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SHOCK Flashcards

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1
Q

What is shock?

A

When there is a drop in BP, tissues aren’t profused enough, cells shift to anaerobic respiration, and cells eventually die

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2
Q

What is the 1st stage of shock?

A

Cold shock (body vasoconstricts)

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3
Q

primary cause of death in those within 24hrs of septic shock?

A

Multi organ failure due to neutrophils circulating to other organs during reprofusion

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4
Q

2 main SS of ALL SHOCK THAT YOU MUST KNOW

A

1. CHANGE IN MENTAL STATUS
2. HYPOTNESION
3. HR >90 (not on BB)
4. RR > 20
5. Early shock -> Warm extrem with bounding pulses and incr pulse pressure (SBP - DBP)
6. Late shock -> COLD extrem
7. Hyperthermia >101F
8. Hypothermia <96.8F
9. Pulse Ox -> relative hypoxemia
10. Decr urine output
11. SS of underyling ET (infx, anaphylaxis, stroke)

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5
Q

4 types of shock

A
  1. Distributive (Vasodilation)
  2. Hypovolemic (Intravascular volume loss)
  3. Obstructive (Physical obstruction of blood)
  4. Cardiogenic (Pump failure)
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6
Q

MC type of shock

A

Distrubitive shock (vasodilation)

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7
Q

Distributive shock:
Definition and Types

A

Anything that causes vessel hyperpermeability
* Septic shock (MC)
* Toxic Shock
* Systemic inflammatory response syndrome (SIRS)
* Anaphylactic Shock
* Adrenal Insufficiency
* Neurogenic Shock

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8
Q

What is the MC type of distributive shock?

A

Septic shock

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9
Q

Can a person be in septic shock if their extremities feel warm?

A

YES
Early shock -> WARM
Late shock -> COLD

At first, the body starts to peripherally vasodilate in hopes of incr CO, so the extremities are full of blood and are very warm. Late shock is cold due to the system getting worse until it eventually fails

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10
Q

Distributive Shock

MC sites for infx in septic shock

A

Chest
Abd
UTI??????? Idk

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11
Q

Distributive Shock

MC bac in septic shock infx

A

G-
G+
MDR Strains

MDR = Multi-drug resistant?

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12
Q

Distributive shock

Is the cognitive impairement from septic shock permanent?

A

Sometimes
At 1 yr follow up, 70% still have cognitive impairment, 1/3 severly

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13
Q

Which organ is affected the most from Multi Organ Dysfn Syndrome (MODS) due to septic shock

A
  • Lungs are affected the most, increasing alveolar permeability and flooding the lungs -> ARDS
  • If kidney perfusion is decreased -> Acute Tubular Necrosis and you will see dramatic increase in Creatinine and oliguria (peeing less and less)
  • If decreased perfusion to heart -> MI or arrhythmias, reduce CO
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14
Q

These are alternative causes of ____ shock

  • Systemic Inflammatory Response Syndrome
  • Toxic Shock Syndrome
  • Adrenal Insufficiency

on test

A

Distributive Shock

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15
Q

Alternative Causes of Distributive Shock

Causes of Systemic Inflammatory Response Syndrome (SIRS)

A

Infx
Burns
Sx
Trauma
Pancreatitis
Fulminant liver failure

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16
Q

Alternative Causes of Distributive Shock

Causes of Adrenal Insufficiency

A

Adrenal destruction (AIDS, TB, Tumor)
HPA axis suppresion by steroid >20mg QD
Hypopituitarism
Drug induced (Ketaconazole)

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17
Q

Distributive shock

Toxic shock syndrome is due to which bacteria

A

Streptococcus pyogenes(Grp AStrep)
or
Staphylococcus aureus

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18
Q

fatigue, HA, confusion, fever, conjunctivitis, ST, vomiting, red skin, watery diarrhea, 3rd-7th day sloughing of epidermis on palms and soles. Within 48 hours of sxs beginning, hypotension, syncope and then shock.

A

Toxic Shock Syndrome

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19
Q

Distributive Shock

Toxic shock syndrome Trmnt

A
  1. remove object
  2. IVF (10-15L/d)
  3. ABX for Grp A Strep & Straph (pick 1):
    * Clindamycin
    * 1st gen Cephalosporin
    * Vancomycin
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20
Q

Distributive Shock

How many L of IV Fluids do you give a pt with toxic shock syndrome each day?

A

10-15L / day

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21
Q

Distributive Shock

What does Anaphylaxis do to your vasculature?

A

Massive histamine mast cells and IgE response, results in decreased peripheral vascular resistance -> vasodilation

This is why we want Epi, which Vasoconstricts!

