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65 Cards in this Set
- Front
- Back
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What is the definition of shock?
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inadequate tissue perfusion
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BP definition of shock?
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systolic <90
drop of systolic >40 |
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What are the classes of shock?
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Hypovolemic
Cardiogenic Septic Neurogenic |
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Causes of hypovolemic shock?
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hemorrhage, burns, bowel obstruction, crush injury, pancreatitis
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What happens to BP, HR and Temp in hypovolemic shock?
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BP - dec
HR - inc Temp - dec ** metab acidosis |
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Mild hypovolemic shock?
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<20% loss
pale cool skin, anxiety |
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Moderate hypovolemic shock
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20-40% loss
oliguria/anuria, agitation, dec BP |
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Severe hypovolemic shock?
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>40% loss
AMS & hypoTN |
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What labs are abnormal in hypovolemic shock?
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metabolic acidosis
inc BUN & creatinine |
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Txtmnt for hypovolemic shock
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stop bleeding
IVF - NS, LR PRBC to get HCT > 24% effectiveness based on urine output |
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cardiogenic shock?
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cardiac insufficiency - LV failure
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causes of cardiogenic shock?
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MI, papillary muscle dysfxn, cardiac contusion, tamponade, tension pneumo, valve failure
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signs/sx of cardiogenic shock?
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dyspnea, rales, pulsus alterans, loud pulmonic component of S2, gallop
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pulsus alterans
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inc pulse with greater filling following a weak pulse
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What are associated signs of cardiogenic shock
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hypoTN, dec CO, inc wedge pressure, oliguria, tachy
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CXR findings with cardiogenic shock?
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pulmonary venous congestion
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Treatment of cardiogenic shock?
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NO FLUIDS
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BP, HR, Temp in cardiogenic shock
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BP - dec
HR - inc with dec pulse Temp - dec |
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Pneumonic for MI
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MONA
morphine, O2, Nitro, ASA |
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Name inotropic agents
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Dopamine
Dobutamine Amrinone Milrinone |
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Dopamine
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B1 - induce epi - inc PVR
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Dobutamine
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B1 - no change in HR or SVR
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Amrinone/Milrinone
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vasodilate so use as last resort b/c of potential hypotension
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How does sepsis cause shock?
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dec SVR, dec intravasc vol, inc capillary perm --> microvasc pooling
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Causes of septic shock?
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gram neg sepsis - MC
trauma, immunosuppression, steroids, hematologic dz, diabetes |
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Initial signs of septic shock
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warm skin c full pulses and nl urine
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delayed signs of septic shock
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oliguria, AMS, hypoTN
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Lab findings in septic shock
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hyperglycemia, resp alkalosis, leukopenia
only 50% have + blood cultures |
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Treatment for septic shock
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I&D wound/site
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BP, HR, Temp in septic shock?
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BP - dec
HR - first inc then dec Temp - first inc then dec |
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Neurogenic shock
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loss of sympathetic vasoconstrictive reflexes
loss of vascular tone |
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Causes of Neurogenic shock
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spinal trauma
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signs/sx of Neurogenic shock
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pallor, weakness, lightheaded, transient hypoTN, brady, Neuro deficits
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BP, HR, Temp in Neurogenic shock
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BP - dec
HR - dec Temp - inc |
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Treatment of Neurogenic shock
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vasopressors to Inc afterload
Fluids |
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another type of shock is
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anaphylactic
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Anaphylactic shock
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inc vasc perm, vasodilation, smooth muscle constriction
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Causes of Anaphylactic shock
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foods, drugs, insects, blood
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Findings in Anaphylactic shock
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usticaria, angioedema, laryngeal swelling, respiratory distress, vomiting, diarrhea, crampy abd pain
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Treatment of Anaphylactic shock
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Airway
Epinephrin Diphenhydramine steroids/aminophylline |
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Sx to recognize shock
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skin
mental status urine output HR/RR |
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Formula for delivery of O2
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CO x (SaO2 + PaO2 x .003) x (Hgb x 1.34) x 10
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Ratio of fluid replacement to blood loss
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3L crystalloid for every 1L blood loss
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CV response to shock
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inc HR c inc contractility
inc SVR - inc DBP & venous return organ perfusion selectivity |
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What organs are preferentially perfused?
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brain, heart, liver, lungs
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What organs are not selectively perfused?
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GI & Kidneys
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Neuroendocrine response to shock
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inc catechol (inc SNS)
inc hypothal-pit-adrenals -> cortisol |
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Immuno/Inflam response to shock
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cytokines - TNF, IL1
PMNs Complement Coag - inc risk of DVT Rxtv O2 |
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Effects of shock on heart?
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BP drops -> dec coronary perfusion -> ischemia
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kidney response to shock
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renin angiotnesin sys activation
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hypotension and the brain
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cushing reflex to maintain BP
when BP <60 -> AMS |
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Hypovolemic shock
CO PCWP SVR |
CO - dec (dec stroke vol)
PCWP - dec (dec venous return) SCR - inc (inc SNS) |
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Cardiogenic shock
CO PCWP SVR |
CO - dec (dec contractility)
PCWP - inc (cannot pump) SVR - inc (SNS) |
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Extracardiac shock
CO PCWP SVR |
CO - dec (dec contractility)
PCWP - inc (cannot pump) SVR - inc (SNS) |
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Septic shock
CO PCWP SVR |
CO - inc (inc stroke vol)
PCWP - dec (venous pooling) SVR - dec (vasodilation) |
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What does PCWP measure?
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LVEDP / LVEDV
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CO =
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SV x HR
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SVR =
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MAP - CVP
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Becks Triad
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JVD, pulsus paradoxus, muffled sounds
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Swan Ganz measures?
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pressure in L heart by obtaining pulmonary artery wedge pressure
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Indications for Swan Ganz
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monitoring ionotrope, pressor or fluids
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Complications of Swan Ganz
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venous thrombosis
pulmonary hemorrhage arrhythmias |
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Central line measures
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placed @ jxn of RA and SVC - venous pressure
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Central line estimates
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fluid status
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Complications of central line
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cardiac tamponade
embolism pneumothorax vascular injury |
