L35 Flashcards
What is shock?
Decreased tissue perfusion
Aerobic -> anaerobic metabolism
Lactic acidosis
4 types of shock
Cardiogenic
Extra cardiac
Hypovolemic
Septic shock
2 requirements for clinical dx of shock
BP
What is cardiogenic shock
Shock post-MI
Patho for what MI causing shock that looks like:
- HIGH LV EDP
- Low CO
Large MI
- Stunned vs hibernation
Stunned - ischemic but now has O2 back
Hibernation - no return of O2 flow
Which drugs don’t you use for cardiogenic shock
Anything to decrease contractility or rate:
- BB
- Ca CB
- Class 1A
Treat cardiogenic shock
- Short term inotopes + pressors - maintain downstream organ perfusion
- Dopamine
- NE
- Dobutamine/milrinone - ASA or heparin for anti-thrombosis
- Mechanical
- Intra aortic balloon pump
- LVAD or ECMO
What does the intra aortic balloon pump do in systole vs diastole
Systole = balloon collapses Diastole = inflate, push low pressures in shock to make sure coronary arteries profusing
What type of MI causes shock that looks like:
- Normal or high LV EDP
- High RV edp
- Low CO
Inferior MI due to RV infarct
How do you treat RV infart
1. + Fluids You know this! Can't add fluid to any other RHF 2. Less afterload 3. Inotropes
EKG for RV infarct
ADD R sided leads!
What drug do you avoid in pts with RV failure
Nitroprusside
Don’t want to drop compensatory BF here
What cardiac pathology causes shock w/
- High LVEDP
- Low CO
- Systolic murmur
Structural abnormalities:
Mitral regurg
VSD
Diagnose LSV (vs MR)
SG cath
O2 sat between RA and RV no the same - higher in RV
Why does tamponade lead to low CO
Decreased filling
= obstructive // extracardiac shock
