Shock (Flemming) Flashcards by Barrett Thompson

What is the overarching reason why shock kills you?

Shock is an overall Lack of Blood Flow to the Organs

Causes:
- Hypoxia in organs which can lead to multiple organ damage with some organs being highly susceptible

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What is the mortality rate of shock?

20%

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What are the 5 types of shock?

- their causes?

Septic Shock - Infectious Process
Hemorrhagic Shock - Blood loss –> Hypovolemia
Neurogenic Shock - Neurologic/Spinal Injury
Cardiogenic Shock - Cardiac Dysfunction
Anaphylatic Shock - Allergic Reaction

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What are the the components that work together to cause Shock?

Lack of Pump function (heart isn’t adequate to perfuse organs)
Blood (content function) - losing too much blood or plasma leaves the heart with nothing to push
Blood Vessels - if they all dilate at once then the heart has nothing left to push against and blood can’t be moved towards organs

**Bottom line - blood isn’t getting to the organs

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What should you do if you walk up on a patient that’s in shock?

ABC’s

Airway
Breathing
Circulation

then recheck it every few minutes

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What is the shock position?

-what is the only exception to not moving someone into the shock position who’s in shock?

Feet Up and and DO NOT elevate the head (you want to keep the brain and other vital organs perfused

*Also turn head to the side to prevent aspiration if the person is nauseous

Neurogenic Shock - if someone has neurogenic shock you don’t want to move them at all unless you know what you’re doing

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T or F: someone can be bacteremic without being septic

True

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What is the Physiology Underlying Septic Shock?

Bacteria get into the blood and body responds to the infection
Massive release of cytokines and catecholamines leads to widespread inflammation

Vasodilation:
- Vasodilation from inflammation leads to systemic Vasodilatation which DECREASES Systemic Vascular Resistance (SVR)

Volume Loss:
- Leaky capillaries cause peripheral edema

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What are the two major symptoms of someone with septic shock?

HYPOtension
Tachycardia
FEVER (usually >38.5)
Rapid Respiratory Rate
RASH (DIC)

(others: confusion, disorientation, chills)

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What causes the Rapid Respiratory Rate associated with Sepsis?

Acidosis in the periphery because blood is not getting there but in breathing heavy you cause alkalosis of respiratory tissues because increasing O2 saturation isn’t helping the fact that you don’t have blood volume

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How do you treat a patient with septic shock?

Treat the Fever (tylenol, no blankets)
Treat Hypovolemia (blood, saline, VASOCONTRICTORS)
Treat Bacteria (identify infection source and use appropriate antibiotics)

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What are some common causes of Sepsis?

Urosepsis (common in the elderly)
Soft tissue infection
Intra-abdominal Infection - Appendicitis
Pneumonia
TOXIC SHOCK - super absorbent tampons

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What are the two facets of sepsis and which can we treat?

Bacteria
Immune System

**We can fight the bacteria but we can’t really suppress our own immune system in the middle of a bacteremic infection

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What is the mortality rate of true septic shock (not just sepsis) ?

45% fatal

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How much blood or volume loss can you take before you go into Hemorragic Shock?
- what puts you at a higher risk of experiencing this type of shock with blood loss?

You can lose 20% of your body’s Blood/Fluid Supply

- Being Old or Having a defective heart

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What is the Difference between hemorrhagic and hypovolemic shock?

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Hemorrhagic
- Bleeding Internal or Externally (not always apparent)

Hypovolemic
- Diarrhea, Severe Burns, Excessive Sweating

What is they main physiological problem with hypovolemic shock?

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Low Venous Return (blood is not getting pushed back into the heart so it has nothing to pump back out)

What are some of the more distinctive symptoms of Hypovolemic Shock?

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More Distinctive

Cyanosis
Anxiety
Profuse Sweating
Shallow Breathing
Angina

General:
- Confusion, Hypotensionl, Tachycardia

What are some signs of internal Hemmorhage that might cause hypovolemic shock?

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Abdominal Pain
Bright Red Blood in Stool
Black Tarry Stool - Melena
Hematuria
Vaginal Bleeding
Hematemesis
Abdominal Distension

What is the difference in having black tarry stools and bright red stools?

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Black Tarry implies Upper G.I. bleed

Red Implies Lower GI bleed

What is the Primary Treatment and Secondary Treatment for Hypovolemic Shock?

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Primary:

IV Fluids
Blood (if hemorrhage)

Secondary Treatment:

Ionotropes (Dopamine, Dobutamine)
Vacoconstrictors (Epinephrine, Norepinephrine)

What do ionotropes do?

- what is the risk of using vascocontrictors?

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Ionotropes - Increase how hard the heart beats

Vasocontrictors have the risk of causing RENAL damage

What causes Neurogenic shock?

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Acute spinal cord injury

What physiology underlies Neurogenic Shock?

Key symptoms
how long does it typically last?

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UNOPPOSED VAGAL TONE

Hypotension and BRADYCARDIA result
Warm and DRY skin

Neurogenic Shock:
- Typically last 1-3 weeks

What is the differnence between neurogenic shock and Spinal Shock?

Neurogenic Shock: - Loss of Sympathetic Tone in Vessels and heart causing Bradycardia and Vasodilation Spinal Shock: - Temporary Loss of Spinal Reflex activity below a total or near total spinal cord injury

How do we treat Neurogenic shock?

Vasopressors: - Epinephrine - Phenylephrine - Vasopressin (ADH) Inotropes: - Dopamine

Symptoms of anaphylatic Shock?

- Swelling of conjuctiva - Runny Nose - Swelling of Lips - Hives - Difficulty Breathing

What are some Common and Less common anaphylatic Triggers?

Common: - Medications - Foods - Insect Stings Less common: - Latex - Medications used in Anesthesia - Excercise (rare)

If someone says they are allergic to shellfish, what might you want to watch out for?

They may actually be allergic to iodine

What is the treatment for anaphylactic shock?

- Remove Source of Anaphylaxis - Epinephrine - Oxygen (MECHANICALLY OPEN AIRWAY) - IV antihistamines and Cortisone - Beta-Agonist (like Albuterol)

What causes cardiogenic shock?

Complete Heart Failure

Symptoms of Cardiogenic Shock?

- Sever Shortness of Breath - Tachycardia - Mental Alteration - Loss of Consciouness - Faint Weak Pulse

What are some of the symptoms of Cardiogenic Shock?

- Complete History (particularly important here) - ECG - Chest X-ray (enlarged heart or fluid in the lungs)

What is the most common cause of Cardiogenic shock?

Left Ventricular Failure after MI

What are some things you might give to treat cardiogenic shock?

``` Medication (vasopressors, inotropes, etc.) Angioplasty and stent Balloon Pump Heart Transplant Ventricular Assist Device ```

What is the only/main type of shock that should cause the following: - Bradycardia - Profuse Sweating - Fever - Rapid Swelling

Bradycardia - Neurogenic Sweating - Hypovolemic Fever - Sepsis Rapid Swelling - Anaphylaxis

T or F: Multiple Types of Shock can work in concert

True

Shock (Flemming) Flashcards

(37 cards)