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100 Cards in this Set
- Front
- Back
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condition in which tissue perfusion is inadequate to delivery 02 and nutrients to support vital organs and cellular function
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shock
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what does shock affect
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all body systems
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shock can result from what (3)
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ineffective pumping
insufficient volume massive vasodilation vascular bed |
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inability of circulatory system to meet the 02 and nutrient needs of body tissues
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shock states
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if cells lack 02 what do they switch to
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anaroebic
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what is the byproduct of anaroebic
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lactic acid
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CO parameter
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4-6l/min
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CVP range
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2-4mmhg
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Sv range
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60-70ml
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SVR range
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900-1400dynes
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PVR range
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30-100 dynes
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what is perfusion dependent upon
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adequate MAP
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what is MODS
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multiple organ dysfuction syndrome
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what moves with electrolyte movement (2)
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fluid and osmolarity
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heart unable to pump enough blood to meet needs of body
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cardiogenic shock
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characteristics of cardiogenic shock
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most common is left vent failure
may be coronary/noncoronary |
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what is coronary/noncoronary
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conditions that stress the myocardium
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inadequate volume in the vascular space
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hypovolemic shock
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causes of hypovolemic shock
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blood loss
third spacing |
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abnormal placement or distribution of volume
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distributive shock
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causes of distributive shock (3)
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sepsis
neurologic anaphylaxis |
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causes of decreased fluid volume in circulation (8)
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loss of blood volume
dehydration burns persistant vomittin/diarrhea diuresis diabetes insipidus trauma 3rd spacing |
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causes of fluid shifts (5)
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hemorrhage
ascites burns peritonitis dehydration |
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causes of cardiogenic shock (9)
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Mi
mechanical complications cardiomyopathy myocardial contusion pericardial tamponade ventricular rupture arrythmia valvular dysfunction end stage HF |
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considered the bus that carries 02 to tissues
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hgb
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transport shock states
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carbon monoxide toxicity
anemia hemorrhage |
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impaired 02 delivery due to cardiac dysfunction
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cardiogenic shock states
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at risk for cardiogenic shock (4)
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elderly
diabetics anterior MI history of MI |
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what does decreased SV and CO result in (3)
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pulmonary congestion
decreased systemic tissue perf decreased coronary artery perf |
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what happens with infacrtion in LV
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tissues decrease 02, SV, CO, BP
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mechanical barrier to blood flow blocks 02 delivery to tissues
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obstructive shock states
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a pattern of responses in an attempt to stabilize life threatening situation
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compensatory mechanisms
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what are the stages of shock
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initial
compensatory progressive refractory |
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what is the refractory shock stage
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irreversible stage
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end organ failure due to cellular damage
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progressive
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what is affected in the progressive stage of shock
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Gi and renal 1st then cardiac with loss of liver and cerebral function
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what is the initial stage of shock
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first cellular changes that include decreasing aerobic and anaerobic with no S&S
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attempt to compensate for decreased CO and increased 02 and nutrients
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compensatory
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rapid phase of shock
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anaphylactic
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does not have tachycardia
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neurogenic shock
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when can one not get positive cultures
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septic shock
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in the compensatory stage where is blood shunted from to maintain vital organs
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skin
kidneys Gi tract |
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S&S of shunting blood to vital organs
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cool clammy skin
decreased bowel sounds decrease UO |
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SNS causes vasoconstriction resulting in...
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increased HR
Increased contractility |
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what does acidosis occur as a result of
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anaerobic metabolism
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acidosis causes what...
