Shock (MEDCRAM aka "high yield") Flashcards Preview

Multisystem Faculty (Final) > Shock (MEDCRAM aka "high yield") > Flashcards

Flashcards in Shock (MEDCRAM aka "high yield") Deck (14):
1

3 Major Types of Shock

  1. Hypovolemic 
  2. Cardiogenic
  3. Septic

 

 

2

Describe Hypovolemic Shock

(i.e., what happens after volume drops)

Most blood is stored in venous system

(Can lose up to 40% of blood volume before BP decreases)
 

  • Drop in BP = Compensatory increase in HR and EF
  • SVR (resistance) increases; increased pressure = better blood delivery w/o adequate volume
  • Cardiac Output DROPS (not enough filling)
  • PCWP (LA pressure) and JVP (RA pressure) drop due to loss of volume
  • Skin temperature drops due to shunting of blood to vital organs

 

3

Increased HR/EF and SVR

+

Cool skin temperature

Hypovolemic Shock

4

Decreased EF

+

Increased RA and LA Pressure (measured via JVP and PCWP, respectively)

+

Cool skin temperature

Cardiogenic Shock

5

Describe Cardiogenic Shock

Decreased CO despite adequate volume (tissue hypoperfusion)

Usually from acute MI (HR can be too fast or too slow depending on type of heart problem)

 

  • Decreased CO/EF leads to compensatory SVR increase
  • RA and LA pressures increase as heart fails to pump correctly
  • BP and skin temperature drop

 

  

6

Increased CO and HR

+

Decreased RA/LA Pressure 

+

Increased Skin Temperature

Septic Shock

7

Describe Septic Shock

MOST COMMON

  • Cytokines lead to dysregulation of vasocontriction (i.e., SVR decreased and blood is inappropriately shunted to non-vital organs)
  • Vital organs extract more oxygen than they otherwise would need to (SvO2 drops below 70%--70 is normal)
  • HR and CO increase to compensate
  • EF and LA/RA pressure drop as a consequence of decreased BP
  • Skin is getting more blood = increase in temperature

8

How does our body compensate during septic shock?

RAS system (aldosterone)

+

ADH

 

Eventually, BP will drop despite compensation (i.e., become decompensated)

9

What happens when oxygen cannot reach tissues?

Cannot be used as final electron acceptor to make ATP

 

Without ATP, cells die

10

Tx of Cardiogenic Shock

Diagnosis: EKG, Echo, CXR

ABC Support then fix cause

 

Digoxin when EF < 40%

Dobutamine (pure β stimulation)

11

What do you have to be mindful of when giving dobutamine?

Drop in BP (β receptors in the periphery cause vasodilation)

12

Tx of Septic Shock

EGDT (Early Goald Directed Therapy)

All Tx must occur within 6 hours

 

1. Abx within 1 hour

2. Central Line (want CVP between 8 and 12)

Correct with normal Saline

3. Vasopressors through central line (want MAP > 65)

DA or NE

4. If SvO2 remains below 70% check Hgb

Hgb < 10 = blood transfusion

Hgb > 10 = correct CO with dobutamine

13

Labs show lactic acidosis

 

Person already suspected of shock

Septic Shock

14

PCWP

Pulmonary Capillary Wedge Pressure