Shock

Question 1

shock

Answer 1

failure of the circulatory system to maintain adequate perfusion of vital organs

Question 2

what occurs when there is a buildup of wastes?

Answer 2

the body switches from aerobic to anaerobic metabolism

Question 3

how do we treat shock in general?

Answer 3

it is cause specific

Question 4

cardiovascular system parts

Answer 4

1. pump (heart)
2. set of pipes (blood vessels and arteries)
3. contents (blood)

Question 5

what are the types of shock and which part of the cardiovascular system do they correlate with?

Answer 5

pump (heart) = cardiogenic
pipes (blood vessels and arteries) = circulatory
contents (blood) = hypovolemic

Question 6

what are the 3 subcategories of shock under circulatory shock?

Answer 6

septic, neurogenic, anaphylactic

Question 7

what is the most common type of shock?

Answer 7

hypovolemic

Question 8

what is the most common form of cardiogenic shock?

Answer 8

MI

Question 9

what is normal MAP?

Answer 9

70-105 mmHG

Question 10

what value of MAP must we obtain and why?

Answer 10

> = 65mm Hg for perfusion

Question 11

how do we calculate MAP?

Answer 11

    3

Question 12

what do we assess with pulse pressure?

Answer 12

narrowing

Question 13

what are cellular changes that occur during shock?

Answer 13

• anaerobic metabolism
• inc cell perm = influx of Na + H20, efflux of K+
• mitochondrial damage leading to death

Question 14

what are assessments and interventions we perform when a pt is entering shock?

Answer 14

• apply O2 d/t dec perfusion
• check perfusion: cap refill, colour, LOC (is it altered)
• RR (is it slowing down?)

Question 15

what is the first change we see with our pt if they may be entering shock?

Answer 15

a change in LOC - may be irritated, annoyed, agitated, sharp

Question 16

what are the systemic effects of shock in relation to the cardiovascular system?

Answer 16

• myocardial deterioration
• DIC
• vasoconstriction
• release of lysosomal enzymes

Question 17

lysosomal enzymes

Answer 17

• vasoactive substances
• catecholamine: epinephrine, dopamine
• histamine
• vasoactive polypeptides (bradykinin, angiotensin)

Question 18

MODS

Answer 18

• phase of progression of shock by any cause

- altered organ fx that requires medical intervention to support continued organ fx

Question 19

how does MODS progress?

Answer 19

usually starts in lungs, followed by cardiac instability

then progresses to hepatic, GI, renal, immunologic and CNS

Question 20

mortality rate of MODS

Answer 20

high - one organ = 20% mortality rate, 4 or more organs = 70% mortality rate

Question 21

who is at increased risk for MODS?

Answer 21

elderly, people with comorbidities, malnutrition, surgical or trauma wounds

Question 22

hypovolemic shock

Answer 22

• internal or external loss of circulating volume
• blocked venous return
• organ hypoperfusion
• stages of compensation

Question 23

management of hypovolemic shock

Answer 23

early recognition, stop and replace losses if indicated

• treat underlying cause
• blood loss, fluid shifts, dehydration, ascites or edema
• fluid and blood replacement
• fluid redistribution
• meds depending on underlying cause

Question 24

crystalloids

Answer 24

• electrolyte solutions that move easily between intravascular and interstitial spaces
• can be given without altering [ ] of plasma e-

ie) NS, LR 3%
- 3:1 crystalloid to blood ratio

Question 25

colloids

Answer 25

• large molecule IV solutions
• generally plasma proteins
• expand intravascular volume by exerting oncotic pressure
  ie) albumin and synthetics

Question 26

positioning for a pt in shock

Answer 26

modified trendelenburg position