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increased RR which may cause compensatory resp alkalosis
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when mechanisms that regulate BP can no longer compensate and BP and MAP decrease
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progressive shock stage
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result of hypoperfusion
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all organs suffer
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what causes mental status to further deteriorate in the progressive stage
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decreased cerebral perfusion and hypoxia
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when does ARF occur in the progressive shock stage
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when MAp goes below 70
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can occur as a complication of shock
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DIC
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what is DIC
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excessive clotting cascade with no clotting factors
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organ damage is so severe that the pt does not respond to tx and cannot survive
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refractory shock stage
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important in tx and identifying all types of shock
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early ID and timely tx
identify and tx underlying cause sequence of events vary mngt and care of pt will vary |
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first line indicators for CO and perfusion
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HR and BP
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what should be looked at a first glance
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HR
BP LOC UO |
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ways to mtr and tx shock
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hemodynamic mtr
swan-ganz art line |
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tx for shock
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fluid replacement
vasoactive meds for cardiac func nutritional support for metabolic |
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what do lactate levels show
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degree of hypoperfusion
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tells how much base it would take to bring ph back to normal
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base deficit
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goals for shock
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optimize 02 delivery
decrease 02 consumption |
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what do crystalloids do
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restore interstitial and intravascular volume
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provides volume and helps pull fluid back into vascular
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albumin
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first line agent to correct hypotension
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levophed
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what is a colliod
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albumin
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what do colliods do
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enhance bloods 02 carrying capacity
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act on smooth muscle layer of blood vessels
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vasoactive drugs
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what are the vasoconstrictors/pressors
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epi
norepi dopamine vasopressin |
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what increases with vasoactive drugs
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increases afterload and preload
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reduces afterload
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vasodilators
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what are the vasodilators
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nitroprusside
nitro |
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increases afterload to left vent and decreases SV
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modified trendelenburg
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decreases WOB
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mech vent
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keeps alveoli open for adequate gas exchange and protects lung tissue from damage
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low tidal volume
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used for critical pts and at risk of death
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xigris
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+ line culture and - peripheral =
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contamination in line
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+ line and peripheral =
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sepsis in blood stream
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when should abx be started
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within 1 hr
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what is target CVP after shock
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>8 or >12 if mech vent
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level of MAP for shock
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>65
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given for inotropic therapy
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dobutamine w/ myocardial dysfunction
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what should be given if pt responds poorly to fluid resuscitation and vasopressors
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IV hydrocortisone
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when is xigris not given
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low risk of death
one organ failure |
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target HGb for shock
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7-9.0
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target tidal volume
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6ml/kg
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target glucose
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150
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used with shock and sepsis to help filter blood and remove waste products
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continuous renal replacement therapy
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DVT prophylaxis with shock
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unfractionated heparin
LMWH |
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stress ulcer prophy
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H2 blocker
PPI |
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what do cystalloids do in tx of shock
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restore fluid volume and increase preload
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inflammatory syndrome that affects the whole body in response to infection that is related to sepsis
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systemic inflammatory response syndrome
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what are the criteria for SIRS
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temp >100.4 or > 96.8
HR >90 RR >20 WBC >12000 |
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comlications of SIRS
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acute lung injury (ALI)
acute kidney injury shock MODS |
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altered function of 2 or more organs in an acutely ill pt
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MODS- multiple organ dysfunction
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stage 1 of MODS (5)
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increased volume requirements
mild resp alkalosis oliguira hyperglycemia increased insulin requirement |
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stage 2 of MODS (4)
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tachypneic
hypocapnic hypoxemic moderate liver dysfunction |
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stage 3 of mods (3)
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azotemia
acid-base disturbances coagulation abnormalities |
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stage 4 of MODS (4)
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vasopressor dependent
oliguric or anuric ischemic colitis lactic acidosis |
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what helps confirm dx of MODS
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elevated ammonia level and confusion
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characteristics of MODS (14)
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* liver enzymes >2x upper
* normal * Ph <7.30 * high plasma lacate * altered LOC * decreased GCS * plt <100,000 * PT/PTT upper limit of normal * UO <0.5ml/kg/hr * increased creatinine * systolic p <90 * MAP <70 * vasopressor support * PEEP>7.5 * req's mech vent |
