Critical Care Test 2 > Shock > Flashcards

Shock Flashcards

(49 cards)

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1
Q

what does inadequate systemic oxygen delivery activate?

A

autonomic response to maintain oxygen delivery

-SNS and RAAS

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2
Q

Sympathetic NS

  • what is released
  • what happens when these are released
A
  • NE, Epi, dopamine, cortisole

- vasoconstriction, increased HR, increased cardiac contractility

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3
Q

Renin-Angiostensin Axis

-what happens during this response

A
  • water and sodium are conserved
  • vasosconstriction
  • increases Blood volume and blood pressure
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4
Q

What is another name for the activation of SNS and RAAS system

A

Compensatory stage of shock

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5
Q

Global Tissue Hypoxia define

A

cellular response to decreased systemic oxygen delivery

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6
Q

what happens during global tissue hypoxia

A
  • ATP depletion
  • cellular edema
  • hydrolysis of cell membrane and cell death
  • endothelial inflammation and disruption
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7
Q

Result of global tissue hypoxia

A

Lactic acidosis

  • cardiovascular insufficiency
  • increased metabolic demand
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8
Q

Stage of shock during global tissue hypoxia

A

Progressive Stage of Shock

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9
Q

Multiorgan dysfunction Syndrome MODS

A

progress of physiological effects as shock ensues

  • cardiac depression
  • respiratory distress
  • renal failure
  • DIC
    • organ failure
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10
Q

Phase name for MODS

A

Refractory Stage of shock

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11
Q

Initial Stage of Shock

A

cardiac ouptut decreases

  • reason varies by type of shock
  • tissue perfusion threatened
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12
Q

Compensatory Stage of shock

A

homeostatic mechanisms kick in

-the body is still able to maintian CO, BP, and tissue perfusion

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13
Q

Progressive Stage of Shock

A

The body cannot keep up

  • not enough O2 to cells
  • switches from aerobic to anaerobic
  • acidosis
  • vasodilation
  • inflammatory dilators
  • SIRS
  • every system effected
  • CELLS DIE
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14
Q

Refactory stage of shock

A

unresponsive to treatment

  • irreversible
  • ORGANS DIE
  • MODS
  • death d/t decr. tissue perfusion
  • circulatory system unable to meet body demands
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15
Q

Approach to pt in shock

ABC’s assessment

A 
cardio-respiratory monitor
-pulse ox
-supplement oxygen
-IV acess
-ABGs
Foley cath
-VS
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16
Q

Diagnosis of Shock

A
  • physical exam
  • hemodynamics
  • Infectious source
  • labs
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17
Q

Diagnosis: LABS

A
  • cbc
  • chemistries
  • lactate
  • coagulation
  • cultures
  • ABGs
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18
Q

Shock and pulses:

if carotid pulse is felt-

A

systolic at least 60

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19
Q

Shock and pulses:

-if radial pulse felt:

A

-systolic BP at least 70

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20
Q

Shock and pulses

-if femoral pulse felt:

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A

-systolic BP at least 80

21
Q

Shock and pulses:

-if Pedal pulse felt

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A

-SBP at least 90

22
Q

Goals of treatment

ABCDE

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A 
A-airway
B-control WOB
C- circulation optimized
D- delivery of oxygen
E- end points of resusc. achieved
23
Q

Control WOB

-how to decrease O2 consumption

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A
  • Resp. muscles consume a lot of oxygen

* * mechanical ventilation and sedation decrease WOB and improve survival

24
Q

Ways to Maintain O2 delivery

1- decrease O2 demands

Study These Flashcards
A

provide analgesics and anxiolytics to relax muscles and avoid shivering

25
Ways to Maintain O2 Delivery | 2- maintain arterial oxygen sats/content
- give O2 | - maintain hgb >10 g/dl
26
Ways to Maintain O2 Delivery | 3- Lactate levels
lactate levels or central venous O2 sats assessed to see tissue extraction
27
End Points of Resuscitation | -Goal
maximize survival and minimize morbididty - UO: >0.5 mL/kg/hr - CVP: 8-12 (if intubated) - MAP: 65-90 - Central venous oxyg. concentration: >70%
28
What do all the types of shock have in common?
INEFFECTIVE TISSUE PERFUSION | ACUTE CIRCULATORY FAILURE
29
5 types of shock
- hypovolemic - septic - cardiogenic - anaphylactic - neurogenic
30
Defining characteristic of HYPOVOLEMIC SHOCK
- inadequate Intravascular fluid volume | - ** MOST COMMON TYPE OF SHOCK
31
Hypovolemic shock | 1- NON-HEMORRHAGIC
- vomiting - diarrhea - Bowel obstruction - pancreatitis - neglect (dehydration)
32
Hypovolemic Shock | 2- HEMORRHAGIC
- GI bleed - trauma - Massive hemoptysis - abdominal aortic aneurysm rupture - ectopic pregnancy - post partum bleeding
33
Treatments for Hypovolemic Shock
- ABC - 2 large bore IVs or a central line - Crystalloids: NS or LR up to 3 liters - PRBC: O negative or crossed matched * control bleeding
34
Evaluation of HYPOVOLEMIC SHOCK
CBC - ABG/lactate - electrolytes - BUN/Cr - Coagulation - type and cross match
35
Diagnostic procedures for HYPOVOLEMIC SHOCK
- CXR - pelvic xray - abd/pelvis CT - chest CT - GI endoscope - bronchoscope - vascular radiology
36
Hypovolemic Shock | -effect on hemodynamics
Loss of circulating volume (decreased PRELOAD) leads to decreased SV & CO --> inadequate cellular O2 supply and ineffective tissue perfusion
37
CARDIOGENIC SHOCK | -defining factors
- SBP 18
38
S/S cardiogenic shock
- cool, mottled skin - tachypnea - hypotension - ALOC - narrowed pulse pressure - rales, murmer
39
Causes of cardiogenic shock
- Acute MI - sepsis - myocarditis - myocardial contusion - aortic and mitral stenosis - aortic insufficiency
40
Pathophys of Cardiogenic shock | -LV function
after ischemia, loss of Left ventricular function | ** loss of 40% of LV--> shock
41
Pathophys of cardiogenic shock | - CO reduction
-CO reduciton--> lactic acidosis & hypoxia
42
Pathophys of cardiogenic shock | -stoke volume reduction
- tachypnea developes to compensate | - ischemia and infarction worsens
43
Pathophys of Cardiogenic shock | -BOTTOM LINE
-heart cant pump blood forward!
44
Diagnostics tests for cardiogenic shock
EKG CXR CBC, chem 10, cardiac enzymes, coag echocardiogram
45
Cardiogenic shock treatment
revascularization procedure or MI pt Medications- inotropes, diuretics, antidysrhythmias -maintain airway -IABP
46
Anaphylactic shock define
- a severe systemic hypersensitive reaction characterized by multisystem involvement * * IgE reaction
47
Anaphylactic shock | -Anaphylactoid reaction
clinically indistinguishable from anaphylaxis - * doesnt require sensitizing exposure * not IgE mediated
48
Anaphylactic shock patho
1- activation of mast cells and basophils (IgE, IgG or non immunologic : cold, heat, ETOH) 2- Release of biochemical mediators (histamine) 3- Vasodilation, permeability, brochoconstriction 4- relative hypov
49
shock definition
inadequate oxygen delivery to meet metabolic needs | results in global tissue hypoperfusion and metabolic acidosis
Critical Care Test 2
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