What is shock?
- sign. reduction of systemic tissue perfusion
- Cell membrane dysfunction
General signs of shock:
- low BP
- decreased urine output
- altered mental status
*What are the main 4 types of Shock?
- hypovolemic
- cardiogenic
- distributive
- obstructive
What is the cause of hypovolemic shock? SSx?
- LOSS OF VOLUME of blood or fluids
- so you will see… rapid, weak, thready pulse w rapid shallow breathing (acidosis)
*What are some drugs that can cause hypovolemic shock?
- NSAIDS, aspirin, ibuprofen, heparin, coumadin
*What do NSAIDS do?
- inhibit aggreg. of platelets increasing risk of bleeding
*Is aspirin, ibuprofen, heparin, coumadin reversible? How to reverse?
- Reversible: ibuprofen, heparin (protamine sulfate), coumadin (vit K)
- Aspirin is irreversible… normal when platelets are replaced
*In what drugs is PT, PTT, and INR checked?
PT, INR: Coumadin
PTT: Heparin
*hemophiliacs have prolonged PTT
*What does Coumadin do?
- inhibits production of vit K in gut so inhibits production of coag factors
- if want to reverse, supplement vit K
*What labs to check with pt using Coumadin? If Pt has hx of PE or DVT, what happens to INR?
- PT, INR
- INR doubles
What is PT and what does it measure? INR?
Prothrombin Time
measures extrinsic pathway of coagulation (factors 2, 7, 9, 10).
- INR is a world-wide standardization for PT
- Shock Index:
- Formula
- predictor of what?
- see need for?
- HT Rate/Systolic BP
- predictor of impact of blood loss
- transfusion, mortality
- so if heart rate is higher than systolic BP (> 0.9), tx pt has though they are bleeding
- normal = 0.5-0.7
*If you don’t have a BP cuff and the pt looks like they in shock, how do you find BP?
measures SYSTOLIC: if this pulse is palpable..
- Radial pulse: 80
- Brachial: 70
- Femoral:60
- Carotid: 50
- first check radial! whew! they might be ok…
- no! its not there, check further up, the brachial! is it there? no?! ahhh femoral nooo…. weird…. okay check closest to heart, carotid! are they alive?!?!
- think… CAROTID, OK YOU ARE HALF ALIVE = 50… radial, 80% alive at least!!
*49 yo M in a car accident found on the street…. you run over and make sure he’s breathing.. establish airway and protect the cervical spine! oxygen! He’s thirsty and asking for your juice…. what do you do?
no food or drink bc they may need surgery!
What is Cardiogenic Shock?
- ex. Eti
primary failure of ventricles… largely irreversible.
- dysrhythmias after MI
SSx of Cardiogenic Shock
low BP, tachycardia, low urine output, JVD, pulsus paradoxus, weak or absent pulse
*What is Distributive Shock and what is MC cause?
output of heart is normal, but vessels become bigger causing a lack of pressure
- MC cause is SEPSIS
- —> DIC
- other causes: anaphylactic, neurogenic, vasodilator, endocrine
Eti of Obstructive Shock
- PE, severe Aortic Stenosis, Cardiac Tamponade
- physical obstruction of great vessels of the HT
*Class I Hemorrhage
Hemorrhage involves up to 15% of blood volume. There is typically no change in vital signs and fluid resuscitation is not usually necessary.
*Class II Hemorrhage
involves 15-30% of total blood volume. A patient is often tachycardic with a narrowing of the difference between the systolic and diastolic blood pressures. The body attempts to compensate with peripheral vasoconstriction
Volume resuscitation with crystalloids such as hypertonic saline solution or lactated Ringer’s solution is generally required.
If the source of blood loss has been adequately treated than a blood transfusion is generally not required.
~livedo reticularis?
*Class III Hemorrhage
involves loss of 30-40% of circulating blood volume. The patient’s blood pressure drops, the heart rate increases, peripheral hypoperfusion (shock), such as capillary refill worsens, and the mental status worsens. Fluid resuscitation with crystalloid and blood transfusion are usually necessary.
*Class IV Hemorrhage
involves loss of >40% of circulating blood volume. The limit of the body’s compensation is reached and aggressive resuscitation is required to prevent death.
