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67 Cards in this Set
- Front
- Back
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Define "shock:"
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Acute, widespread process of impaired tissue perfusion
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Explain impaired tissue perfusion:
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Imbalance between cellular O2 demand and cellular O2 supply
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All kinds of shock eventually result in what?
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Acute circulatory failure
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What is 'shock syndrome?'
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The systemic, generalized body response to inadequate perfusion
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What type of metabolism is involved in the INITIAL STAGE of Shock Syndrome?
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Anaerobic cell metabolism
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What is cardiac output like in the initial stage of shock syndrome?
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Low
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What are the pH conditions in the initial stage of Shock syndrome?
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Lactis acidosis
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What is the main goal in the Compensatory Stage of Shock Syndrome?
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Body tries to improve perfusion
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What is the mediator for compensation?
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Sympathetic nervous system
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What is involved in "neural compensation" during the Compensatory Stage of Shock Syndrome?
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*Increased heart rate
*Increased contractility of the heart *Shunting blood to vital organs via arterial / venous vasoconstriction |
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What is involved in hormonal compensation during the Compensatory Stage of Shock Syndrome?
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*More angiotensin II(vasoconstriction)
*More aldosterone & ADH (sodium & water retention) *More ACTH (more glucocorticoid production =increased blood sugar) *More epinephrine/norepinephrine from adrenal medulla (further compensation) |
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What is ACTH?
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Adreno-cortico-tropic hormone
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What is involved in chemical compensation during the compensatory stage of shock syndrome?
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Hyperventilation to correct lactic acidosis ("quick fix" to get rid of excess CO2)
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What are the key occurences during the Progressive Stage of Shock Syndrome?
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*Compensatory mechanisms fail
*Aerobic metabolism cannot keep functioning *Na+ & K+ pumps in cell membrane fail *Cells begin to swell |
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What is the problem after the cell begins to swell during the Progressive Stage of Shock Syndrome?
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*O2 utilization (not O2 availability)
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Is cell damage reversible after the Progressive Stage of Shock Syndrome?
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No
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Which body systems are affected in the Progressive Stage of Shock Syndrome?
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Every body system
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In which stage is shock unresponsive to therapy?
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Refractory Stage
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In which stage does death of organ systems occur?
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Refractory Stage
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What causes death in the refractory stage of shock syndrome?
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Impaired tissue perfusion
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What are the three cardinal symptoms of shock?
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*SBP below 90
*Tachycardia or bradycardia *Altered mental status |
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What is involved in adequate transported oxygen?
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*Pulmonary gas exchange
*Adequate cardiac output *Adequate HB/HCT levels |
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What is the focus in management of shock?
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Maintain tissue perfusion
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What is required for pulmonary gas exchange?
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*Airway (may have to use ET tube)
*Ventilation (may have to use ventilator) *Oxygenation (give enough o2 whether on ventilator or not) |
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Upon what does cardiac output depend?
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*Heart rate
*Heart muscle contractility *Appropriate preload and afterload |
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11. What type of medication is used to maintain heart rate in shock patients?
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Antidysrhythmics
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What type of medication is used to maintain heart muscle contractility in shock patients?
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Positive inotropics
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What is used to manage preload & afterload in shock patients?
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*Give IV fluid (crystalloids & colloids) if volume depletion exists
*Give vasoconstrictor meds (to increase preload) or vasodilator meds (to decrease SVR) |
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List the vasoconstrictors used for patients with hypovolemic shock:
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Dopamine Hcl
Epinephrine Norepinephrine Phenylephrine |
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What is the usual dosage for Dopamine when the problem is hypotension?
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5 – 30 mcg/kg/min
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What is the dosage range for Dopamine when the goal is renal perfusion?
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2 – 5 mdg/kg/min
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What is the dosage range for epinephrine?
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*0.5 – 1 mg IV initially
*Follow with 0.5 mg q5min. |
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What is the dosage range for norepinephrine?
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0.5 – 1.0 mcg/kg/min continuous IV infusion to maintain pressure at 90-100 mmHg
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What is the dosage range for phenylephrine?
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80-200 mcg/min IV
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What is a symptom of dopamine overdose?
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Hypertension
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What is important to remember when using vasoconstrictors?
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Vasoconstriction may impair cardiac oxygenation
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List the medications used to enhance contractility in shock patients:
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*Amrinone (Inocor)
*Atropine sulfate *Dobutamine hcl |
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Which contractility drug cannot be administered through the same tubing as furosemide?
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Amrinone (Inocor)
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Which contractility drug should be administered cautiously in patients with glaucoma?
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Atropine sulfate
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Which drug is used to enhance myocardial perfusion in shock patients?
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Sodium nitroprusside (Nitropress, Nipride)
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What is the treatment for shock patients with low HB/HCT levels?
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Blood transfusion
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Oxygen utilization in the cells depends on what?
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Metabolic environment in the cells
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What is the goal to improve oxygen utilization?
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Correct lactic acidosis
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What is administered in cases of severe lactic acidosis?
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Na+ bicarbonate
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What is Hypovolemic Shock?
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Not enough volume in the intravascular space
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What is cardiogenic shock?
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Failure of the heart as a pump; blood is not pushed forward effectively
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What does a decreased CVP indicate?
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Dehydration
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What does an increased CVP indicate?
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Overload
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What is the correct positioning for a patient who is in hypovolemic shock?
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*Trunk flat
*Legs elevated *Head & shoulders above chest |
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In the refractory phase of hypovolemic shock, blood loss is how much?
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Greater than 2000 ml or greater than 40%
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In cardiogenic shock, what drops?
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*Stroke volume
*Cardiac output |
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In cardiogenic shock, what leads to a decrease in tissue perfusion and the general shock response?
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Blood is left in the ventricle after systole
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If there is left ventricular cardiogenic shock, why does the patient have pulmonary edema?
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Blood backs up in the pulmonary artery
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To what does pulmonary edema lead?
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*Low po2
*Further hypoxia |
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What are two major symptoms in patients with cardiogenic shock?
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*Chest pain
*Diminished S1 & S2 |
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What is a usual urinalysis finding of a patient with cardiogenic shock?
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*Low Na+
*High specific gravity & osmolarity |
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Which drugs are used to enhance cardiac output in patients with cardiogenic shock
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*Inotropic agents
*Vasodilators (decrease afterload) *Diuretics (decrease preload) *Antidysrhythmics |
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In anaphylactic shock, the antigen triggers what?
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Immunologic response
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What does benadryl do?
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Blocks the histamine response
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Which type of shock has no compensatory tachycardia?
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Neurogenic shock
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Which type of shock has impaired thermoregulation?
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Neurogenic shock
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In septic shock, what is eventually overwhelmed?
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The immune system
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The following is true in what type of shock: the process designed to protect the body, harms it
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Septic shock
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What is a major symptom of septic shock?
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Tachycardia/bounding pulse
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Why should a septic shock patient eat a high protein diet?
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To promote wound healing
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What is the cause of 80 % of mortality in the ICU?
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MODS
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What initiates secondary MODS?
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Systemic inflammatory response
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