February 4, 2016 - Shock I Flashcards Preview

COURSE 3 > February 4, 2016 - Shock I > Flashcards

Flashcards in February 4, 2016 - Shock I Deck (13):
1

Categories of Shock

Hypovolemic

Cardiogenic

Obstructive

Distributive

2

Physiologic Components of Shock

Afterload

Rate

Rhythym

Preload

Blood content

Contractility

3

Hypovolemic Shock

The body does not have sufficient volume. Could be due to bleeding or dehydration.

The primary problem is preload.

Signs are a low JVP, cool extremities, and tachycardia.

4

Cardiogenic Shock

The heart can't pump enough blood to perfuse the tissues.

The primary problem is contractility.

Signs are an increased JVP, cool extremities, and tachycardia.

5

Distributive Shock

The blood is not distributed properly to the tissues. For example, in sepsis or anaphylaxis.

The primary problem is afterload.

Signs are warm extremities, and tachycardia.

6

Obstructive Shock

Complicated. The blood cannot get to certain areas. For example, in a pulmonary embolism or a tension pneumothorax.

The primary problem is contractility and preload.

Signs are elevated JVP, cool extremities, and tachycardia.

7

Shock and Organ Systems

Shock focuses primarily on five major organ systems.

 

Heart - hypotension, cardiac rate and rhythm

Lungs - tachypnea, hypoxemia

Kidneys - decreased urine output

CNS - decreased mentation

Skin - mottling and temperature

8

Adjusting Preload in Shock

Not enough preload, give fluids

Too much preload, give diuretics

9

Adjusting Rate in Shock

Too fast - usually need to treat the underlying cause. May need a rate-controlling agent or cardioversion.

Too slow - give atropine, epinephrine, or pacing.

10

Adjusting Rhythm in Shock

Anything other than sinus rhythm is usually a problem.

Consider chemical or electrical cardioversion.

11

Adjusting Contractility in Shock

Can be assessed with echocardiography.

If inadequate contractility, inotropes can be given. Also want to optimize oxygen delivery to the myocardium and correct any metabolic derangements.

12

Adjusting Afterload in Shock

Too much - give vasodilators

Too little - give vasoconstrictors

13

Adjusting Blood Content in Shock

The biggest bang for your buck is cardiac output. If you double cardiac output, you double oxygen delivery to the tissues.

Therefore, optimizing CO should take precedent over optimizing PaO2

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