Shock Flashcards
Goals of primary assessment in shock?
Provide oxygen
Substitute hypovolemia
Identify life-threatening causes
What effects in shock are caused by sympathetic stimulation?
Tachycardia Sweating Pallor (reduced skin perfusion) Thready pulse (reduced pulse pressure) Ileus (reduced gut perfusion)
Why does plasma lactate rise in a shocked patient?
Oxygen dept due to insufficient oxygen delivery to tissues increases anaerob metabolism.
What mechanisms can lead to insufficient oxygen delivery?
Decreased oxygen uptake in lungs Reduced venous return Impaired cardiac function Reduced arterial tone Impaired organ autoregulation Decreaded oxygen uptake and use by tissues
What causes are there to hypovolemic shock?
Bleeding: GI or ruptured aorta
Plasma: Diarrea/vomiting, diabetes, osmotisk diures, pankreatit, hyponatremi och glukokortikoidbrist, fistlar, brännskador
What drugs can make an apparent hypovolemia?
Venodilators such as nitrates, opioids, loopdiuretics
What happens to pulse and blood pressure in grade II shock? How much volume loss does it indicate?
Pulse rises (>100)
Diastolic pressure rises to narrow pulse pressure
Indicates loss of 0,75-1 L (15-30% av blodvolymen)
In what grade of shock does the blood pressure fall?
grade III
Indicates loss of 30-40% of blood volume
name pitfalls in shock responser
elderly athletes drugs Pregnancy tissue damage hypothermia pacemaker
How will hypothermia affect vital parameters irrespectively of co-existing shock?
Reduced RR, Pulse, BP
Resistance against cardiovascular drugs
What are the response to inflammatory activators at anaphylactic shock?
Inflammatory activators: Vasodilatation and oedema
Spasmogenics: smooth muscle contraction
Chemotactic agents: Attracts WBC
How is the mechanism of hypovolemia in anaphylactic shock?
increased vascular permeability
vasodilatation
decreased venous return secondary to increased thoracic pressure due to bronchospasm
What conditions mimic sepsis?
MI PE Pankreatit Fat embolism syndrome Adrenal insufficiens Liver decompensation GI-bleeding Diuresis Drug reactions Transfusion reaction Procedure related bacteremia amniotic fluid embolism advanced malignancy
What principle causes to cardiogenic shock exist?
Myocardial (ventricular failure/conduction problems)
Endocardial (valve lesions)
Epikardiell (tamponad, konstriktiv perikardit)
What are classical vital parameters in neurogenic shock?
BP 90
Pulse 50
Warm and pink
Could be delayed by initial catecholamine release
