Shock Flashcards
(24 cards)
What is shock?
no tissue perfusion
What is SIRS?
systemic inflammatory response system
What are sx of SIRS?
fever, hypothermia
leukocytosis or leukopenia
tachypnea, tachycardia
Who are at risk for shock?
young/old pts
immunocompromised
very sick people
indwelling catheter
What is bacterial ipopolysacchardie and peptidooglycans?
potent activaros that trigger production of cytokines, chemokines, etc –> inflammatory response
What is the hallmark for local inflammatory response?
intravascular thrombosis
What can widespread endothelial injury result in?
DIC
organ dysfxn
hyporesponse of bone marrow and useless WBC
What is early sign of sepsis?
hyperventilation
What are other sx of sepsis?
tachycardia
weird WBC ct
encephalopathy
acrocyanosis
necrosis of digits - d/t ischemic tissues
petechaie, purpura - platelets going out of wack -DIC
acidosis -d/t poor tissue perfusion –> lactic acid build up
hyper/hypoglycemia
What are major complications of sepsis?
cardiopulm
renal
coagulopathy
hepatic dysfxn
What are cardiopulm complications from sepsis?
VQ mismatch -shunting and less perfusion
pulm capillary leakage –> ARDS occurs
heart failure
What are renal complications from sepsis?
oliguria azotemia - high nitrogen in urine proteinuria lyte imbalance Acute tubular necorsis
What are coagulopathy complications from sepsis?
DIC
thrombocytopenia
What are hepatic dysfxn complications from sepsis?
dec in clotting factors
glucose, albumin, etc goes out of wack
How is SIRS defined?
2 or more of:
Temp: 38C/100F
HR: >90/min
RR: >20/min or PaCO2 12,000 OR >10% bands
How to tx sepsis/septic shock/SIRS? -infxn
tx ASAP warm pt glucose control empirical abx remove source of infxn if any (foley, iv catheters
How to tx sepsis/septic shock/SIRS? -heart
support heart: preload, afterload, contractility, O2, vasopressor (dopamine)
How to tx sepsis/septic shock/SIRS? -liver
bicarb for severe metabolic acidosis
correct clotting factor
RBC transfusion
hemodialysis
What is APACHE II Scores?
used to gauge severity of disease
can be used to determine if activated protein C is useful
can use to predict morbidity/morality
What is early goal directed therapy?
step wise approach
may be used in ICU
What is most common cx of DIC?
bacterial sepsis
malignant disorder
obstetric complications
What leads to bleeding DIC?
consumptive coagulopathy - using up coagulation factors and platetles
What labs for DIC?
PT, PTT
How to tx DIC?
tx underlying cx
replace clotting factors and platelets
control coagulation state +/- heparin
support
