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33 Cards in this Set

  • Front
  • Back
What 3 things define shock?
1. Abnormal circulatory system function
2. Resulting inadequate tissue perfusion
3. Resulting inadequate tissue oxygenation
What is the first step in initial management of shock?
Recognize its presence
What is the second step in initial management of shock?
Identify the probably cause of shock
What are the major types of shock?
1. Hypovolemic (most often hemorrhagic in injured pt)
2. Obstructive - tension ptx or cardiac tamponade
3. Neurogenic - spinal cord injury
4. Distributive - septic, anaphylactic
MCC of shock in injured patient?
Hemorrhage
Cardiac output (L/min) =
HR (beats/min) x Stroke Volume (mL/beat)
Name 3 parameters affecting stroke volume?
1. Preload
2. Afterload
3. Myocardial contractility
Earliest circulatory sign of shock?
Tachycardia
What is the most effective method of restoring adequate CO and end-organ perfusion in shock?
Restore venous return to normal -- stopping the source of bleeding + appropriate volume repletion
Describe the cellular pathophysiology of shock
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
What are the 2 goals of treatment for hemorrhagic shock?
1. Definitive hemorrhage control
2. Restore adequate circulating volume
Patient's with hemorrhagic shock require vasopressors, T/F?
False; vasopressors further decrease tissue perfusion
What % of a patient's blood volume must be lost in order for systolic BP to change?
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
A trauma patient is cool and tachycardic, what must be ruled out?
Shock
T/F -- lab values (Hgb/Hct) can rule out massive blood loss?
False
What are 5 parameters to pay attention to early in the 1/1 survey in order to promptly dx shock?
1. Pulse rate
2. Pulse character
3. Respiratory rate
4. skin circulation
5. pulse pressurert
A rapid deceleration injury to the thorax necessitates what?
Constant ECG monitoring in order to detect injury patterns and dysrhythmias
Name 5 common causes of non-hemorrhagic shock.
1. Cardiogenic shock
2. Cardiac tamponade
3. Tension pneumothorax
4. Neurogenic shock
5. Septic shock
How do you differentiate between cardiac tamponade and tension pneumothorax? (3)
Unilateral absence of breath sounds, tracheal deviation, and hyperresonance to percussion over the affected hemithorax
T/F, isolated intracranial injuries cause shock.
False; look for concomitant c-spine or upper t-spine injuries-->hypotension w/out compensatory tachycardia (2/2 loss of sympathetic tone)
How is neurogenic shock treated?
Initial fluid resuscitation-->failure of therapy-->continuing hemorrhage vs neurogenic shock-->CVP monitor
What is the typical blood volume of an adult? Child?
Adult = ~7% body weight (e.g. 5L in a 70kg pt)

Child = 8-9% body weight
What guides volume replacement therapy in hemorrhagic shock?
Patient's response
Bleeding patients need ____?
BLOOD
Describe the spectrum of hemorrhagic shock.
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
What is the initial choice of fluid therapy in shock?
Adult = 1-2 L WARMED, ISOTONIC

Peds = 20 mL/kg
What is the lethal triad?
1. coagulopathy
2. acidosis
3. hypothermia
T/F, sodium bicarb is useful in treatment of metabolic acidosis commonly associated with hypovolemic shock.
False
In shock patients who fail to respond to initial fluid resuscitation, what must always be considered?
1. Need for immediate definitive intervention
2. Non-hemorrhagic causes of shock - blunt cardiac injury, cardiac tamponade, or tension pneumothorax
What is type specific blood?
ABO and Rh compatible blood, readily available in 10 minutes
What are the levels of possible blood transfusion? (3)
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
How does BP relate to CO in shock monitoring?
V = I x R, or BP = CO x SVR

Inc BP does NOT equate to inc CO, as SVR can account for this.
What are two locations which adequately reflect core temperature?
1. Esophageal
2. bladder