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50 Cards in this Set
- Front
- Back
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Shock is an imbalance between ___ and ____.
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supply, demand
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What is the biggie with neurogenic shock?
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bradycardia and vasodilation; loss of nerve function
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What is occurring in Stage 1?
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cellular changes, production of lactic acid
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How is Stage 1 diagnosed?
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lactic acid
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What are the normal clues for Stage 1?
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normal BP, increased HR, few signs of metabolic acidosis
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What is not sufficient in Stage II?
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oxygen
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What s/s are present in Stage II?
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modeling, increased creatinine and BUN, increased liver enzymes, sodium, potassium pump fails
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50% of septic shock patients end up getting ____.
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DIC
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_____ is big time in Stage II?
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hypotension
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What type of fluids will most likely be ordered for stage II fluid resuscitation?
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NS rapid infusion
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What happens in Stage III?
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mega cell death; irreversible tissue damage
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What is S.I.R.S
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systemic inflammatory response syndrome
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What is the main problem with shock?
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inflammatory response releasing inflammatory mediators
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What is specific criteria for S.I.R.S?
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WBC, temperature
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What is happening in the capillaries in shock?
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blockage, obstruction (fibrin formation)
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What is extremely instrumental in treating shock?
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hemodynamic monitoring: CVP and BP
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What type of dysrhythmia is associated with shock?
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PVC
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What is the maximum amount of oxygen that can be administered to a patient?
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15 L (non-rebreather)
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What are the first s/s of ARDS?
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hypoxemia, increased RR
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How do we classically diagnose ARDS?
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CXR: white-out
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What can occur within 48 hours of shock onset related to gastrointestinal?
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stress ulcers: PPIs, H2 blockers; check for blood in stools
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This renal manifestation indicates progressive shock.
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Oliguria (less than 20ml/hr)
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What are the types of distributive shock?
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septic, anaphylactic, neurogenic (vasodilation)
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What causes metabolic acidosis?
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lactic acid (anaerobic metabolism)
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What is the most important electrolyte for diagnosing dehydration?
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sodium
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What is the universal blood donor?
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O-
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What are colloids?
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maintains oncotic pressure; keep fluids in vascular space
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If there is no problem with ascites or edema, which type of fluid is appropriate to treat shock?
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colloids
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What is the best drug choice for increasing myocardial contractility?
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Dobutamine
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What is the main thing we're going to do for hypovolemic shock?
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give blood replacement; then fluids, then vasoconstrictors (Dopamine, NE, vasopressin)
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What are the big signs of decreased CO?
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low blood pressure, low MAP
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What type of sound is an S3?
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ventricular
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What lab value is important for diagnosing cardiogenic shock?
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troponin
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What is another important lab value for diagnosing cardiogenic shock?
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Pro-BNP (indicates hypervolemia)
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Why is Nitrate effective in cardiogenic shock?
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helps with perfusion; must have BP; decrease afterload
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What is the main treatment for cardiogenic shock?
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fluids, inotropic medications
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What is PCWP?
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pulmonary catheter wedge pressure (estimate patients of fluid status); now use CVP to assess fluid status
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What is the big deal with distributive shock?
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massive vasodilation
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What is the criteria for S.I.R.S.?
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temp >38 C, WBC >12,000, RR >20, HR > 90bpm
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What is the first s/s of septic shock?
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warm, dry skin; flushing
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What is secondary to shunting of the GI tract?
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N/V
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What type of labs do you want to get with septic shock?
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lactate, WBC with diff, CBC with diff
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What are D-dimers?
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first indicator that body is starting to clot
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What are you going to get before you give ABX?
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blood cultures
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What are the broad spectrum ABX?
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carbapenems, flouroquinolones
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How fast do you want to give a broad spectrum ABX?
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within one hour; get C&S to determine specific bacteria after broad spectrum is started
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What does Xigris do?
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decreases inflammation and helps with coagulation cascade
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When is spinal shock over?
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when there is return of reflexes
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What type of bronchodilators are appropriate for anaphylactic shock?
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Beta 2 agonists (Albuterol)
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What lab do you want to check with DIC?
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d-dimer
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