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33 Cards in this Set
- Front
- Back
What 3 things define shock?
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1. Abnormal circulatory system function
2. Resulting inadequate tissue perfusion 3. Resulting inadequate tissue oxygenation |
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What is the first step in initial management of shock?
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Recognize its presence
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What is the second step in initial management of shock?
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Identify the probably cause of shock
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What are the major types of shock?
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1. Hypovolemic (most often hemorrhagic in injured pt)
2. Obstructive - tension ptx or cardiac tamponade 3. Neurogenic - spinal cord injury 4. Distributive - septic, anaphylactic |
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MCC of shock in injured patient?
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Hemorrhage
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Cardiac output (L/min) =
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HR (beats/min) x Stroke Volume (mL/beat)
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Name 3 parameters affecting stroke volume?
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1. Preload
2. Afterload 3. Myocardial contractility |
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Earliest circulatory sign of shock?
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Tachycardia
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What is the most effective method of restoring adequate CO and end-organ perfusion in shock?
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Restore venous return to normal -- stopping the source of bleeding + appropriate volume repletion
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Describe the cellular pathophysiology of shock
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inadequate perfusion-->decreased O2-->switch to anaerobic metabolism-->inc. [lactic acid] -->metabolic acidosis-->-->loss of cellular membrane integrity & electrochemical gradient w/ release of pro-inflammatory mediators -->end-organ damage-->multi-system organ dysfunction
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What are the 2 goals of treatment for hemorrhagic shock?
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1. Definitive hemorrhage control
2. Restore adequate circulating volume |
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Patient's with hemorrhagic shock require vasopressors, T/F?
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False; vasopressors further decrease tissue perfusion
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What % of a patient's blood volume must be lost in order for systolic BP to change?
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Up to 30% of a patient's blood volume; which is why it's so important to recognize tachycardia and skin color (compensatory mechanisms) in 1/1 survey
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A trauma patient is cool and tachycardic, what must be ruled out?
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Shock
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T/F -- lab values (Hgb/Hct) can rule out massive blood loss?
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False
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What are 5 parameters to pay attention to early in the 1/1 survey in order to promptly dx shock?
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1. Pulse rate
2. Pulse character 3. Respiratory rate 4. skin circulation 5. pulse pressurert |
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A rapid deceleration injury to the thorax necessitates what?
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Constant ECG monitoring in order to detect injury patterns and dysrhythmias
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Name 5 common causes of non-hemorrhagic shock.
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1. Cardiogenic shock
2. Cardiac tamponade 3. Tension pneumothorax 4. Neurogenic shock 5. Septic shock |
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How do you differentiate between cardiac tamponade and tension pneumothorax? (3)
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Unilateral absence of breath sounds, tracheal deviation, and hyperresonance to percussion over the affected hemithorax
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T/F, isolated intracranial injuries cause shock.
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False; look for concomitant c-spine or upper t-spine injuries-->hypotension w/out compensatory tachycardia (2/2 loss of sympathetic tone)
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How is neurogenic shock treated?
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Initial fluid resuscitation-->failure of therapy-->continuing hemorrhage vs neurogenic shock-->CVP monitor
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What is the typical blood volume of an adult? Child?
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Adult = ~7% body weight (e.g. 5L in a 70kg pt)
Child = 8-9% body weight |
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What guides volume replacement therapy in hemorrhagic shock?
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Patient's response
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Bleeding patients need ____?
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BLOOD
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Describe the spectrum of hemorrhagic shock.
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1. Class I - minimal loss, +/- tachycardia
2. Class II - early shock, + tachycardia, +/- Uop change 3. Class III - drop in SBP, +transfusion requirement 4. Class IV - life threatening, rapid transfusion, surgical intervention |
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What is the initial choice of fluid therapy in shock?
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Adult = 1-2 L WARMED, ISOTONIC
Peds = 20 mL/kg |
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What is the lethal triad?
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1. coagulopathy
2. acidosis 3. hypothermia |
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T/F, sodium bicarb is useful in treatment of metabolic acidosis commonly associated with hypovolemic shock.
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False
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In shock patients who fail to respond to initial fluid resuscitation, what must always be considered?
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1. Need for immediate definitive intervention
2. Non-hemorrhagic causes of shock - blunt cardiac injury, cardiac tamponade, or tension pneumothorax |
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What is type specific blood?
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ABO and Rh compatible blood, readily available in 10 minutes
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What are the levels of possible blood transfusion? (3)
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1. Cross-matched blood - fully compatible with all Ab, takes about 1 hr
2. Type-specific - ABO and Rh compatible, takes about 10 mins 3. O blood - make sure to use Rh(-) in females of child bearing age |
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How does BP relate to CO in shock monitoring?
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V = I x R, or BP = CO x SVR
Inc BP does NOT equate to inc CO, as SVR can account for this. |
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What are two locations which adequately reflect core temperature?
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1. Esophageal
2. bladder |