial blood pressure
• cardiac index
• oxygen delivery & consumption
• right & left ventricular filling pressures
• pulmonary & systemic vascular resistance
Treatment of cardiogenic shock is based on what four methods?
• altering preload & afterload
• controlling arrhythmias
• increasing contractility
• providing mechanical support
What are the 3 drugs commonly used to increase cardiac contractility?
• dobutamine
• dopamine
• isoproterenol
What are significant lab abnormalities in pure neurogenic shock?
no significant abnormalities in acid-base status, indices of renal function, or hemoglobin concentration will be noted