Itls Shock

Front 1

Four components that need to be intact to maintain normal tissue perfusion

Back 1

1. Intact vascular system
2. Adequate air exchange
3. Adequate volume of fluid
4. functioning pump

Front 2

Formulas that describe the "steady state" of activity needed to maintain blood pressure (BP + cardiac output)

Back 2

Blood Pressure = Cardiac Output x Peripheral Vascular Resistance
Cardiac Output = Heart Rate x Stroke Volume

Front 3

4 basic rules of shock management

Back 3

1. Maintain airway
2. Maintain oxygenation / ventilation
3. Control bleeding where possible
4. Maintain circulation - adequate HR and vascular volume

Front 4

How positive pressure ventilations can have a negative effect on cardiac output

Back 4

by decreasing the blood return to the heart

Front 5

Description of shock

Back 5

condition that occurs when the perfusion of the body's tissues with oxygen, electrolytes, glucose, and fluid becomes inadequate to meet the body's needs

Front 6

the backup process of energy production the body uses when deprived of oxygen

Back 6

anaerobic metabolism

Front 7

by product of anaerobic metabolism that disrupts cellular activity

Back 7

lactic acid

Front 8

With inadequate oxygen to the body, the sympathetic nervous system increases release of what 2 circulating catecholamines? What are their effects?

Back 8

epinephrine and norepinephrine. increase in heart rate and contractility and constriction of peripheral blood vessels

Front 9

Response of the midbrain to hypoxia and acidosis

Back 9

increases respiratory rate

Front 10

Clinical manifestations of shock. When present, what do they imply?

Back 10

pale, diaphoretic, tachycardic. Cells in vital organs are vulnerable and susceptible to severe and permanent damage. Multisystem organ failure can develop days after admission to ICU

Front 11

hypotension is a late sign of the state of shock, how low can a blood pressure get and still maintain proper perfusion?

Back 11

varies with each patient; elderly or patients with chronic hypertension can't tolerate hypotension as well as a healthy young patient

Front 12

What type of shock is most often categorized into either compensated or decompensated?

Back 12

hypovolemic shock

Front 13

Shock state in which the body is able to employ regulatory mechanisms to maintain perfusion

Back 13

compensated shock

Front 14

signs and symptoms associated with compensated shock

Back 14

Weakness, thirst, pallor, tachycardia, diaphoresis, tachypnea, decreased urinary output, weakened peripheral pulses

Front 15

cause of pallor in hypovolemia

Back 15

catecholamine-induced vasoconstriction and/or loss of circulating RBC's

Front 16

cause of diaphoresis in hypovolemia

Back 16

effect of catecholamines on sweat glands

Front 17

cause of tachypnea in hypovolemia

Back 17

combined effect of stress, catecholemines, acidosis, and hypoxia

Front 18

cause of thready pulse in hypovolemia

Back 18

arteries shrink in diameter as volume is lost

Front 19

signs and symptoms of decompensated shock

Back 19

Hypotension, altered LOC, cardiac arrest

Front 20

causes of cardiac dysfunction in shock

Back 20

hypoxia and acidosis

Front 21

effects of acidosis on blood pressure

Back 21

causes a loss of response to catecholamines, worsening the drop in BP; usually the point where compensating patient crashes

Front 22

the pressure driving blood through the vascular system

Back 22

pulse pressure

Front 23

how to measure pulse pressure

Back 23

subtract diastolic from systolic

Front 24

Why is there almost always a narrowing in pulse pressure early in shock syndrome?

Back 24

vasoconstriction causes initial rise in BP, raising diastolic more than systolic

Front 25

the loss of approx. 15 - 25% of the blood volume stimulates slight to moderate compensation symptoms. pulse is fast

Back 25

early shock

Front 26

loss of approx. 30 - 45% of blood volume causes hypotension as body's ability to compensate has failed. patient is near death. pulse weak or absent

Back 26

late shock

Front 27

tip to estimating systolic BP in late shock

Back 27

radial 80
femoral 70
carotid 60

Front 28

What are the pros and cons of using capillary refill time as a diagnostic tool

Back 28

pros: useful in evaluating small children in whom it is difficult to get an accurate BP.
cons: associated with late shock, associated with both false-positives and false-negatives, affected by cold, low blood volume, and vasoconstriction

Front 29

earliest reliable sign of shock

Back 29

tachycardia - anyone sustaining HR over 100 must be suspected of having occult hemorrhage until proven otherwise; over 120 is red flag

Front 30

Factors that could prevent tachycardia in hypovolemia

Back 30

- 20% of abdomen bleeding victims don't develop tachycardia
- medications: beta-blockers, calcium channel blockers

