Term
| What is the deifinition of shock? |
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Definition
| Failure of end organ perfusion |
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Term
| The 5 causes/types of shock are... |
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Definition
1. Hypovolemic
2. Septic
3. Cardiogenic
4. Neurogenic
5. Anaphylactic |
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Term
What signs are seen with hypovolemic shock?
HR, CO, BP, SVR, PCWP |
|
Definition
increases, decreases, decreases, increases, decreases
Caused by:
Hemorrhage
3rd spacing
vomitting/diarrhea
poor resuscitation
burns
pancreatits |
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Term
What are the signs of seprtic shock?
HR, CO, BP, SVR, PCWP |
|
Definition
increases, increases, decreases, decreases, increases
Etiology - usually gram - bacteria
Early - high output cardiac failure
Late - decreased C.O.
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Term
| What are the 3 most feared complications of septic shock? |
|
Definition
1. Disseminated Intravascular Coagulation
2. Acute Respiratory Distress Syndrome
3. Multi-system Organ Failure |
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Term
| What is the treatment of septic shock? |
|
Definition
1. Antiobiotics / get rid of source
2. Fluid resuscitation
3. Vasopressors |
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Term
What are the signs of cardiogenic shock?
HR, CO, BP, SVR, PCWP |
|
Definition
| increases, decreases, decreases, increases, increases |
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Term
| What are the 5 causes of intrinsic cardiogenic shock? |
|
Definition
1. Myocardial infarction
2. Congestive Heart Failure
3. Valvular disease
4. Arrythmia
5. Papillary muscle dysfunction |
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Term
| What are the 3 causes of external cardiogenic shock? |
|
Definition
1. Cardiac tamponade
2. Tension pneumothorax
3. Increased abdominal pressure |
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Term
| What is the treamtnet of cardiogenic shock? |
|
Definition
1. Correct underlyind problem
2. Inotropes (Dobutamine - B agonist)
3. Diuretics |
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Term
| What are the 2 signs of neurogenic shock? |
|
Definition
Bradycardia and Hypotension
Caused by either spinal cord injury or spinal anesthesia |
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Term
| First step in the assesment of a shock patient? |
|
Definition
Assess the ABC's
then
Vitals
UOP
I/O
Mental Statues
Cardiopulmonary exam |
|
|
Term
|
Definition
1. Tachycardia
2. Hypotension
3. Decreased UOP
4. Tachypnea
5. Altered Mental Status
6. Decreased Perfusion |
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Term
| How do you fluid resuscitate a shock patient? |
|
Definition
500cc - 1L crystalloid fluids
Observe for UOP and watch for fluid overload |
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Term
| How do you monitor resuscitation efforts in a patient with indeterminate fluid statues? |
|
Definition
Swanz-Ganz catheter
[image] |
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Term
| What is the crystalloid rule after blood loss? |
|
Definition
| 3:1 ratio of crystalloid fluid for blood loss |
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Term
| What are the indications to give pRBC's? |
|
Definition
|
|
Term
| What are the indications to give fresh frozen plasma (FFP)? |
|
Definition
|
|
Term
| What are the indications to administer platelets? |
|
Definition
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Term
| After Resuscitation, ABC assesment, next step in shock treatment is .... |
|
Definition
History taking:
1st Q: What happened recenetly
i.e.
Surgery
Bee Sting
Transfusion |
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|
Term
Cardinal symptoms of shock
cardiogenic, septic, neurogenic, anaphylactic |
|
Definition
| massive CP radiating to Left arm/jaw, F/C, paralysis, wheezing/itching/cramps |
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Term
| During resuscitation the goal Mean Arterial Blood Pressure is? |
|
Definition
MAP - 65mm Hg
MAP = 1/3 systolic + 2/3 diastolic |
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Term
| What labs would you order in a shock patient? |
|
Definition
CBC
BMP
ABG
T&S
Coagulation
Cardiac Enzymes
Blood cultures
Fibrinogen/d-dimer (DIC cx sepsis)
Lactate (perfusion status) |
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Term
| What studies would you order in a shock patient and why? |
|
Definition
1. CXR - r/o pulmonary edema
2. EKG
3. TTE/TEE - rule out cardiogenic cause
4. CT - unknown etiology |
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Term
| What is the most common pressor and how does it work? |
|
Definition
Phenylepherine - an alpha agonist
Increases SVR and MAP by vasoconstricting |
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Term
| What is the most common inotrope used and how does it work? |
|
Definition
Dobutamine is utilized to increase heart contractility
It is a beta agonist |
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Term
| What is the role of Dopamine in shock patients? |
|
Definition
At low doses Dopamine vasodilates renal, mesenteric, coronary, and cerebral vessels during times of hypoperfusion.
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Term
| Treatment of Hypovolemic Shock includes... |
|
Definition
1. Resuscitation
3:1 crystalloid
pRBC Hct <30
If unstable after 4-6L crystalloid and 4-6U pRBC go to OR
2. Stop bleeding
3. No vasopressors, will make heart work more |
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Term
| 5 points of sepsis treatment |
|
Definition
1. Identify source
2. IVF
3. Abx - Van/Gent/Flag
4. Pressors/Inotropes (phenylepherine, dopamine, NE)
5. Monitor Cx: MSOF, DIC |
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Term
| First step in treating cardiogenic shock? |
|
Definition
Identifying source of cardiogenic shock...
- catherization
- pericardiocentesis
- surgery |
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Term
| 2 step treatment of cardiogenic shock |
|
Definition
Inotropes
Vasopressors
Monitor PWCP with Swanz Ganz catheter, want it to decrease |
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Term
| Last resort in treatment of cardiogenic shock is... |
|
Definition
Intra-aortic balloon pump
and ventricular assisted device |
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Term
| 2 point treatment of neurogenic shock |
|
Definition
1. Fluids
2. Phenylepherine |
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Term
| Treatment of anaphylactic shock |
|
Definition
Epinepherine and Albuterol
Others: Benadryl, Hydrocortisone, Pressors |
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