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54 Cards in this Set
- Front
- Back
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What is the definition of shock? |
Inadequate tissue perfusion |
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What are the types of shock? |
- Hypovolemic - Septic - Cardiogenic - Neurogenic - Anaphylactic |
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What are the signs of shock? |
- Pale, diaphoretic, cool skin - Hypotension, tachycardia, tachypnea - Decreased mental status and pulse pressure - Poor capillary refill - Poor urine output |
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What are the best indicators of tissue perfusion? |
- Urine output - Mental status |
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What lab tests help assess tissue perfusion? |
- Lactic acid (elevated with inadequate tissue perfusion) - Base deficit - pH from ABG (acidosis associated with inadequate tissue perfusion) |
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What is the definition of hypovolemic shock? |
Decreased intravascular volume |
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What are the common causes of hypovolemic shock? |
- Hemorrhage - Burns - Bowel obstruction - Crush injury - Pancreatitis |
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What are the early signs of hypovolemic shock? |
- Orthostatic hypotension - Mild tachycardia - Anxiety - Diaphoresis - Vasoconstriction (decreased pulse pressure with increased diastolic pressure) |
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What are the late signs of hypovolemic shock? |
- Changed mental status - Decreased BP - Marked tachycardia |
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What are the signs/symptoms of class I hemorrhage (<15% or 750 cc blood loss)? |
- Mild anxiety - Normal vitals |
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What are the signs/symptoms of class II hemorrhage (15-30% or 750-1500 cc blood loss)? |
- Normal systolic BP w/ decreased pulse pressure - Tachycardia - Tachypnea - Anxiety |
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What are the signs/symptoms of class III hemorrhage (30-40% or 1500-2000 cc blood loss)? |
- Tachycardia (HR >120) - Tachypnea (RR >30) - Decreased systolic BP - Decreased pulse pressure - Confusion |
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What are the signs/symptoms of class IV hemorrhage (>40% or >2000 cc blood loss)? |
- Decreased systolic BP - Tachycardia (HR >140) - Tachypnea (RR >35) - Decreased pulse pressure - Confused and lethargic - No urine output |
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What is the treatment for hypovolemic shock? |
1. Stop bleeding 2. Volume: IVF (isotonic LR) then blood products as needed |
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How is the effectiveness of treatment evaluated bedside? |
- Urine output - BP - HR - Mental status - Extremity warmth - Capillary refill - Body temperature |
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How is the effectiveness of treatment evaluated based on labs? |
- pH - Base deficit - Lactate level |
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What usually causes failure of resuscitation in hypovolemic shock? |
Persistent massive hemorrhage, requiring emergent surgical procedure
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Why does decreased pulse pressure occur with early hypovolemic shock? |
Pulse pressure (systolic - diastolic BP) decreases because of vasoconstriction, resulting in elevated diastolic BP |
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What is the most common vital sign change associated with early hypovolemic shock? |
Tachycardia |
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What type of patient does not mount a normal tachycardic response to hypovolemic shock? |
- Pts on beta-blockers - Spinal shock (loss of sympathetic tone) - Endurance athletes |
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Should vasopressors be used to treat hypovolemic shock? |
No |
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Should patients with hypovolemic shock be put in Trendelenburg position? |
No |
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What is the definition of septic shock? |
Documented infection and hypotension |
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What is the specific etiology of septic shock? |
- Most common: G- septicemia - Less common: G+ septicemia, fungus |
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What factors increase the susceptibility to septic shock? |
Any mechanism that increases susceptibility to infection: - Trauma - Immunosuppression - Corticosteroids - Hematologic disease - Diabetes |
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What complications are major risks in septic shock? |
- Multiple organ failure - DIC - Death |
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What are the initial signs/symptoms of septic shock? |
- Vasodilation - Warm skin and full pulses - Normal urine output |
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What are the delayed signs/symptoms of septic shock? |
- Vasoconstriction - Poor urine output - Mental status changes - Hypotension |
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What percentage of blood cultures are positive in patients with bacterial septic shock? |
Only about 50% |
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What are the associated vital sign findings with septic shock? |
- Fever - Hyperventilation - Tachycardia |
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What are the early associated lab findings with septic shock? |
- Hyperglycemia / glycosuria - Respiratory alkalosis - Hemoconcentration - Leukopenia |
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What are the late associated lab findings with septic shock? |
- Leukocytosis - Acidosis - Elevated lactic acid |
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What is the treatment of septic shock? |
1. Volume (IVF) 2. Antibiotics (empiric, then by cultures) 3. Drainage of infection 4. Pressors PRN 5. Xigris PRN (protein C) |
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What is Xigris? Utility? |
Activated protein C, shown to decrease mortality in septic shock and multiple organ failure |
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What is the definition of cardiogenic shock? |
Cardiac insufficiency; LV failure (usually), resulting in inadequate tissue perfusion |
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What are the causes of cardiogenic shock? |
- MI - Papillary muscle dysfunction - Massive cardiac contusion - Cardiac tamponade - Tension pneumothorax - Cardiac valve failure |
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What are the signs/symptoms on exam of a pt with cardiogenic shock? |
- Dyspnea - Rales - Pulsus alternans (increased pulse with greater filling following a weak pulse) - Loud pulmonic component of S2 - Gallop rhythm |
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What are the associated vital signs/parameters? |
- Hypotension - Decreased cardiac output - Elevated CVP / wedge pressure - Decreased urine output (low renal blood flow) - Tachycardia (possibly) |
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What are the signs on CXR associated with cardiogenic shock? |
Pulmonary edema |
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What is the treatment of cardiogenic shock? |
Based on diagnosis / mechanism: 1. CHF: diuretics and afterload reduction (eg, ACE-I), with or without pressors 2. LV failure (MI): pressors, afterload reduction |
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What are the last resort support mechanisms for cardiogenic shock? |
- Intra-aortic balloon pump (IABP) - Ventricular assist device (VAD) |
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What is the definition of neurogenic shock? |
Inadequate tissue perfusion from loss of sympathetic vasoconstrictive tone |
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What are the common causes of neurogenic shock? |
Spinal cord injury: - Complete transection of spinal cord - Partial cord injury with spinal shock - Spinal anesthesia |
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What are the signs/symptoms of neurogenic shock? |
- Hypotension - Bradycardia - Neurologic deficit |
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Why are HR and BP decreased in neurogenic shock? |
Loss of sympathetic tone (but hypovolemia - hemoperitoneum - must be ruled out) |
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What are the associated findings of neurogenic shock? |
Neurologic deficits suggesting cord injury |
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What MUST be ruled out in any pt where spinal shock is suspected? |
Hemorrhagic shock! |
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What is the treatment of neurogenic shock? |
IVF (vasopressors reserved for hypotension refractory to fluid resuscitation |
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What percentage of patients with hypotension and spinal neurologic deficits have hypotension of purely neurogenic origin? |
About 67% (2/3) of patients |
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What is spinal shock? |
Complete flaccid paralysis immediately following spinal cord injury; may or may not be associated with circulatory shock |
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What is the lowest reflex available to the examiner? |
Bulbocavernosus reflex: checking for contraction of the anal sphincter upon compression of the glans penis or clitoris |
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What is the lowest level of voluntary muscle? |
External anal sphincter |
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What are the classic findings associated with spinal cord shock? |
- Hypotension - Bradycardia or lack of compensatory tachycardia |
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What is the acronym for treatment options for anaphylactic shock? |
BASE: - Benadryl - Aminophylline - Steroids - Epinephrine |
