Shock

Question 0

What are the three things the body needs to adequately perfume tissues?

Answer 0

A good pump
Good vessels
Sufficient amount of blood

Question 1

What is the definition of shock?

Answer 1

A life threatening syndrome with a variety of causes characterized by decreased tissue perfusion and impaired cellular metabolism

Question 2

What are the three things all shock states have?

Answer 2

Imbalance of oxygen and nutrient supply and demand
Activation of inflammatory response (increase SNS response, cytokines, cortisol)
Hypercoagulability

Question 3

What is the definition of cardiogenic shock?

Answer 3

The heart cannot effectively circulate the blood to meet the body’s needs and results in low blood flow, poor tissue perfusion, and low cardiac output (bad pump)

Question 4

What conditions can cause cardiogenic shock?

Answer 4

Heart failure, massive MI, cardiomyopathy, structural problems, ischemia, dysrhythmias

Question 5

What are some manifestations of cardiogenic shock?

Answer 5

Early ADHF symptoms: Low O2 sat, increased lactic acid from anaerobic metabolism, increased heart rate, decreased blood pressure, increased respiratory rate, narrow pulse pressure, cool clammy skin, decreased loc, confusion, decrease urinary output, poor renal perfusion, RAAS activation, angina, decreased bowel sounds, ulcer risk,increased blood sugar, ekg changes

Question 6

How can cardiogenic shock be diagnosed?

Answer 6

By symptoms, ekg, and labs

Question 7

What is the treatment of cardiogenic shock?

Answer 7

Fix the cause, limit the damage, increase the contractility, decrease pre and afterload, maintain o2 perfusion, vent if needed, tpa if ischemic event, Meds, rest

Question 8

What kind of medications would you give to a patient with cardiogenic shock?

Answer 8

Tpa for ischemia

Diuretics, antidysrhythmics, aspirin, beta blockers, maintain BP, dopamine, nitro

Question 9

What is hypovolemic shock?

Answer 9

A response to acute volume loss according to injury, age, and health state

Question 10

What can cause hypovolemic shock?

Answer 10

Decreased preload, heart rate, stroke volume, decreased cardiac output, decreased tissue perfusion, decrease in circulating volume due to blood loss

Question 11

What are some manifestations of hypovolemic shock?

Answer 11

Anxiety, tachypnea, low intravascular blood volume

Question 12

What is the goal of hypovolemic shock?

Answer 12

Replace blood loss and correct the cause

Question 13

What is anaphylactic shock?

Answer 13

Acute, life threatening hypersensitive reaction with massive vasodilation, release of mediators, and increased capillary permeability that causes severe bronchospams that compromise the airway

Question 14

What occurs during an allergic reaction?

Answer 14

When antibodies swarm with severe systemic inflammatory reaction

Question 15

What are manifestations of anaphylactic shock?

Answer 15

Swelling of tongue, angioedema, wheezing, stridor, flushing, pruritis, urticaria, respiratory distress, circulatory failure and collapse

Question 16

What is the treatment of anaphylactic shock?

Answer 16

Restore the vascular tone, stop bronchoconstriction, epinephrine, benedryl, albuterol, cortisone

Question 17

What is septic shock?

Answer 17

The presence of sepsis with hypotension despite fluid resuscitation and decreased tissue perfusion

Question 18

What are manifestations of septic shock?

Answer 18

Increased inflammatory response, increased coagulation, decreased fibrinolysis, tachypnea hyperventilation, temperature dysregulation, decreased urine output, altered neuron status, gi dysfunction, respiratory failure

Question 19

What is the definition of neurogenic shock?

Answer 19

Occurs when there is an injury to the spine of T6 or above, drug overdose, severe hypoglycemia, and spinal anesthesia

Question 20

What does neurogenic shock occur?

Answer 20

Because of a decreased sympathetic outflow resulting in an unopposed vagal response- too much parasympathetic, too little SNS

Question 21

What are manifestations of neurogenic shock?

Answer 21

Decreased blood pressure, decreased heart rate, decreased cardiac output, inability to sweat, pooling of blood in vessels

Question 22

What is the treatment of neurogenic shock?

Answer 22

Vasoconstrictors, atropine for heart rate, compression stockings, elevate legs, passive range of motion exercises, Lovenox

Question 23

What occurs during the initial stage of shock?

Answer 23

Usually not clinically apparent
Cool clammy skin, increased heart rate, agitation, lactic acid accumulation, metabolism changes from aerobic to anaerobic

Question 24

What occurs during the compensatory stage of shock?

Answer 24

The body starts to compensate and the SNS system kicks in. Cortisol levels increase, blood shunts to brain: kidney, skin, and GI shoe the earliest signs. Baroreceptors cause vasoconstriction but increases the O2 demands.

Question 25

What are early indicators of shock and what systems show the earliest symptoms?

Answer 25

Narrow pulse pressure, and kidney, skin and GI show the earliest signs

Question 26

When does the progressive stage of shock occur?

Answer 26

When compensatory mechanisms fails

Question 27

What are manifestations of the progressive stage of shock?

Answer 27

Decreased cellular perfusion, altered capillary permeability, interstitial edema, increased lactic acid, anasarca, ARDS, myocardial dysfunction, dysrhythmias, angina, ischemia, mi, stomach becomes ischemia and causes ulcers and bleeding, aki, acute tubular necrosis, liver dysfunction

Question 28

What is the treatment for progressive stage of shock?

Answer 28

IV fluids, correct vasodilation, support respiratory system, nutrition, glycemic control, PPi, histamine blockers, treat pain

Question 29

What occurs during the refractory stage of shock?

Answer 29

Anaerobic metabolism, high lactic acid, increased capillary permeability, profound hypotension, cellular destruction

Question 30

What are manifestations of the refractory stage of shock?

Answer 30

Decreased tissue perfusion, increased heart rate, decreased coronary blood flow, cerebral ischemia, organ failure