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Flashcards in Shock I Deck (38):
1

shock

arterial blood flow inadequate to meet tissue O2 demand

defined by CO, preload, and afterload

2

shock defined by

CO, preload, and afterload

3

pulmonary capillary wedge pressure

PCWP
-left atrial pressure

4

hypovolemic shock

decreased CO
decreased PCWP
increased SVR

hemorrhage, fluid loss, poor intake

5

systemic vascular resistance

SVR
afterload indicator

6

cardiogenic shock

decreased CO
increased PCWP
increased SVR

cardiomyopathy, arrhythmia, mechanical, obstruction (tamponade, PE, tension pneumo)

7

distributive shock

vasodilatory - warm

increased CO
decreased SVR
decreased PCWP

sepsis, TSS, anaphylaxis, toxin, spinal cord injury

normal to high central venous O2 sat

blood to skin

8

SBP < 90

marker for shock

9

markers for shock

1. SBP < 90
2. 3 windows - cutaneous - mottled, renal < 0.5, neuro - abnormal mentation
3. blood lactate > 1

10

levito reticualris

giraffe looking skin

in shock

11

alcoholic, cirrhosis, ascites, vomiting, dry membranes, BP 70/50

hypovolemic shock

will see
-decreased CO
-decreased PCWP
-decreased CVP
-increased SVR

12

CVP

right atrial pressure

13

Tx of hypovolemic shock

0.9% saline - 1-2 liters wide open - continue based on BP, skin, urine, and mental status

PRBCs

goal - CVP 8-12mmHg

14

dobutamine

inotropic

15

dyspnea, BP 65/50, old MI, HR 140, cool skin, clammy skin, restless, basilar crackles, distended neck veins

cardiogenic shock

16

Tx of cardiogenic shock

O2
dobutamine (low BP)
nitro (normal/high BP)
AF
post MI - NE, dopamine, milrinone

17

NE

vasopressor with some inotropic

18

dopamine

alpha agonist with some inotropic
-increases PCWP

19

milrinone

inotrope that also produce vasodilation

Tx for cardiogenic shock - if patient does not have that severe hypotension

20

becks triad

for cardiac tamponade

1 - distended neck veins
2 - muffled heart sounds
3 - hypotension

21

echocardiography with free space around ventricular wall

obstructive shock

22

obstructive shock

tension pneumo
pericardial disease
PE
cardiac tumor
left atrial mural thrombus
obstructive valvular disease

23

SIRS

systemic immune response syndrome
-dysregulated inflammation related to autoimmune, pancreatitis, vasculitis, VTE, burns, surgery, etc.

usually respiratory alkalosis

24

respiratory alkalosis

with SIRS

25

labs in SIRS, sepsis, distributive shock

CMP
ABG
type and crossmatch
coag parameters
lactate
blood culture

26

clustered gram positive cocci

staph

27

DAMPs

damage-associated molecular patterns

activate TLRs

28

PAMPs

pathogen-associated molecular patterns

activate TLRs

29

SIRS

TPR
-temp >38.3
-pulse > 90
-respirations > 20

with infection - becomes sepsis

30

WBC > 12,000 with bandemia >10%

sepsis

31

WBC < 4,000 with increased CRP and procalcitonin

sepsis

32

variables with sepsis

inflammatory
-WBC levels high, or elevated CRP and procalcitonin

hemodynamic
-SBP < 90, MAP < 70

organic dysfunction
-PaO2 0.5
INR >1.5
ileus
platelets < 100,000
bilirubin >4
hyperprolactinemia
decreased cap refill

33

severe sepsis

involves at least ONE organ system

ARDS, AFR, DIC, serum lactate >4

34

unable to maintain MAP >60 after fluid resuscitation

septic shock

35

distributive shock

septic shock, anaphylaxis, adrenal insufficiency

SVR <800***

and elevated mixed venous O2 sat**

36

sepsis protocol

within 2 hours pt with infection, SIRS, dysfunction of one organ

1 - serum lactate
2 - 2x blood cultures
3 - 2 18 gauge lines
4 - antibiotics
5 - 2L normal saline
6 - CBC and BMP
7 - O2 sat >90
8 - NE if shock present
9 - transfer - lactate >4, SBP <60 after 2 L normal saline

37

goal for septic shock

maintain CVP 8-12
fluids - 5L in 6 hrs
maintain MAP >65
cardiac index 2-4

NE - vasopressor
phenylephrine - warm shock
E - anaphylactic shock
vasopressin - potentiates NE

maintain CV O2 sat - >70
PRBCs

dobutamine

goal - reduce lactate by 20% in first 2 hours

38

relative adrenal insufficiency

use hydrocortisone 50mg q6hrs