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Flashcards in 100714 shock Deck (28):
1

shock definition

inadequate tissue perfusion marked by decreased delivery of required metabolic substrates and inadquate removal of cell waste

2

classification of shock

hypovolemic
cardiogenic
septic
neurogenic
traumatic
obstructive

3

ex of obstructive shock

cardiac tamponade, pulmonary embolus

MAP is reduced

4

stages of shock

initial
compensatory
progressive
refractory

5

what stage is hyperventilation?

compensatory stage of shock

6

refractory stage of shock

irreversible organ damage, cell death, degradation of ATP to adenosine

7

physiological response to shock

progressive vasoconstriction (NE, epinephrine)
increased blood flow to vital organs (shunting away from skin, acral regions, splanchnic system)

increase in respiratory rate and tidal volume
reduced urine production
reduced GI activity

8

pathophysiology of cardiogenic shock

inadequate myocardial perfusion (decreased duration of diastole due to compensatory tachycardia)

excessive increase in myocardial oxygen consumption (tachycardia and increased myocardial wall tension)

metabolic derangement (lactic acidosis, leading to cardiac dysfxn)

9

in cardiogenic shock, compensatory mechanisms result in

increased pre and afterload (lead to further increase in myocardial oxygen consumption and progression of shock). worsening of cardiac fxn

10

management of cardiogenic shock

optimize ventricular filling

improve coronary perfusion pressure with vasopressors (ne, phenyepinephrine), inotropics (dobutamine, epinephrine, milrinone), IABP/mechanical circulatory support (LVAD, RVAD)

if acute MI-coronary agiography and immediate revascularization

11

what adrenergic receptor causes vasoconstriction?

alpha 1

12

SIRS

at least 2 of the following criteria:

tachypnea
WBC 12000 cells/mm3
HR>90
fever >38 (100.4 F) or hypothermia <36 (96.8 F)

13

sepsis

SIRS with an infec

on top of SIRS, at least 1 of the following showing inadequate organ perfusion is included:

-altered mental state
-hypoxemia
-elevated plasma lactate
-oliguria

14

severe sepsis

sepsis induced hypoperfusion or organ dysnfxn

15

septic shock

has all of the findings of SIRS, sepsis, and severe sepsis BUT has also persistent arterial hypotension in severe sepsis DESPITE ADEQUATE FLUID RESUSCITATION or by tissue hypoperfusion not explained by other causes

culture positive bacteremia exists in only 30-50 % of cases

16

multi organ dysfxn syndrome

beyond severe sepsis

there's primary and secondary MODS

primary: direct result of insult

secondary: consequences of host response (ex is cytokine release). inflam response to toxins and other components of microorganisms, leading to clinical manifestations of sepsis

17

causes of septic and vasodilatory shock

infec
noninfec systemic inflam
pancreatitis
burns
anaphylaxis
acute adrenal insuff
prolonged, severe hypoten
hemorrhagic shock
cardiogenic shock
cardiopulmonary bypass
metabolic-hypoxia, lactic acidosis
carbond monoxide posioning

18

recommendations in sepsis

initial resuscitation
screening of at risk pts
diagnosis
antimicrobial therapy (empiric started within 1 hr)
source control-draining abscesses, etc
infec prevention

19

initial fluid resuscitation

crystalloids or albumin (if require excessive amts)

20

therapy for hemorrhagic shock

volume therapy

21

neurogenic shock

profound vasodilation of arterial and venous blood vessels

causes are injury of brain stem, sp cord, or traumatic brain injury

22

in higher doses, epinephrine is a

alpha mimetic, leading to vasoconstriction

23

intraarterial balloon pump

inflates during diastole-use to increase diastolic perfusion pressure to coronary arteries

24

what do you want to do for shock pts?

optimize milieu
control rate and rhythm
optimize preload
enhance contractility
decrease or increase SVR

25

what to consider when giving beta adrenergic agents

heart rate
systemic vascular resistance

26

for hypotension that does not respond to initial fluid resuscitation, what will you do?

vasopressors
measure CVP, central venous oxygen saturation

27

diaphoresis can be seen in

shock
also MI

28

loss of bladder control could indicate

anaphylactic shock