Shock

Question 1

what will happen to O2 supply and demand during shock

Answer 1

• decreased supply and increased demand
• leads to cell death and end organ failure

Question 2

what is cardiogenic shock

Answer 2

• state when the heart can no longer pump blood forward

Question 3

left side disfunction of ventricles for cariogenic shock show

Answer 3

• pulmonary edema
• increased preload and after load

Question 4

right side dysfunction ventricles

Answer 4

• JVD distention
• peripheral edema
• increased preload and after load
• decreased CO and SV

Question 5

systolic dysfunction

Answer 5

• ineffective forward movement of blood

Question 6

diastolic dysfunction

Answer 6

• ineffective filling
• increased pulmonary pressures (edema)

Question 7

hypoxemia is shown by

Answer 7

lowered PaO2 levels

Question 8

PaO2 levels are:

Answer 8

80-100
- after age 60 you minus 1

Question 9

pH levels are:

Answer 9

• 7.35-7.45 (7.4 being median)
• if within normal limits if pH is below 7.4 then its more acidic and above more basic

Question 10

PaCO2 levels are:

Answer 10

• 35-45
• under 35 is basic and over 45 is acidic

Question 11

what can cause respiratory acidosis

Answer 11

• COPD, over sedation, head trauma

Question 12

what can cause respiratory alkalosis

Answer 12

• hypoxia, anxiety, PE

Question 13

Normal HCO3 levels

Answer 13

• 22-26

Question 14

what causes metabolic acidosis

Answer 14

• ketoacidosis
• lactic acid
• renal failure
• diarrhea

Question 15

what causes metabolic alkalosis

Answer 15

• fluid loss from GI
• diuretic therapy
• severe hypokalemia (HCO3 gets reabsorbed in kidneys)

Question 16

common signs and symptoms of cariogenic shock

Answer 16

• tachypnea
• hypotension
• high HR
• decreased urine output
• chest pain (angina)
• eat thready pulse
• pale, cool skin

Question 17

lab results to look for when cariogenic shock starts

Answer 17

• troponin increases
• BNP and BUN increases
• decreased urine Na
• decreased PaCO2 (alkalosis)

Question 18

signs and symptoms when left ventricle fails and we see pulmonary edema:

Answer 18

• crackles
• hypoxemia (low PaO2)
• hear S3 and S4
• JVD
• dysrhythmias

Question 19

signs and symptoms for what happens when compensatory mechanism no longer work during cardiogenic shock (7)

Answer 19

• increased HR
• dysrythmias
• chest pain
• respiratory distress
• respiratory and metabolic acidosis and hypoxemia (increased PaCO2, decreased PaO2 and HCO3)
• renal failure (increased BUN and creation)
• decreased LOC (drop in cerebral perfusion pressure)

Question 20

pharmacological management for cariogenic shock:

Answer 20

• inotropic agents to increase contractility (dobutamine)
• vasopressors to increase BP (norepinephrine)
• diuretics to decrease preload (lasix)
• antidysrhythmics (amiodarone)

Question 21

what does inotropic medication do (dobutamine)

Answer 21

• stimulates beta-1 adrenergic
• increase myocardial contractility
• decrease LV pressure
• increases CO without greatly affecting HR

Question 22

what does vasopressors do (norepinephrine)?

Answer 22

• increases BP and CO

Question 23

what does lasix do for cariogenic shock

Answer 23

• inhibits reabsorption of Na and Cl
• decreases BP but won’t if used with vassopressures

Question 24

what are non-pharmacological agents for cariogenic shock

Answer 24

• support ventilation and oxygenation (keep PaO2 above 80)
• support contractility (intraaortic balloon pump)

Question 25

what is the pathophysiology of hypovolemic shock

Answer 25

- decreased circulation volume - decreased preload, SV, CO, - vasoconstriction to fix low BP - increased after load) - decreased oxygen perfusion and volume supply to organs and tissues

Question 26

what is absolute hypovolemia

Answer 26

- volume lost from the body - vomiting, diarrhea - hemmorage - diabetes - hyperglycaemia - over use of diuretics (diuresis)

Question 27

what is relative hypovolemic shock

Answer 27

- no loss of volume leaving the body - move from intravascular space to extravascular space (third spacing) - vasodilation

Question 28

class 1/mild hypovolemic shock signs and symptoms (15-20%/ 750mL)

Answer 28

- compensatory mechanisms maintain CO - mild anxiety - free of symptoms - as volume loss increases (vasoconstriction, cool extremities, increased cap refill)

Question 29

class II/moderate hypovolemic shock signs and symptoms (15-30%/ 750-1500mL)

Answer 29

- decrease CO (more use of comensatory) - high HR - increased RR (respiratory alkalosis) - postural hypotension - decreased urine output (20-30 mL/h

Question 30

class III/moderate hypovolemic shock (30-40% or 1500-2000mL)

Answer 30

- compensatory mechanisms begin to fail - decreased BP - high HR - dysrhythmias - ABG = increased lactate, decreased HCO3 (acidic) - increased BUN and creation

Question 31

class IV/severe hypovolemic shock signs and symptoms (greater than 40%) (8)

Answer 31

- no tissue perfusion - tachycardia - hypotension - severe lactic acidosis - absent peripheral pulses - cyanotic, severe diaphoresis - organ failure - no Urine output

Question 32

management of hypovolemic shock

Answer 32

- control active blood or volume loss - initial volume loading - vasopressors

Question 33

crystalloid use for hypovolemic shock

Answer 33

- volume expanders - isotonic or hypertonic - molecules easily enter extravascular space - increase preload and SV, CO

Question 34

colloid solution for hypovolemic shock

Answer 34

- volume expanders - isotonic or hypertonic - large molecules can't enter extravascular space

Question 35

blood products for hypovolemic shock

Answer 35

- RBC - increase oxygen carrying capacity - platelets - bleeding due to low platelet count - frozen plasma - deficient in coagulation factors

Question 36

Pathophysiology of septic shock

Answer 36

- Vasodilation (low BP, low preload, low afterload, low CO - decreased tissue perfusion - inflammation in the blood stream

Question 37

SIRS

Answer 37

- systemic inflammatory response system - temp above 38 or less than 36 - HR above 90 - RR above 20 and or PaCO2 less than 32 - WBC - greater than 12000 or less than 4000 (bacteria winning battle)

Question 38

SIRS

Answer 38

- systemic inflammatory response system - temp above 38 or less than 36 - HR above 90 - RR above 20 and or PaCO2 less than 32 - WBC - greater than 12000 or less than 4000 (bacteria winning battle)

Question 39

Antibiotics for septic shock management

Answer 39

- start broad then go narrow once we know what to fight off

Question 40

Antibiotics for septic shock management

Answer 40

- start broad then go narrow once we know what to fight off

Question 41

What are the different managements for septic shock

Answer 41

- aggressive fluid resuscitation (increase volume in vasculature) - antibiotics - vasopressors (increase BP) - inotropes (dobutamine) - increase CO and has little effect on HR - anticoagulants (assess INR before giving) - control blood glucose levels (continuous infusion of insulin and glucose)