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Flashcards in 850-IP8-Shock Deck (20)
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1
Q

SHOCK

A
  1. Systemic hypoperfusion caused by a reduction in cardiac output or blood volume
  2. Hypotension –> inadequate tissue perfusion –> cellular injury and dysfunction –> multiple organ failure
  3. 3 main types: Hypovolemic, Cardiogenic, Distributive
2
Q

HYPOVOLEMIC SHOCK:

A
  1. Decreased cardiac output due to inadequate blood or plasma volume - Common causes: hemorrhage, burns, trauma
  2. Presentation:
    - Thirst, nausea, anxiousness, weakness, light-headedness, dizziness, decreased urine output
    - Severe volume loss may result in tachycardia, elevated RR, hypotension, mental status changes/unconsciousness
3
Q

HYPOVOLEMIC SHOCK TREATMENT:

A
  • Non-pharmacologic: control of inciting event, surgery, fractures stabilization, control of blood loss, etc.
  • Pharmacologic: Fluids (crystalloids vs. colloids), blood products (packed red blood cells, FFP, platelets)
4
Q

Hypovolemic shock

Crystalloids fluids

A
  • Normal Saline (NS)
  • Lactated Ringers (LR)
  • 5% Dextrose in Water (D5W)
  • Hypertonic (3%) Saline
5
Q

Hypovolemic shock

Colloids fluids

A
  • Albumin
  • Hydroxyethyl starch
  • Dextrans
6
Q

Hypovolemic shock

Blood Products fluids

A
  • Packed red blood cells (pRBC)
  • Fresh frozen plasma (FFP)
  • Platelets
7
Q

Hypovolemic shock

Crystalloids considerations for use

A
  1. Preferred initial fluid
  2. Consider D5W for dehydration w/minor s/s of volume depletion
  3. Consider hypertonic saline (in addition to NS/LR) for head trauma; caution due to osmolarity, risk of cellular crenation and damage
8
Q

Hypovolemic shock

Colloids considerations for use

A
  1. Potential longer intravascular retention time vs. crystalloids
  2. No evidence of reduced mortality compared with crystalloids; benefits may exist with certain subsets of patients
  3. Hydroxyethyl starch: FDA warning for increased mortality, severe renal injury and risk of bleeding – do not use in critically ill patients
  4. Dextrans: increased risk of anaphylaxis, may aggravate bleeding, and cause renal dysfunction
9
Q

Hypovolemic shock

Blood Products considerations for use

A
  1. pRBC: increase the oxygen carrying capacity in the blood
  2. FFP: replacement of clotting factors
  3. Platelets: administer for thrombocytopenia
10
Q

CARDIOGENIC SHOCK:

A
  1. End-organ hypoperfusion due to cardiac failure (i.e. dysfunctional pump)
    - Common causes: myocardial ischemia, arrhythmia, outflow obstruction, mechanical abnormalities
    - Occurs in 5-8% of STEMI patients and 2.5% in NSTEMI
  2. Presentation:
    - AMS, pulmonary edema, hypotension, weak pulses, cool extremities, decreased urine output
  3. Diagnostic criteria:
    - Sustained hypotension (SBP<90) and a reduced CI (<2.2 l/min/m2) in the presence of elevated PCWP>18
11
Q

CARDIOGENIC SHOCK Treatment:

General Treatment

A
  1. Fluid resuscitation unless frank pulmonary edema is present (conservative 250-500 ml bolus) o Considerdiuresis(furosemide)forpulmonaryedema
  2. Correction of rhythm abnormalities or electrolyte (magnesium/potassium) disturbances
  3. Avoid beta-blockers and calcium channel blockers due to negative inotropic effects
  4. Individualized vasopressors therapy; use of dopamine may be associated with excess hazard
12
Q

CARDIOGENIC SHOCK Treatment:

For STEMI patients

A
  1. Emergent revascularization with either PCI or CABG if due to pump failure after STEMI
  2. Fibrinolytic therapy for patients who are unstable for PCI or CABG
  3. Intra-aortic balloon pump counterpulsation unstable patients after pharmacologic therapy (Class IIa)
  4. Alternative LV assist devices for circulatory support may be considered in refractory cardiogenic
    shock
13
Q

DISTRIBUTIVE SHOCK

A
  1. Excessive vasodilation resulting in impaired distribution of blood flow
  2. Common types:
    - Septic
    - Neurogenic
    - Anaphylactic
14
Q

Septic:

A

Excessive inflammation due to infectious source

15
Q

Neurogenic:

A

Not associated with blood loss, but rather a disruption of autonomic regulation in the spinal
cord resulting in decreased SVR and pooling of blood in the periphery

16
Q

Anaphylactic:

A

Marked arterial vasodilation

17
Q

SIRS:

A

-Causes of are multifactorial including ischemia, infection, pancreatitis, trauma, and burns

  • SIRS Criteria (presence of 2 of the following):
    1. Temperature >38.3°C or <36°C
    2. HR > 90 bpm
    3. RR>20ormechanicalventilation
    4. WBC>12,000 OR <4,000 OR >10% immature forms
18
Q

Sepsis:

A

SIRS due to infection

19
Q

Severe sepsis:

A
  1. Sepsis with sepsis induced organ dysfunction or tissue hypoperfusion
    - Evaluated by decreased urine output, elevated creatinine, coagulopathy, acute lung injury, etc.
20
Q

Septic shock:

A

Sepsis hypotension = hypotension persisting after initial fluid challenge or lactate ≥ 4 mmol/L