Shock

Front 1

Shock is defined as ?

Back 1

Inadequate tissue perfusion

Front 2

Increased Cardiac Output and Perfusion means what?

Back 2

Increased Preload

Front 3

Causes of Shock?

Back 3

• Blood or vascular volume loss
• Trauma
• Cardiac
• Spinal cord injury
• Drug overdose
• Infection- sepsis
• Allergic reaction

Front 4

What do the baroreceptors do in response to a lowering blood pressure?

Back 4

Cardiac effects

• increase inotropy
• increase chronotropy

Peripheral effects

• increase PVR
• decrease container size
• arteriolar constriction

Front 5

What do the chemoreceptors do in response to a lowering blood pressure?

Back 5

They detect changes in blood O2, Co2, and/or pH. Thus, they stimulate the vasomotor center and can cause peripheral vasoconstriction.

Front 6

What two hormones do the kidneys secrete?

Back 6

Epinephrine and Norepinephrine

(sympathetic response)

Results in...

- increased chronotropy

- increased stroke volume

- vasoconstriction

Front 7

This hormone is excreted from the pituitary gland is a known as an "Anti-diuretic hormone".

Back 7

Vasopressin

It functions by causing vasoconstriction on the blood vessels and decreasing urinary output.

Front 8

The 3 stages of shock?

Back 8

1. Compensated
2. Decompensated
3. Irreversible

Front 9

What are some signs and symptoms you can predict and/or see in the first stage of shock (Compensated)?

Back 9

• Tachycardia (CO is elevated)
• Tachypnea and increased tidal volume
• Pale, cool, moist skin signs
• Delayed Cap refill (greater than 3 seconds)
• lethargy, confusion, combative, irritable (due to from decreased perfusion in the CNS)
• Normal to increased blood pressure.
• Thirst

Front 10

What are some signs and symptoms you can predict and/or see in the second stage of shock (Decompensated)?

Back 10

Body is now "unable" to compensate and maintain perfusion.

• Weak, thready pulse, blood supply to the heart is diminishing
• Hypotension
• Delayed Cap refill
• Cool to tough in extremities
• Cyanotic
• Confusion or unconsciousness (due to decreased blood flow in the CNS)

Front 11

What are some signs and symptoms you can predict and/or see in the third, and final, stage of shock (Irreversible)?

Back 11

The body's compensatory mechanisms fail, cell death begins, and vital organs fail.

• Bradycardia or severe dysrhythmia's (pump failure)
• Coma
• Hypotension
• Disseminated Intravascular Coagulation (Just start bleeding out everywhere from every orifice)

Front 12

What are the classifications of shock?

Back 12

• Hypovolemic (loss in blood volume)

• Cardiogenic (inability of heart to pump effectively)

• Obstructive (physical blockage to blood flow causing a decrease in right heart return, decreased cardiac output)

• Distributive (inadequate PVR due to widespread vasodilation)

Front 13

Hypovolemic shock is what?

Back 13

loss of blood volume

Front 14

Cardiogenic shock is what?

Back 14

The inability of the heart to pump effectively

Front 15

Obstructive shock is what?

Back 15

A physical blockage to blood flow causing a decrease in right heart return, end result is decreased cardiac output.

Front 16

Distributive shock is what?

Back 16

Inadequate PVR due to widespread vasodilation

Front 17

GI bleed, trauma, dehydration, GSW, Ruptured aneurysm, burns, and profuse sweating are all examples of what kind of shock?

Back 17

Hypovolemic

Front 18

Acute myocardial infarctions, dysrhythmia's, and CHF are examples of what kind of shock?

Back 18

Cardiogenic

Front 19

Pulmonary embolism, tension pneumothorax, and cardiac tamponade are all examples of what kind of shock?

Back 19

Obstructive

Front 20

Sepsis, anaphylaxis, envenomation, neurogenic/spinal trauma, and drug overdoses are examples of what kind of shock?

Back 20

Distributive

Front 21

What happens to the vasomotor center when you suffer a neurological/spinal injury in relation to shock?

Back 21

When the spinal cord is injured neurotransmitters (epi and norepi) are no longer secreted. Thus, there is no vasomotor tone and the resulting action is widespread vasodilation which leads to hypovolemia.

This patient will need vasopressors immediately.

Front 22

How does septic shock work?

Back 22

Toxins invade the body, releasing vasoactive agents that cause peripheral vasodilation and increased capillary permeability.

Front 23

How does anaphylactic shock work?

Back 23

There is a release of histamines which cause arterioles and capillaries to dilate and it then increases permeability of capillary membranes.

Decreased blood volume due to fluid lying in the intravascular spaces (in the gutters).

Histamines=dilated vessels=increased permeability

Front 24

What is the dose amount of Epinephrine given for an adequately perfusing adult experiencing an allergic reaction/anaphylaxis? How many times may you repeat this treatment?

Back 24

0.3mg (1:1,000) IM

After BASE, may repeat same initial dose of 0.3mg (1:1,000) IM every 20 mins two times for a total of 3 doses max.

Front 25

What is the dose amount of Epinephrine given for an poorly perfusing adult experiencing an allergic reaction/anaphylaxis? How many times may you repeat this treatment?

Back 25

0.1mg (1:10,000) SLOW IVP

BASE, may repeat 0.1mg (1:10,000) SLOW IVP, repeat every 3mins

or, if unable to obtain IV access...

0.5mg (1:1,000) IM

BASE, then may repeat 0.3mg (1:1,000) IM, repeat every 20mins two times.

Front 26

Name four different drugs or treatments that we can give for patients suffering from severe allergic reactions or anaphylaxis.

Back 26

1. Epinephrine
2. Albuterol
3. Fluid challenge
4. Dopamine
5. Diphenhydramine (Benadryl)

Front 27

What is the dose of Albuterol for a wheezing adult patient?

Back 27

5mg via hand-held-nebulizer (HHN)

Front 28

How much normal saline do we administer for patient according to protocol 1242?

Back 28

10ml/kg in 250cc increments (providing lung sounds are clear)

Front 29

How much Dopamine do we administer for a patient according to protocol 1242?

Back 29

400mg/500ml in NS IVPB, start at 30mcgtt/min, titrate till SBP reaches 90-100 and signs of adequate perfusion, or to a max of 120mcgtt/min.

Front 30

How much Diphenhydramine (Benadryl) do we administer for a patient according to protocol 1242?

Back 30

50mg IV @ 25mg/min or 50mg DEEP IM

May repeat in 15mins one time, max dose of 100mg all routes.

It competes with histamines at the receptor sites.