Shock

Question 1

what causes DIC in shock states?

Answer 1

cell destruction, microemboli

Question 2

triggers of DIC

Answer 2

sepsis, PE, trauma, metabolic acidosis

Question 3

labs for DIC

Answer 3

50% platelet drop! prolonged PT, elevated d-dimer

Question 4

s/s of DIC

Answer 4

purpura, cyanosis, petechiae, leaking from IV sites, +1 pulses, hypotension

Question 5

why are those in shock at risk of an ileus or GI bleed?

Answer 5

decreased perfusion to the GI tract

Question 6

what are signs of organ dysfunction in progressive stage of shock

Answer 6

ARDS begins, AKI, AMS, dysrhythmias, DIC or poor clotting

Question 7

MODS

Answer 7

multiple organ dysfunction syndrome

Question 8

what effects does norepinephrine have

Answer 8

increased BP, mild increase in HR

Question 9

what effects does phenylephrine have?

Answer 9

increased BP, risk of reflex bradycardia

Question 10

what kind of patient should NOT get phenylephrine, why

Answer 10

heart failure, solution is v diluted

Question 11

what effects does epinephrine have

Answer 11

increased BP, greatly increased HR

Question 12

considerations with epi

Answer 12

watch HR closely, make sure lines are good - will cause sloughing & necrosis if it infiltrates

Question 13

what effects does vaso have?

Answer 13

pure vasoconstriction –> increases BP

Question 14

why is vaso not titrated

Answer 14

very powerful, can cause coronary vasodilation if doses get too high

Question 15

what do you need in order to titrate vasoactive meds

Answer 15

a line for accurate BPs

Question 16

what lines can you give pressors through?

Answer 16

PIV for 12h max, should be central

Question 17

what type of shock are inotropes best for

Answer 17

cardiogenic

Question 18

effects of milrinone

Answer 18

increases contractility to increase CO

Question 19

effects of dobutamine

Answer 19

increases contractility to increase CO

Question 20

risks of milrinone & dobutamine

Answer 20

vasodilation - give with pressor

Question 21

effects of dopamine

Answer 21

increased contractility, increase in BP

Question 22

risks of dopamine

Answer 22

causes renal damage in high doses - monitor UO closely!!

Question 23

normal lactate/lactic acid

Answer 23

less than 1

Question 24

what does a high lactic indicate?

Answer 24

hypoperfusion causing anaerobic metabolism

Question 25

normal CRP

Answer 25

less than 1

Question 26

what does a high CRP indicate?

Answer 26

inflammatory response

Question 27

normal procal

Answer 27

0

Question 28

what does a procal above 2 indicate

Answer 28

bacterial infection

Question 29

normal PT

Answer 29

11-13.5

Question 30

normal PTT

Answer 30

25-35

Question 31

why are tube feeds preferred over TPN

Answer 31

less infection risk, maintains GI motility

Question 32

why is it important to check residuals

Answer 32

ileus can form

Question 33

risks of fluid replacement in shock states

Answer 33

hypothermia, FVO, coagulopathy, F&E imbalance

Question 34

causes of hypovolemic shock

Answer 34

hemorrhage, burns, n/v, DKA, polyuria, dehydration

Question 35

s/s of hypovolemic shock

Answer 35

low orthostatic BP, high HR, low CVP, slowed cap refill

Question 36

interventions for hypovolemic shock

Answer 36

replace lost fluids, fix cause

Question 37

modified trendelenburg

Answer 37

increases venous return from the legs, not tolerated by some pts

Question 38

what patient might not tolerate modified trendelenburg?

Answer 38

pts with HF

Question 39

what is cardiogenic shock?

Answer 39

hypoperfusion d/t the LV pumping ineffectively

Question 40

causes of cardiogenic shock

Answer 40

cardiomyopathy, acute MI, defects, acidosis

Question 41

s/s of cardiogenic shock

Answer 41

hypotension, tachycardia, low CO & UO, AMS, JVD, crackles, mottling

Question 42

meds for cardiogenic shock

Answer 42

fluids, morphine, lasix, antiarrythmics, inotropes, pressors, nitro

Question 43

intra-aortic balloon pump

Answer 43

balloon in aorta that deflates during systole & inflates during diastole to decrease afterload by pulling blood

Question 44

IABP considerations

Answer 44

must be synched to cardiac cycle, usually inserted at fem

Question 45

impella

Answer 45

helps LV pump more efficiently

Question 46

impella considerations

Answer 46

can only have for 6h max

Question 47

ventricular assist device considerations

Answer 47

no palpable pulse

Question 48

s/s of obstructive shock

Answer 48

hypotension, tachycardiac, JVD, pulsus paradoxus

Question 49

pulsus paradoxus

Answer 49

drop in SBP during inspiration

Question 50

causes of obstructive shock

Answer 50

abd compartment syndrome, PE, tension pneumo, tamponade

Question 51

tension pneumo treatment

Answer 51

needle decompression

Question 52

PE treatment

Answer 52

tPA, embolectomy

Question 53

tamponade treatment

Answer 53

pericardiocentesis

Question 54

distributive shock

Answer 54

vasodilation with redistribution of blood volume

Question 55

dx criteria for anaphylactic shock

Answer 55

acute symptom onset with CV compromise with 2 of the following: GI upset, skin/mucosal irritation, respiratory compromise, & hypotension

Question 56

anaphylactic shock s/s

Answer 56

hives, n/v, cramping, bronchospasm, wheezing, stridor, angioedema, palpitations, AMS

Question 57

mgmt of anaphylactic shock

Answer 57

remove causative agent, give O2, give epi - maintain airway, document reaction

Question 58

meds for anaphylactic shock

Answer 58

diphenhydramine, epi, steroids, famotidine, bronchodilator

Question 59

what is SIRS

Answer 59

systemic immune response syndrome, can progress into sepsis & septic shock

Question 60

SIRS s/s

Answer 60

high/low temp & WBC, HR above 90, high RR with low CO2

Question 61

s/s of septic shock

Answer 61

map <65, high WBC, CRP, BG, PT, INR, procal & lactic, low plt

Question 62

hour 1 of septic shock bundle

Answer 62

lactic & cultures, then start abx, fluid resus - pressors if needed

Question 63

fluid resus formula for septic shock

Answer 63

30mL/kg

Question 64

meds for septic shock

Answer 64

levo first, vaso, epi, can add dobutamine & steroids

Question 65

mgmt of septic shock

Answer 65

determine & treat cause of infection, support organs & perfusion

Question 66

neurogenic shock

Answer 66

massive vasodilation from loss of SNS d/t spinal cord injury

Question 67

s/s of neurogenic shock

Answer 67

hypotension, bradycardia, warm dry skin

Question 68

s/s of spinal cord injury

Answer 68

paralysis, bowel/bladder dysfunction, loss of reflexes, priapism

Question 69

neurogenic shock treatment

Answer 69

spinal cord immobilization! fluid resus, pressors, atropine, vent if C3-C5 damage