L4: Shock Flashcards
1
Q
Def of Shock
A
2
Q
Pathophysiology of Shock
A
3
Q
Compensatory Mechanisms in Shock
A
4
Q
Stages of Shock
A
5
Q
Stages of Shock
- BP
- Blood Flow
- Vital Organs Function
A
6
Q
CP of Shock
A
7
Q
CP of Shock
- Vital Organs
A
8
Q
CP of Shock
- Pulse
A
9
Q
CP of Shock
- RR
A
10
Q
CP of Shock
- BP
A
11
Q
CP of Shock
- Skin
A
12
Q
CP of Shock
- CRT
A
13
Q
CP of Shock
- Level of Consciousness
A
14
Q
- Early diagnosis requires a high index of suspicion.
- Diagnosis is made through the physical examination focused on tissue perfusion.
- Hypotension is a late & pre-morbid sign.
A
…
15
Q
Early Signs of Shock
A
16
Q
Late signs of shock
A
17
Q
Initial evaluation of shock
A
18
Q
Classification of Shock
A
19
Q
Incidence of Hypovolemic Shock
A
- Most common form of shock world-wide
20
Q
Etiology of Hypovolemic Shock
A
21
Q
CP of Hypovolemic Shock
A
22
Q
TTT of Hypovolemic Shock
A
23
Q
Septic Shock
A
24
Q
Charaters of Warm Septic Shock
A
◈ Early
◈ Compensated
◈ Hyperdynamic state
25
**Warm Septic Shock**
- Clinical Signs
26
**Warm Septic Shock**
- Physiological
27
**Warm Septic Shock**
- INVx
- Hypocarbia – elevated lactate
- Hyperglycemia
28
**Warm Septic Shock**
- TTT
29
**Cold Septic Shock**
30
**Cold Septic Shock**
- Charcaters
◈ Late
◈ Uncompensated
◈ Drop in cardiac output
31
**Cold Septic Shock**
- Clinical Signs
32
**Cold Septic Shock**
- Physiological
33
**Cold Septic Shock**
- INVx
- Hypoxia – metabolic acidosis
- Hypoglycemia
- Coagulopathy
34
**Cold Septic Shock**
- TTT
35
Etiology of **Cardiogenic Shock**
36
CP of **Cardiogenic Shock**
37
TTT of **Cardiogenic Shock**
38
Mechanism of **Distributive shock**
39
Etiology of **Distributive shock**
◈ Anaphylaxis
◈ Early sepsis “warm shock”
◈ Drugs
◈ Neurogenic injury
40
Signs of **Distributive shock**
⇡⇡ COP & ⇣⇣ SVR
41
TTT of **Distributive shock**
◈ TTT of the cause
◈ ABC & fluid
◈ Inotropic: to ⇡⇡ SVR
42
Mechanism of **Obstructive Shock**
Mechanical obstruction to ventricular outflow
43
Etiology of **Obstructive Shock**
◈ Aortic stenosis
◈ Aortic coarctation
◈ Cardiac tamponade
◈ Tension pneumothorax
◈ Hypoplastic left heart syndrome
44
Signs of ****Obstructive Shock****
⇣⇣ COP & ⇡⇡ SVR
45
TTT of **Obstructive Shock**
◈ TTT of the cause
◈ Pericardial drain
◈ Chest tube
◈ Surgical intervention
◈ If neonate with ductal dependent lesion ⇢ Prostaglandin E (PGE)
46
Management of **Shock**
- Goals
47
Management of **Shock**
- Lines
48
Each additional hour of persistent shock was associated with
- > 2 folds increased probability of mortality
....
49
Management of **Shock**
- Airway and Breathing
50
Management of **Shock**
- Indications of ETT
51
Management of **Shock**
- Circulation
52
Management of **Shock**
- Cardiotonics
53
Management of **Shock**
- Indicatiosn of Cardiotonics
① Possible cardiogenic or obstructive shock
② Distributive shock
③ Failure to respond to proper volume expansion
54
Management of **Shock**
- Examples of Cardiotonics
◈ Dopamine ◈ Dobutamine
◈ Epinephrine ◈ Nor-epinephrine
◈ Milrinone ◈ Phenylephrine
55
Management of **Shock**
- Route of Cardiotonics
All cardiotonic drugs need to be administered through a central line.
56
Management of **Shock**
- Doses of Cardiotonics
57
Management of **Shock**
- Supportive Therapy
58
Therapeutic end points of resuscitation of shock
59
Signs of multiple organ failure
60
Signs of multiple organ failure
- CVS
61
Signs of multiple organ failure
- RESP
62
Signs of multiple organ failure
- CNS
63
Signs of multiple organ failure
- Heme
64
Signs of multiple organ failure
- Renal
65
Signs of multiple organ failure
- Liver
