NP School > Shock > Flashcards

Shock Flashcards

(16 cards)

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1
Q

Which type of shock would you suspect with the following values:
- CVP is decreased
- PAOP/PCWP increased
- CO/CI decreased
- SVR increased
- SvO2 decreased

A

cardiogenic shock
- heart not able to effectively pump blood out resulting in back up into the lungs and reduce output
- not a volume problem

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2
Q

Which type of shock would you suspect with the following values:
- CVP is decreased
- PAOP/PCWP decreased
- CO/CI decreased
- SVR increased
- SvO2 decreased

A

hypovolemic shock
- reduced overall volume (loss or third spacing) causes decreased blood return to the heart

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3
Q

What is the treatment for cardiogenic shock?

A
  • treat underlying cause
    1) Acute Myocardial Infarction (Heart Attack): The primary cause, where damaged heart muscle cannot contract effectively.
    2) Heart Failure (Acute Worsening): Severe decompensation of chronic heart failure.
    3) Arrhythmias: Extremely fast or slow heart rhythms (ventricular tachycardia/fibrillation, severe bradycardia).
    3) Myocarditis: Inflammation of the heart muscle, often due to infection.
    4) Mechanical Defects: Acute valvular dysfunction (e.g., mitral regurgitation), or rupture of the ventricular wall or septum.
    5) Pericardial Tamponade: Fluid buildup around the heart restricting its motion.
    6) Pulmonary Embolism: A blood clot in the lung that causes acute right ventricular failure.
    7) Cardiotoxic Agents/Medications: Drug overdoses or toxins that inhibit heart function
  • cardiac support
    • nitroglycerin dilates coronary arteries to increase cardiac perfusion
    • vasopressors to increase BP
    • inotropes to increase CO/CI
  • support airway/O2
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4
Q

Which is the only type of shock where the PAOP/PAWP will be increased?

A

cardiogenic shock

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5
Q

What are causes of cardiogenic shock?

A
  • Acute myocardial infarction
  • acute heart failure
  • arrhythmias
  • cardiac tamponade
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6
Q

Which type of shock would you suspect with the following values:
- CVP is increased
- PAOP/PCWP decreased
- CO/CI decreased
- SVR increased
- SvO2 decreased

A

obstructive shock
- blockage of blood to the ventricles or superior/inferior vena cava
- causes reduce cardiac filling

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7
Q

What are causes of obstructive shock?

A
  • acute pulmonary embolism
  • tension pneumothorax
  • cardiac tamponade
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8
Q

What is the treatment for obstructive shock?

A
  • treat underlying cause (remove obstruction)
  • vasopressors
  • fluid replacement, prevents hypotension post treatment
  • airway/O2 support
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9
Q

Which type of shock would you suspect with the following values:
- CVP is decreased
- PAOP/PCWP decreased
- CO/CI decreased
- SVR decreased
- SvO2 decreased

A

distributive shock
- septic shock (infection)
- neurogenic shock (spinal cord injury)
- anaphylactic shock (allergy)

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10
Q

What is the treatment for anaphylactic shock?

A
  • fluid replacement
  • epinephrine
  • glucocorticoids to stop the late stage eosinophilic inflammatory response
  • antihistamine
  • consider H2 agonist and inhaled B2-agonist
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11
Q

What is the treatment for neurogenic shock?

A
  • fluid replacement
  • alpha-agonist, causes vasoconstriction (phenylephrine)
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12
Q

In what type of shock is the SVR decreased?

A

distributive shock
- septic shock
- neurogenic shock
- anaphylactic shock

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13
Q

What are the 2 types of septic shock?

A
  • Warm Shock (Early/Compensated): Patients display vasodilation, high cardiac output, warm skin, and rapid pulse (tachycardia).
  • Cold Shock (Late/Uncompensated): Marked by vasoconstriction, decreased cardiac output, and cold, clammy skin due to advanced cardiovascular collapse.
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14
Q

Why is the SvO2 increased in a patient with hyperdynamic or warm septic shock?

A

O2 delivery at the tissues is decreased or impaired resulting in an increased O2 return to the heart

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15
Q

What is the treatment for septic shock (1 hr bundle)?

A
  • measure lactate, redo at later time if >2 mmol/L
  • blood cultures prior to ABX
  • broad spectrum ABX
  • fluid resuscitation with crystalloid (LR or plasmalyte) at 30 mL/kg for hypotension or lactate >4
  • vasopressor and saline if still hypotensive after fluids
    • levo is 1st line
    • vasopressin if levo is not enough
    • dobutamine or epi if cardiac dysfunction is present and BP is adequate
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16
Q

What is the 1st line vasopressor to use to treat septic shock?

Study These Flashcards
A

Norepinephrine or levophed

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