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67 Cards in this Set

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