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62 Cards in this Set

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