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22
Q

Distributive Shock

Anaphylaxis SHOCK Trmnt

A
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23
Q

Distributive Shock

Neurogenic Shock

A

Loss of sympathetic vascular tone from severe injury to the nervous system
* CVA
* TBI
* Spindal cord injury

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24
Q

Distributive Shock WU

Study These Flashcards
A
  • Gluc POC (Goal: 150-180)
  • CBC W/Diff
  • UA + Cultures
  • CMP (e-, BUN/Creatinine)
  • Liver enzymes +/- Amylase/Lipase
  • PT/INR
  • Blood Cultures
  • ABG
  • Serum lactate (esp if metabolic acidosis or high anion gap)
  • ECG
  • CXR

When cells are low on O2, they resort to anaerobic resp. This produces lactic acid -> HIGH serum lactate

25
Distributive Shock Trmnt
* Treat underlying ET ASAP * Fluid **Resuscitation** ~ 6hrs * Transfuse pRBC to a goal of HCT 30, Hgb 10 * **Vasopressors: Dobutamine or NorEpi** ## Footnote If HypoTN continues -> 2nd Line **Vasopressin** (risk of acidosis/MI)
26
Empiric ABX are only for what type of distributive shock?
Septic Shock
27
MC recommended empiric ABX for Septic Shock?
Ceftriaxone (3rd gen Cephalosporin) | aka Rocephin
28
Empiric ABX for Septic Shock involving abd sepsis, aspiration pneumonia, pelvic infx, or necrotizing cellulitis
3rd gen Cephalosporin or Metronidazole
29
Empiric ABX for Septic Shock due to Meningitis
Ceftriaxone + Vancomycin
30
What does the body do to compensate for fluid loss?
Pulls water from its extravascular reserves (interstitium & cells) and puts it into the vascularture to maintain BP at expense of body water
31
Use IVF ______ for acute brain injury - 0.9% NS? - Lactated Ringers?
**0.9% NS** for acute brain injury over LR It keeps water intravascular, as opposed to intracellular, reducing brain swelling
32
Use IVF ____ for shock & large volumes
Lactated ringers ## Footnote Has less Cl- than Saline & is less likely to cause acidosis
33
Use IVF ____ for volume replacement during major hemorrhage
Albumin (Colloid)
34
Use IVF ____ for volume replacement during major hemorrhage
Albumin (Colloid)
35
Hyperchloremic Acidosis is a ______ acidosis
Non-anion gap
36
if a pt is at risk of severe blood loss, transfuse 1 unit of pRBCs within ___min | packed RBCs = pRBCs
5
37
If in shock: adults tolerate ____L at max infusion rate, and then reassess
1
38
Children in shock need ____mL/kg
5-20
39
Most children with intravascular volume depletion (w/o shock) can tolerate ____mL/hr
500
40
Children receive half their daily fluid requirements by weight in first _____hours
8
41
Children should receive fluids up to a **MAX OF _____mL DAILY**
**2400**
42
Urine output of >_______mL/kg/hour = they’re hydrated!
0.5 to 1
43
in traumatic shock, try to get the SBP > ____
80 ## Footnote 80-90 SBP is okay
44
Pt is severely bleeding and requires >6 units pRBCs. What also needs to be given?
**Platelets and FFP** should be administered **WITH** blood products, **1 unit of each for each unit of pRBCs** Blood must be warmed if giving >2 units ## Footnote Rules >6 units pRBCs require Platelets and FFP (1:1 unit ratio) Give together Warm up the blood if giving >2 units (avoid hypothermia)
45
What is FFP?
Fresh Frozen Plasma
46
Stable patients w/o CAD or CVD req blood transfusions if Hgb <____g. Stop transfusing once Hgb is at least _____g
7 & 8
47
Pts with CAD, CVD, or Active Bleed req blood transfusions if Hgb <____g. Stop transfusing once Hgb is at least ___g
10 & 10 ## Footnote These pts are higher risk & therefore, req more blood vol
48
is **_HIGH_ or _VERY LOW_ dose Dopamine** a ***Vasoconstrictor***?
**HIGH Dose Dopamine** Inotrope (heart beats harder) Vasoconstricter
49
# Norepinephrine (Levophed) Chronotrope or Inotrope? Vasoconstrictor or Vasodilator?
Intrope Vasoconstrictor
50
# Vasopressin Vasodilater or vasoconstricter? Inotrope?
**Vasoconstricter** ## Footnote **NOT** and inotrope or vasodilator
51
Hypovolemic Shock
A critical decrease in intravascular volume Diminished venous return (preload)→decreased ventricular filling and reduced stroke volume.→Unless compensated for by increased heart rate, cardiac output decreases.
52
Common causes of hypovolemic shock?
1. **Bleeding due to: Trauma, Sx, GI bleed, Ruptured Aortic Aneurysm** 2. Incr losses of bodily fluids other than blood 3. Inadequate fluid intake
53
Ways you can lose fluid (aside from bleeding out)
54
Trmnt for hypovolemic shock
* Restore fluid loss (IVF if fluid loss, transfuse if blood or plasma loss * Correct cause (beeding, etc)
55
Obstructive shock
Mechanical factors that interfere with filling or emptying of the heart or great vessels
56
Main causes of Obstructive shock?
Tension Pneumo, Cardiac Tamponade Pulmonary Embolism
57
Cardiogenic Shock: What is it? Causes?
Reduction in CO due to primary heart problem
58
Cardiogenic Shock Trmnt

Emergency Medicine (11 decks)

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