Shock

Question 1

Shock stages

Answer 1

-compensatory
-progressive
-irreversible

Question 2

Compensatory Shock stage

Answer 2

-multi system response to decreased tissue perfusion
-the body can compensate for changes
-if the cause is corrected, then minimal residual effects
-pt is experiencing fight/flight = high HR, normal BP
-beta blockers might prevent high heart rate

Question 3

Progressive Shock stage

Answer 3

-when compensator mechanisms fail
-cardiac profoundly affected, decreased BP and CO, increased capillary permeability, leaky vessels
-Goals: prevent MODS (e.g., add pressors

Question 4

Irreversible Shock stage

Answer 4

-profound hypotension & hypoxemia
-failure of organs r/t waste products (lactate, urea)
-recovery unlikely

Question 5

early signs

Answer 5

-pallor
-tachypnea
-confusion
-tachycardia

Question 6

late signs

Answer 6

-cold, moist skin
-weak, thready pulse
-anuria
-hypotension
-metabilic acidosis

Question 7

Vasopressors

Answer 7

increase cardiac output
-multiple side effects
-different pressors for different types of shock

Question 8

Hypovolemic Shock types

Answer 8

-External: fluid losses (fluid lost from the body completely)
-external causes: stabbing, hemorrhage, diarrhea, vomiting
-Internal: fluid shifts (third spacing)
-internal causes: ascites

Question 9

Hypovolemic Shock causes

Answer 9

-hemorrhage
-GI loss
-Fistula drainage
-DI
-diuresis
-burns
-ascites
-internal bleeding

Question 10

Hypovolemic Shock presentation

Answer 10

-tachypnea
-hypotension
-tachycardia
-peripheral hypoperfusion
-decreased urine output
-mental status changes

Question 11

Hypovolemic Shock patho

Answer 11

-decreased venous return to heart leads to decreased CO

Question 12

Hypovolemic Shock treatment

Answer 12

-Rapid fluid replacement
-correct the cause
-safety of blood transfusion
-rapid infuser

Question 13

rapid fluid replacement in Hypovolemic Shock

Answer 13

-2 large bore IV lines (14-16g), IO, or central venous catheter
-restore fluids (Blood, IVF)

Question 14

Cardiogenic Shock types

Answer 14

-coronary (more common, most MI patients)
-noncoronary (conditions that stress the myocardium)

Question 15

Cardiogenic Shock presentation

Answer 15

-tachypnea
-crackles
-hypotension
-tachycardia
-peripheral hypoperfusion
-decreased urine output
-mental status changes

Question 16

Cardiogenic Shock causes

Answer 16

-MI (number one cause)
-cardiomyopathy
-cardiac tamponade
-blunt cardiac injury
-hypoxemia
-acidosis
-tension pneumothorax

Question 17

Cardiogenic Shock patho

Answer 17

decreased cardiac output
-impaired tissue perfusion
-weakens heart and ability to pump

Question 18

Cardiogenic Shock treatment

Answer 18

GOAL: correct underlying cause
-cardiac Cath/fibrinolytics/CABG/IABP/VAD
-2-6L NC, SpO2 goal: 95%
-morphine for pain control
-use A-line or PA Cath for hemodynamic monitoring
-Labs: BNP, cardiac enzymes, lactate
-fluids: monitor for overload

Question 19

Cardiogenic Shock medications

Answer 19

-drug of choice: Dobutamine (inotropic) to increase contractibility
-nitrates
-dopamine: increase HR & contractility
-pressors
-antiarrhythmic meds

Question 20

Distributive shock

Answer 20

-intravascular volume pools in peripheral blood vessels
-leads to relative hypovolemia b/c not enough blood returns to the heart –> inadequate tissue perfusion
-septic, neurogenic, anaphylactic

Question 21

Septic shock

Answer 21

-persistent hypotension despite adequate fluid resuscitation
-requires vasopressors
-inadequate perfusion resulting in tissue hypoxia

Question 22

Septic shock major pathophysiologic effects

Answer 22

-vasodilation
-misdistribution of blood flow
-myocardial depression/decreased cardiac output

Question 23

Septic shock treatment

Answer 23

-aggressive fluid resuscitation (30mg/kg)
-blood cultures before antibiotics
-Vasopressors for BP (norepinephrine is the 1st line)
-monitor temp, glucose, nutritional therapy
-stress ulcer prophylaxis

Question 24

Neurogenic shock manifestations

Answer 24

-hypotension & bradycardia
-difficulty regulation body temp

Question 25

what type of SCI does Neurogenic shock typically occur in?

Answer 25

-cervical or high thoracic injury (T6 & above)

Question 26

SCI in T6 or above….

Answer 26

leads to massive vasodilation, which leads to not compensated due to loss off SNS vasoconstrictor tone, leads to pooling of blood in vessels, tissues, hypoperfusion

Question 27

Neurogenic shock treatment

Answer 27

-maintain airway
-VTE prophylaxis
-cautious administration of fluids
-Vasopressors
-atropine
-minimize spinal cord trauma with stabilization
-monitor temperature

Question 28

Anaphylactic shock

Answer 28

-life threatening response to allergen
-massive vasodilation
-increased capillary permeability
-leads to respiratory distress from laryngeal edema or bronchospasm
-sudden onset: wheezing, swelling, incontinence, flushing, purities, angioedema

Question 29

Anaphylactic shock treatment

Answer 29

-maintain airway
-aggressive fluid resuscitation
-medications: Epi IM, antihistamines, H2 blockers, bronchodilators, corticosteroids
-avoidance of known allergies

Question 30

Prioritizing Interventions

Answer 30

-ABCs
-mental status assessments
I/Os
-body temp/skin changes
-evidence of adequate tissue perfusion
-restoration of normal BP
recovery of organ function