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19 Cards in this Set
- Front
- Back
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Fluid- fill the tanks first!
Crystalloid (volume expander – isotonic) Blood Isotonic, keep fluid in vasculature Pressor- 2nd line response Only if no response to volume Beta blocker? Do not want to slow heart rate bc its compensating, if slow hr, further impair CO NO. CO dependent upon HR. Treatment for low SaO2? Volume. Blood. Ventilator. |
TREATMent of hypovolemia
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For decreased contractility
Positive inotropes dobutamine For increased preload Dilators and diuretics pee it or park it, will optimize squeeze of the heart For high afterload Dilators (arterial) IABP Enhancement of O2 supply and decrease demand ASA, heparin, supplemental O2 (ventilation) Morphine |
treatment of cardiogenic shock
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Myocardial depressant factor, coagulation and fibrinolytic factors, platelet-activating factor, prostaglandins, oxygen radicals, complements, kinin, neutrophils, macrophages, mast cells, endothelial cells
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Results in:
a) myocardial depression (decreased HR, contractility CO) b) peripheral vasodilation (decreased preload, afterload CO) c) microemboli (decreased tissue perfusion (capillary surface area) ie. Supply, extraction) d) increased capillary membrane permeability (third spacing decreased preload CO; also decreased extraction b/c increased intracapillary distance) e)selective vasoconstriction (decreased perfusion of select tissues eg gi) FEED |
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Increased activation of mediators
Increased membrane permeability Clotting cascade Selective vasoconstriction |
Endothelial damage by endotoxins and mediators
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Epi and norepi hypermetabolic state increased O2 demand
AND constriction of renal, pulmonary and splanchnic bed decreased perfusion Glucose intolerance, hyperglycemia, and relative insulin resistance, further acidosis (INSULIN RX) |
CNS and Endocrine Activation
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hypovolemic
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increased SVR, HR
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CARDIOGENIC
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INCREASED PCWP, CVP, SVR, HR
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NEUROGENIC
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NOTHING INCREASES, EVERYTHING DECREASES
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ANAPHYLACTIC
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ONLY HR INCREASES
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EARLY SEPTIC SHOCK
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SVO2, CI, HR INCREASES
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LATE SEPSIS
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PCWP, CVP, SVR, HR INCREASES
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T > 38°C or < 36°C
HR > 90 bpm RR > 20 bpm or PaCO2 < 32 mm Hg WBC > 12 K/mm3, < 4 K/mm3, or > 10% bands” |
SEPSIS
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PCWP/PAWP , CVP
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Measures preload
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SVR, PVR
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MEAUSRES AFTERLOAD
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LVSWI, RVSWI
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CONTRACTILITY
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dopamine (at a high dose), epinephrine, norepinephrine, neo-synephrine
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pressors
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nitroglycerin
nitrates nipride inocor doapmine (low) |
dilators
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volume expanders
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blood, colloid, crystalloid
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positive inotropes (to increase contractility)
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dobutamine, dopamine, inocor, digitalis
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