Front 31

capnography findings that can indicate circulatory collapse and worsening shock

Back 31

falling much under 35, especially into the 20's or below

Front 32

3 major classifications (types) of shock

Back 32

Low volume (absolute hypovolemia)
High space (relative hypovolemia)
Mechanical (cardiogenic or obstructive)

Front 33

Examples of low-volume shock

Back 33

- hemorrhage, diarrhea, vomiting
- third spacing from burns, peritonitis, etc

Front 34

Examples of high-space shock

Back 34

- spinal injury, vasovagal syncope, sepsis, OD of vasodilators

Front 35

Examples of mechanical shock

Back 35

- damage to heart (contusion or MI), cardiac tamponade, tension pneumothorax, pulmonary embolism (obstructs pulmonary blood flow)

Front 36

number one cause of preventable death from injury

Back 36

hemorrhagic shock

Front 37

term that describes the shock that develops from loss of fluid volume only

Back 37

absolute hypovolemic shock

Front 38

another term for high-space shock

Back 38

relative

Front 39

blood volume an adult vascular system could conceivably hold if arterioles were fully dilated. What prevents this

Back 39

25 L
steady-state action of the sympathetic nervous system

Front 40

spinal shock

Back 40

neurogenic shock

Front 41

causes/types of high-space shock

Back 41

neurogenic shock (only traumatic cause), OD, sepsis

Front 42

in neurogenic shock, the brain's sympathetic signals cannot be sent because the pathway is disrupted; what physiological factor may allow the body to maintain BP for a short time in this case?

Back 42

circulating catecholamines already present in the bloodstream

Front 43

presentation of neurogenic shock

Back 43

skin is warm, dry, and pink (no catecholamine production)
hypotensive, HR is normal or slow
may have paralysis or deficit
diaphragmatic breathing
priapism

Front 44

what is observed with diaphragmatic breathing

Back 44

abdomen protrudes with inspiration; often only observed when patient is asked to consciously take a deep breath

Front 45

average cardiac output for adult

Back 45

5 L / min

Front 46

type of shock caused by a traumatic or medical condition that slows or prevents normal blood flow

Back 46

mechanical shock (cardiogenic or obstructive)

Front 47

causes of mechanical shock

Back 47

tension pneumothorax, cardiac tamponade, cardiac contusion

Front 48

physiology of tension pneumothorax effect on blood flow

Back 48

developing high positive pressure in the pleural space collapses the low pressure superior and inferior vena cava, preventing blood return to the heart, thus lowering cardiac output (this is why JVD may be present)

Front 49

physiology of pericardial tamponade (cardiac tamponade)

Back 49

blood fills potential space between heart and pericardium, squeezing the heart and preventing it from filling; lowers cardiac output. (JVD may be present)

Front 50

name given to three major signs of cardiac tamponade

Back 50

Beck's triad

Front 51

3 major signs of pericardial tamponade

Back 51

JVD, muffled heart tones, pulsus paradoxus

Front 52

a drop of >10mmHg in systolic BP during inspiration (may lose radial pulse during inspiration and regain during expiration)

Back 52

pulsus paradoxus

Front 53

tx of cardiac tamponade

Back 53

surgical care for pericardial decompression
IV fluids only under medical direction (could increase filling pressure, but also increase bleeding)

Front 54

physiology of cardiac contusion

Back 54

heart loses pumping strength due to direct injury to the heart muscle and/or disrhythmias that may result.
difficult to differentiate from cardiac tamponade in the field

Front 55

effect of taking the time to immobilize a patient with penetrating injury to the trunk

Back 55

doubles the death rate

Front 56

signs of mechanical shock

Back 56

JVD
cyanosis - extremely late sign from lung hypoperfusion
tachycardia

Front 57

O2 administration for shock

Back 57

give high-flow to all patients at risk for shock. (don't forget to put on capnography, too)

Front 58

steps to control bleeding

Back 58

direct pressure in most cases
otherwise quickly apply tourniquet

Front 59

body position to transport trauma patient

Back 59

horizontal

Front 60

IV gauge for trauma patient

Back 60

large bore (16 g or more)
IO if you can't get quick IV access

Front 61

fluid administration for external controlled bleeding

Back 61

20 mL / kg IV rapidly then repeat Ongoing exam. if signs of shock persist, continue to administer fluid in boluses and reassess

Front 62

fluid administration for external uncontrolled bleeding or internal bleeding

Back 62

give only enough to maintain a BP high enough for adequate peripheral perfusion.
measured with radial pulses and LOC (brain perfusion)
higher BP may be required for head injured patient or patient with hx of htn

Front 63

recommended BP in hemorrhagic shock with head injury

Back 63

120 systolic to maintain 60 mmHg cerebral perfusion pressure