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Hesi Med surg > Shock > Flashcards

Flashcards in Shock Deck (26):
1

Stage 1. Initiation

No observable clinical indications

2

Stage 2. Compensatory

^ HR
Narrowed pulse pressure
Rapid deep respiration's causing alkalosis
Thirst, cool moist skin
diminished bowel sounds, RAAS
Hyperglycemia
Restless progressing to confusion

3

Stage 3. Progressive

Dysrhythmias
Deceased BP
Tachypnea
Absent bowel sounds
lethargy progressing to coma
Hyperglycemia
^ BUN, creatinine, potassium
Respiratory and metabolic acidosis

4

Stage 4. Refractory

MODS, SIRS
Life threatening dysrhythmias
ACIDOSIS
ARDS
DIC
Kidney failure
MI

5

SIRS

Release of mediators
causes Hypovolemia

6

Hypovolemic Shock LABS

^ HR
Normal to low
Low CO
Low CI
Low RAP
Low PAWP

7

Cardiogenic Shock LABS

^HR
Low CO
Low CI
^ RAP
^PAWP

8

Obstructive Shock LABS

^ HR
Low CO
Low CI

9

Septic Shock LABS

^ HR
High then low CO
High then low CI

10

Hypovolemic Shock Causes

External loss of blood
Diarrhea
Burns
Hemothorax
ascites

11

Hypovolemic Shock Clinical presentation

^ HR
↓ BP
Tachypnea
Flat neck veins
Cool pale, skin
↓ CO, CI, RAP, PAP, PAWP
^SVR
↓ HCT

12

Hypovolemic Shock management

Eliminate and treat cause
Replace lost volume with fluid

13

Cardiogenic Shock causes

MI
HF
Dyshrythmias

14

Cardiogenic Shock Clinical presentation

^ HR
Dysrthymias
↓ BP
Chest pain
↓ CO, CI, SVO2
^RAP,PAP,PAWP,SVR

15

Cardiogenic Shock managment

Improve CONTRACTILITY with inotropic meds
Mechanically ventilate
Emergency Revascularization

16

Neurogenic Shock Causes

General or Spinal anesthesia
Epidural block
Cervical spinal cord injury
meds: barbituates

17

Neurogenic Shock Clinical presenation

↓ HR, BP
Hypothermia
Warm, dry flushed skin
EVERYTHING LOW

18

Neurogenic Shock Management

Eliminate and treat cause
Maintain MAP
VTE Propholaxis

19

Septic Shock Causes

Extreme Age
Malnutrition
Immunosuppresive therapy
BACTERIA

20

Septic Shock EARLY

^HR
Normal to ↓ BP
Widened pulse pressure
Skin warm
Oliguria
Confusion
^CO, CI, SVR

21

Septic ShocK LATE

^HR
↓ BP
↓ Pulse pressure, LOC
Skin COOL
↓ CO, CI, SVR

22

Hypovolemia Fluids

1. Isotonic Crystalloids, NS is typically used first
May use blood first IF pt is bleeding
2. 3-for-1 rule.
Infusion of 300 Ml of fluid for every 100 ml of blood
lost

23

Cardiogenic Shock also includes

Left sided HF, S3 Heart sound, crackles, dyspnea
R sided HF, Vein distention, edema

24

Cardiogenic Shock, you should

PCI or stent placement
Fibrolynics when PCI is not available
Beta-blockers
Oxygen administration

25

Cardiogenic MEDS

Diuretics and Vasodilators, Morphine, nitroglycerin
Dobutamine

26

For pts receiving Spinal Blocks

Elevate the HOB
Dopamine
norepi