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COMAT: Surgery > Shock > Flashcards

Shock Flashcards

1
Q

what is the definition of shock?

A

inadequate tissue perfusion

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2
Q

what are the different types of shock?

A
  • hypovolemic
  • septic
  • cardiogenic
  • neurogenic
  • anaphylactic
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3
Q

what are the signs of shock?

A
  • pale, diaphoretic, cool skin
  • hypotension, tachycardia, tachypnea
  • decreased mental status and pulse pressure
  • poor capillary refill
  • poor urine output
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4
Q

what are the best indicators of tissue perfusion?

A

urine output, mental status

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5
Q

what lab tests help assess tissue perfusion?

A

lactic acid - elevated with inadequate tissue perfusion
base deficit
pH from ABG - acidosis assoc with inadequate tissue perfusion

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6
Q

what is hypovolemic shock?

A

decreased intravascular volume

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7
Q

what are the common causes of hypovolemic shock?

A 
hemorrhage
burns
bowel obstruction
crush injury
pancreatitis
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8
Q

what are the early signs of hypovolemic shock

A

orthostatic hypotension, mild tachycardia, anxiety, diaphoresis, vasoconstriction (decreased pulse pressure with increased diastolic pressure)

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9
Q

what are the late signs of hypovolemic shock?

A

changed mental status, decreased BP, marked tachycardia

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10
Q

what is the treatment of hypovolemic shock?

A

stop the bleeding

volume: IVF (isotonic LR) then blood products PRN

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11
Q

why does decreased pulse pressure occur with early hypovolemic shock?

A

pulse pressure decreases because of vasoconstriction, resulting in elevated diastolic BP

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12
Q

what is the most common vital sign change associated with early hypovolemic shock?

A

tachycardia

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13
Q

what type of patient does not mount a normal tachycardia response to hypovolemic shock?

A

patients on ß blockers, spinal shock, endurance athletes

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14
Q

should vasopressors be used to treat hypovolemic shock?

A

no

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15
Q

what is septic shock?

A

documented infection and hypotension

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16
Q

what are the signs/symptoms of septic shock?

A 
initial:
- vasodilation, resulting in warm skin and full pulses
- normal urine output
delayed:
- vasoconstriction and poor urine output
- mental status changes
- hypotension
17
Q

what are the associated findings with septic shock?

A

fever, hyperventilation, tachycardia

18
Q

what is the treatment of septic shock?

A
  • volume (IVF)
  • antibiotics (empiric, then by cultures)
  • drainage of infection
  • pressers PRN
19
Q

what is cardiogenic shock?

A

cardiac insufficiency, left ventricular failure (usually), resulting in inadequate tissue perfusion

20
Q

what are the causes of cardiogenic shock?

A

MI, papillary muscle dysfunction, massive cardiac contusion, cardiac tamponade, tension pneumothorax, cardiac valve failure

21
Q

what is neurogenic shock?

A

inadequate tissue perfusion from loss of sympathetic vasoconstrictive tone

22
Q

what are the common causes of neurogenic shock?

A

spinal cord injury:

  • complete transection of the spinal cord
  • partial cord injury with spinal shock
  • spinal anesthesia
23
Q

what are the signs/symptoms of neurogenic shock?

A

hypotension and bradycardia, neurologic deficit

24
Q

why are heart rate and BP decreased?

A

loss of sympathetic tone (but hypovolemia must be ruled out)

25
Q

what are the associated findings with neurogenic shock?

A

neurologic deficits suggesting cord injury

26
Q

what must be ruled out in any patient where neurogenic shock is suspected?

A

hemorrhagic shock

27
Q

what is the treatment of neurogenic shock?

A

IV fluids

28
Q

what is spinal shock?

A

complete flaccid paralysis immediately following spinal cord injury
may or may not be associated with circulatory shock

29
Q

what is the lowest reflex available to the examiner of neurogenic shock?

A

bulbocavernous reflex: checking for contraction of the anal sphincter upon compression of the glans penis or clitoris

30
Q

what is the lowest level voluntary muscle for neurogenic shock?

A

external anal sphincter

31
Q

what are the classic findings associated with neurogenic shock?

A

hypotension, bradycardia or lack of compensatory tachycardia

32
Q

what is the acronym for treatment options for anaphylactic shock?

A

BASE

  • benadryl
  • aminophylline
  • steroids
  • epinephrine

COMAT: Surgery (17 decks)

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