Tncc-Shock

Front 1

Thoracentesis

Back 1

Insertion site is 2nd intercostal space, midclavicular line on same side absent breath sounds, opposite of tracheal shift. Use 10-14g over the needle catheter 3-6 cm in length above 3rd rib into pleural space until air escapes. Remove needle, leave catheter in place until chest tube placed.

Front 2

Chest tube monitoring

Back 2

FOCA
F-fluctuation
O-Output
C-Color of drainage
A-Air leaks (bubbles)

Front 3

Ventilator monitoring

Back 3

DOPE
D-displaced tube
O-Obstruction-secretions or pt biting tube
P-Pneumothorax
E-Equipment failure-detached or kink in tubing

Front 4

4 types of shock

Back 4

Hypovolemic
Cardiogenic
Obstructive
Distributive

Front 5

Hypovolemic Shock Etiology, underlying pathology

Back 5

1) Hemorrhage-whole blood loss
2) Burns-plasma loss

Front 6

Cardiogenic Shock Etiology, underlying pathology

Back 6

1) Myocardial Infarction- loss of cardiac contractility
2) Dysrhythmias- reduced cardiac output
3) Blunt cardiac injury- loss of cardiac contractility

Front 7

Obstructive Shock Etiology, underlying pathology

Back 7

1) Cardiac tamponade-compression of heart with obstruction to atrial filling
2) Tension pneumothorax- mediastinal sift with obstruction to atrial filling
3) Tension Hemothorax- combination of preceding

Front 8

Distributive Shock Etiology, underlying pathology

Back 8

1) Neurogenic shock- loss of vasomotor tone due to decreases in sympathetic control
2) Anaphylactic shock- Vasodilation of vessels due to immune reaction to allergens e.g. release of histamine
3) Septic Shock- Mediated by systemic inflammatory response syndrome (SIRS) with hypotension and perfusion abnormalities

Front 9

3 Stages of Shock

Back 9

1) Compensated
2) Progressive/uncompensated
3) Irreversible

Front 10

Compensated shock stage

Back 10

Normal physiologic compensatory mechanisms, mediated by SNS are activated to restore adequate tissue perfusion and preserve vital organ function. Nonvital cells convert to anaerobic metabolism. Byproduct of this is lactic acid which causes cellular damage

Front 11

Progressive shock stage

Back 11

Compensatory mechanisms begin to fail and unable to maintain perfusion to vital organs. Further progression of lactic acidemia, activation of inflammatory response and deterioration of organ function.

Front 12

Irreversible Shock Stage

Back 12

Cellular destruction is so severe that death is inevitable

Front 13

Compensatory Mechanism of Shock- vascular response

Back 13

1) SNS inhibits baroreceptors causing vasoconstriction
2) Chemoreceptors and the bifurcation of the common carotid arteries and aortic bodies near the aorta are sensitive to low 02 and high C02. When arterial blood pressure is below 80 mm Hg they activate and cause vasoconstriction.

Front 14

Compensatory Mechanism of Shock- Cerebral Response

Back 14

BP drops below 50 mm Hg, cerebral ischemia occurs. CO2 buildup on the brains vasomotor center will stimulate the CNS's ischemic response which further stimulates the SNS. LOC changes indicate cerebral ischemia

Front 15

Compensatory Mechanism of Shock- Renal Response

Back 15

Renal ischemia causes release of renin which causes angiotensin to release angiotensin 1, which converts to angiotensin 2 and causes:
-vasoconstriction of arterioles and some veins
-stimulation of the SNS
-retention of water by the kidneys
-release of aldosterone from the adrenal cortex (sodium retention hormone)
10-60 min to activate fully

Front 16

Compensatory Mechanism of Shock-Adrenal gland response

Back 16

Adrenals stimulated by SNS release catecholamines (epinephrine and norepinephrine)
Epi stimulates force of cardiac contraction (positive inotropy) and increase in heart rate (positive chronotorpy) and causes vasoconstriction.
Norepi- vasoconstriction
ACTH releases from pituitary causes adrenal release of cortisol. Cortisol elevates blood sugar and causes renal retention of water and sodium.

Front 17

Compensatory Mechanism of Shock- Hepatic response

Back 17

glycogen stored in liver breaks down into glucose and heapatic vessels