General principles Flashcards
Four classifications of shock
Hypovolemic, Cardiogenic, Distributive, Obstructive
Types of hypovolemic shock
Hemorrhagic, Nonhemorrhagic
Types of cardiogenic shock
Myopathic (ischemia), Mechanical (valvular), Arrhythmic
Types of distributive shock
Septic, adrenal crisis, neurogenic (spinal shock), anaphylactic
Types of obstructive shock
Massive PE, tension pneumothorax, cardiac tamponade, constrictive pericarditis
Hemodynamics of hypovolemic shock
Decreased CO, right and left ventricular filling pressures (preload), increased after load (SVR). SVO2 or SCVO2 is decreased because of decreased CO and increased tissue O2 demands. Look for flat, non distended jugular veins.
Hemodynamics of distributive shock
Normal or increased CO with low SVR, low to normal ventricular filling pressures, increased pulse pressure, normal or increased SVO2 or SCVO2.
Hemodynamics of cardiogenic shock
Decreased CO, elevated ventricular filling pressures, increased after load (SVR) and decreased SvO2 or ScvO2. Look for JVD, pulmonary edema and S3 gallop.
What type of MI is more likely to lead to cardiogenic shock?
Anterior MI
Why might you hear an S3 in cardiogenic shock?
Rapid ventricular filling or poor LV function
Hemodynamics of obstructive shock
Decreased CO, increased after load, variable LV filling pressures, depending on etiology. Look for JVD as a clue.
What is pulsus paradoxus?
A drop in >10mm Hg in systolic BP during inspiration.
Three major components of shock management
Blood pressure, cardiac output, oxygenation
Blood pressure interventions
Fluids, vasopressor or vasodilator agents
Cardiac output interventions
Fluids, vasodilator agents, vasopressor agents, inotropes
