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62 Cards in this Set
- Front
- Back
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In early shock how much is MAP affected
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<10mmhg ↓
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In stage 1 shock how much is the MAP affected
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↓ 10-15 mmhg
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How much is blood volume ↓ in stage 1 shock
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1000+ mL
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What are some clues that a pt is in stage 1 shock
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normal BP
↑HR metabolic acidosis ↓ HCO3 hyperkalemia ↑ lactic acid |
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How much is MAP affected in stage 2 shock
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↓ 20 mmhg
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How much fluid is lost in stage 2 shock
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35-50% (1800-2500 mL)
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What stage of shock does O2 become insufficient for vital organs
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stage 2
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In what stage of shock does hypoxia and ischemia to vital organs begin
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stage 2
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In what stage of shock does the Na/K pump fail
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stage 2
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What stage of shock is refractory or irreversible
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stage 3
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Name some CARDIAC clinical s/s of shock
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↓BP
↑ HR (120+) dysrhythmias (r/t K+ probs) vasoconstriction hypovolemia ↓ peripheral pulses |
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Name some RESP clinical s/s of shock
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↑ RR
↓ alveoli ↓ gas exchange ↓ O2 sat ↑ CO2 resp acidosis ARDS |
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What SaO2 % indicates refractory shock?
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<70%
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Name some GI clinical s/s of shock
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GI organs ischemic
Stress ulcers ↓ gastric motility paralytic ileus |
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Name some HEPATIC clinical s/s of shock
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Initial ↑ gluconeogenesis & glycogenolysis
Hypoglycemia later ↓ fat/protein metabolism ↓ lactic acid removal = ↑ metabolic acid |
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Name some NEURO clinical s/s of shock
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↓ LOC
lethargy feeling of doom unconscious in late stage |
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Name some RENAL clinical s/s of shock
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Oliguria b/c blood normally going to kidneys is shunted to brain/heart
Tubular necrosis Renal failure |
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What urine output indicates stage 2 (progressive) shock
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<20 mL/hr
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Hypovolemic shock occurs when ___% blood causes ↓MAP
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15% or >
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Name some causes of hypovolemic shock
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Hemorrhage
Dehydration Renal loss ↓ intravascular fluid |
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s/s of hypovolemic shock
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↑ HR
absent pulses ↓ SaO2 narrow BP pulse pressure cyanosis oliguria |
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Tx for hypovolemic shock
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Tx the cause
O2 Fluid replacement Vasoconstricting drugs (dopamine, norepi) Inotropics – Dobutamine Sodium Nitroprusside |
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Causes of cardiogenic shock
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Acute MI
Cardiac tamponade Pericarditis Cardiac arrest Dysrhythmias Valve problems – stenosis |
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What is the most common cause of cardiogenic shock
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acute MI
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s/s of cardiogenic shock
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Profound sweating
Mottled extremities Dyspnea Tachycardia Hypotension ↓ pulses JVD Murmurs/gallop |
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What labs are used to dx cardigenic shock
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Cardiac enzymes
CBC Lytes Coag profile ABGs Serum lactate level BNP Echocardiogram CVP/PA cath |
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Tx for cardiogenic shock
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Fluid replacement
IV vasopressors Dopamine to ↑BP Dobutamine = inotropic Nitrates/morphine for pain Furosemide |
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Describe obstructive shock
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Blood flow obstructed = cardiac arrest
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Causes of obstructive shock
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Cardiac tamponade
Constructive pericarditis PE Tension pneumo Aortic stenosis |
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s/s of obstructive shock
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Paradoxical pulses
Cyanosis around mouth then extremities |
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s/s of septic shock
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Must have 2 or more of:
Temp >38c or <36c HR >90 RR >20 PaCO2 <32mmhg WBC >12,000, <4000/ul or 10% immature |
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s/s of sepsis
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Change in LOC
PaO2 <72mmhg ↑ lactate oliguria |
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What stage of septic shock has warm skin
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early
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what stage of septic shock has cold skin
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late
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What lab should be obtained STAT to dx septic shock
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Lactate level – if > 4mmol/dl = tissue hypoperfusion
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What are important labs used to dx sepsis
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Lactate level
CBC WBC Glucose and lytes ABGs Coag profile Blood cx UA |
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what is the ONLY type of shock that does NOT have an increase in HR
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neurogenic
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Tx for sepsis
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Early recognition
ABX PA cath O2 – intubate Fluid replacement Vasopressors – dopamine, norepi/epi Inotropics – dobutrex Corticosteroids Tight glycemic control |
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What is Xigris
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Recombinant human activated protein C
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What is Xigris used for
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Hi risk adult pts w/ severe sepsis
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How does Xigris work
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↓ inflammation
↓ inflammatory mediators |
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Causes of neurogenic shock
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Head injury
SCI Insulin reactions CNS – benzos/narcs Anesthesia Severe pain Prolonged heat exposure |
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What is life-threatening about anaphylactic shock?
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laryngeal edema & bronchial spasm
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s/s of anaphylactic shock
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Hypotension
↑ HR dysrhythmias resp probs warm, flushed edematous skin mental status changes oliguria to anuria |
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Respiratory s/s of anaphylactic shock
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Dyspnea
Stridor Wheezes Laryngospasm Bronchospasm Pulmonary edema |
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Tx for anaphylactic shock
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Epi for severe reactions
Benadryl O2 Steroids Bronchdilators |
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What does DIC stand for
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Disseminated Intravascular Coagulation
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s/s of DIC
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Widespread hemorrhage
Oozing blood Purpura, petechiae, bruising Cyanosis GI bleeding Dyspnea/tachypnea Bloody sputum Hematuria Oliguria Acute renal failure Bleeding from 3 unrelated sites |
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What labs are used to dx DIC
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Coag profile
Platelet count D-dimer Fibrin degradation products (FDPs) Fibrinogen PT and aPTT |
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what is the BIGGEST sign of ARDS
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hypoxemia
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how do we dx ARDS
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white-out on CXR
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Tx for DIC
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Heparin
PRBCs Platelets FFP Aminocapric acid (Amicar) |
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what is a "normal" urine output
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0.5 mL/kg/hr
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what will ABGs be like initially in septic shock
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lactic acid from anaerobic metabolism will cause metabolic acidosis
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what is the single most important electrolyte used for dx dehydration
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Na+
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what are the best drugs to use for hypovolemic shock
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vasopressors - dopamine, levafed, any alpha constrictor
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what will Pro BNP tell us regarding cardiogenic shock?
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indicates HYPERvolemia
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what does PCWP stand for
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pulmonary capillary wedge pressure
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what is PCWP used for in cardiogenic shock
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monitoring how much fluid/pressure is entering R atrium
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for exam 3 know/understand some CAUSES of obstructive shock
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cardiac tamponade
tension pneumo aortic valve stenosis |
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why would a pt w/ septic shock experience N/V
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blood is shunted away from gut - digestion slows, N/V follows
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initially, what will the CO be like on a pt in septic shock
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usually high
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