Exam 3 shock blueprint

Question 1

what is shock?

Answer 1

decreased perfusion (hypotension — decreased C.O. — organ failure — death

Question 2

what are the stages of shock?

Answer 2

initial
compensatory
progressive
irreversible

Question 3

not enough O2 in blood to perfuse organs; usually asymptomatic

Answer 3

initial stage of shock

Question 4

HR increases, RR increases, Renin and Angiotensin released to try to balance, organs begin to fail

Answer 4

compensatory stage of shock

Question 5

progressive poor perfusion leads to cold, clammy skin

Answer 5

progressive stage of shock

Question 6

death is imminent

Answer 6

irreversible stage of shock

Question 7

what are the types of shock?

Answer 7

neurogenic shock
hypovolemic shock
cardiogenic shock
anaphylactic shock

Question 8

what is neurogenic shock?

Answer 8

Disconnect between SNS and PNS causes the PNS to slow everything down w/o the SNS to balance

Bradycardia is unique to this bc of the dissociation

Skin is warm, pink, dry due to pooling of blood from massive vasodilation

Question 9

what is the hemodynamic phenomenon related to neurogenic shock?

Answer 9

loss of vasomotor tone and loss of sympathetic nervous system tone > impaired cellular metabolism

Question 10

what are the critical features of neurogenic shock?

Answer 10

Hypotension: due to massive vasodilation

Bradycardia: due to unopposed parasympathetic stimulation

Poikilothermia: unable to regulate temperature

Question 11

when does neurogenic shock occur?

Answer 11

within 30 M cord injury level T5 or above; last up to 6 weeks; also due to effect some drugs that effect vasomotor center of medulla as opioids, benzodiazepines

Question 12

what is the management for neurogenic shock?

Answer 12

Airway support

Fluids PRN: typically o.9 NS, rate depends upon need

Atropine for Bradycardia

Vasopressor as phenylephrine (neosynephrine for BP support)

Question 13

occurs when there is a loss in intravascular blood volume due to severe bleeding or fluid loss

Answer 13

hypovolemic shock

Question 14

what are the causes and S/S of hypovolemic shock?

Answer 14

Causes: vomiting, diarrhea, bleeding, and burns

S/S:
Cardiac: hypotension, tachycardia (rapid, weak and thready pulse)
Respiratory: rapid, shallow breathing
Skin: pale, cool/clammy
GU: oliguria
CNS: confusion, restless, anxiety

Question 15

what is the treatment for hypovolemic shock?

Answer 15

treat underlying cause of the severe bleeding or fluid loss. Fluid resuscitation, O2 therapy, blood transfusion if applicable. Patient position: supine with legs elevated.

Question 16

what is the priority treatment for hypovolemic shock?

Answer 16

Manage hemodynamics (Trendelenburg)

Fluid resuscitation before vasopressors

Dopamine and nor-epi (do not let nor-epi run out without a new bag ready to prevent refectory hypotension

Goals: MAP > 65 to keep organs alive (perfusion) and CVP 2-6

Question 17

what is cardiogenic shock?

Answer 17

Hypoxia and pulmonary inflammation induce pulmonary vasoconstriction, increasing biventricular afterload and myocardial O2 demand. The renal response to impaired glomerular perfusion increases tubular NA+ reabsorption and activation of the renin-angiotensin-aldosterone axis, resulting in further volume overload and compromised diuretic effectiveness.

Positive inotropes will increase pumping mechanism of heart muscle

Question 18

progressive cycles of inflammation, ischemia, vasoconstriction, and volume overload.

Answer 18

cardiogenic shock

Question 19

a serious allergic reaction that comes on quickly and has the potential to become life threatening. The most common reactions are to foods, venom, meds, and latex.

Answer 19

anaphylaxis

Question 20

what are key points to know about anaphylaxis?

Answer 20

Epi injection is always the 1st choice treatment

May repeat epi injection every 5-15M as long as reaction continues

Epi can lose its efficacy if not stored at room temperature

Epi pens should be used on the outer thigh, can be given through clothes, and should be held in place for 10 seconds once initiated

Immediate medical attention is needed once the person is stabilized.

Question 21

what is important to know about the MAP with shock?

Answer 21

MAP > 65 to keep organs alive (perfusion)