Exam 2 SHOCK Flashcards Preview

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Flashcards in Exam 2 SHOCK Deck (29):
1

Shock is?

Inadequate tissue perfusion:
Not enough O2 delivered to tissues to meet demand

2

Shock results in?

Acidosis from anaerobic metabolism ->
hypoTN

3

Direct determinants of Shock are?

CO
O2 saturation
Hgb levels

4

What is NOT a direct determinant of Shock?

BP

5

O2 delivery (DO2) is a direct fxn of what?

DO2 = CO x CaO2

CaO2 = arterial gas content

6

Direct determinants of BP are?

CO
Preload
Peripheral vascular resistance

7

What is NOT a direct determinant of BP?

O2 sat

8

Shock presentation? (4)

1) Tachycard
2) Tachypnea
3) +/- hypoTN
4) Sxs of ↓ end organ perfusion:
∆ mental status
↓ urine
Lactic acidosis
Cool/mottled extremities
Thready pulse

9

Methods of ↑ DO2 (supply)? (2)

Maximize CO:
Pre/After loads
Contractility
HR

Maximize CaO2:
Hct
Supplement O2

10

Methods of ↓ VO2 (demand)? (3)

Treat fever
Support respiratory effort
Sedation/Pain control

11

Causes of Shock: Cardiogenic? (3)

↓ cardio fxn
Arrhy
Obstruction

12

Causes of Shock: Hypovolemic? (6)

Hemorrhage
Over-diuresis (DM, DI)
D/V
Dehydration
DKA
Burns

13

Causes of Shock: Septic?

Exaggerated response to Infection

14

Hypovol Shock: Compensation mechanisms?

GOAL is to maintain CO

Barorecept-mediated vasoconstriction:

↑ Epi/Renin/ADH ->
Tachycard
Tachypnea
Narrowed pulse pressure
↓ urine output

15

Hypovol Shock from Hemorrage: Compensated/Non-Progressive is?

Body's response?

< 20% loss

BP maintained w/ vasoconstriction, ↑ flow to vital organs

CO maintained w/ ↑ stroke vol, slight ↑HR

16

Hypovol Shock from Hemorrage: Non-Compensated/Progressive is?

Body's response?

20 - 40% loss

↓ vol = inadequate preload, too low to overcome w/ ↑ contractility and CO

SNS/Neurohormonal response inadequate to overcome w/ ↑ vasoconstriction

= acidosis, mental ∆s, ↓↓ urine output

17

Hypovol Shock from Hemorrage: Profound/Irreversible is?

Body's response?

> 40% loss

↓↓ or no BP
↑↑ tachy
Lethargic

18

Cardiogenic Shock hypoTN BP?

< 90/60

19

Septic Shock results in? (3)

Circulatory collapse
Multi organ fail
Death (>35% w/ hypoTN, 45% w/ sustained)

20

Septic Shock: Body's response

Preload?

CO?

Afterload?

BP?

Organ Perfusion?

Preload: ↓

CO: ↑ (opp of vol/card shock)

Afterload: ↓ (opp of vol/card shock)

BP: ↓

Organ Perfusion: ↓

21

Systemic Inflamm Response Synd (SIRS) is? (4)

response to severe clinical insults:
1) ↑ or ↓ temp
2) HR > 90 bpm
3) Resp > 20 bpm or PaCO2 < 32 mmHg
4) WBC > 12k or < 4k or >10% band

22

Sepsis definition?

Severe Sepsis definition?

Septic Shock definition?

Systemic response to infection PLUS ≥ 2 SIRS

Sepsis w/ organ dysfxn, hypoTN or hypoperfusion

Sepsis-induced hypoTN despite adequate resuscitation

23

Sepsis General Variables? (7)

Fever > 100.1
Hypothermia < 96.8
HR > 90
Tachypnea
∆ mental state
Significant edema
Hyperglycemia w/o DM

24

Sepsis Inflamm Variables? (4)

Leukocytosis > 12k
Leukopenia < 4k
N count w/ > 10% band cells
Plasma C-react Protein or Procalcitionin

25

Sepsis Hemodynamic Variables? (3)

Arterial hypoTN w/
SBP < 90
MAP < 70
or SBP ↓ > 40

26

Sepsis Organ Dysfxn Variables? (7)

Arterial hypoxemia
Acute oliguria
Cr ↑
Coag
Ileus
Thrombocytopenia
Hyperbilirubinemia

27

Sepsis Tissue Perfusion Variables? (2)

Lactic acidosis/Metabolic acidosis
↓ cap refill

28

Multi System Organ Failure includes:

Hepatic?

Renal?

Pulmonary?

Cardiac?

Neuro?

Other?

Hepatic: Transaminitis, ↑ bilirubin, ↓ ablumin, coag, NH4

Renal: Acute tubular necrosis, olig/anuria, uremia

Pulmon: ARDS, infection

Card: arrhy, myocard depression

Neuro: mental status -> coma

Other: coag, immune

29

Hyperdynamic vs Hypodynamic Septic Shock?

Both: hypoTN, tachycard, tachyp

Hyper: bounding pulse, warm and well perfused extremities, flushed and moist skin

Hypo: thready pulse, cold and poor perfused extrem, pale and dry skin