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Emt Side Notes > Shock/Resuscitation lecture > Flashcards

Shock/Resuscitation lecture Flashcards

1
Q

What is shock?

A

the inadequate perfusion of cells, tissue, and organs with oxygen and other nutrients resulting in cell, tissue, and organ dysfunction. It is also often referred to as hypoperfusion

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2
Q

What are the etiologies/cause of shock

A

Inadequate volume
inadequate pump
inadequate vessel tone

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3
Q

What are the 4 main categories of shock?

A

Hypovolemic
Cardiogenic
Distributive
Obstructive

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4
Q

What is the sometimes mentioned 5th category of shock?

A

metabolic/respiratory

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5
Q

What is hypovolemic shock?

A

Shock caused by low blood volume caused by loss of blood or fluid lost from intravascular space; loss of whole blood

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6
Q

What are the categories of hypovolemic shock?

A

hemorrhagic: loss of whole blood

non hemorrhagic: shift of fluid out of the intravascular space; however, red blood cells and hemoglobin remain within the vessels. It is primarily water, plasma proteins, and electrolytes that are lost; ex: vomit

burn: specific form of nonhemorrhagic hypovolemic shock resulting from a burn injury. Burns can interrupt the integrity of the capillaries and vessels and allow them to leak plasma and plasma proteins.

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7
Q

What is distributive shock?

A

a decrease in intravascular volume caused by massive systemic vasodilation and an increase in capillary permeability

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8
Q

what are the types of distributive shock?

A

anaphylactic, septic, neurogenic

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9
Q

What is anaphylactic shock?

A

Chemical mediators that are released in the anaphylactic reaction cause massive and systemic vasodilation. These chemical mediators also cause the capillaries to become permeable and to leak

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10
Q

What is Septic Shock?

A

results from sepsis, which is an exaggerated inflammatory response to an infection that causes the vessels throughout the body to dilate and become permeable.

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11
Q

What is neurogenic shock?

A

referred to as vasogenic shock, A spinal cord injury may damage the sympathetic nerve fibers that control vessel tone below the level of injury. Loss of sympathetic tone causes the vessels to dilate. If the injury is high in the thoracic spinal cord or in the cervical region, enough vessel tone may be lost to cause a drop in systemic vascular resistance, blood pressure, and perfusion

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12
Q

What is sepsis

A

exaggerated inflammatory response to an infection that overwhelms the body’s defense and regulation systems. disrupts organ and cell function

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13
Q

what are the s/s of sepsis

A

tachycardia
tachypnea
hyperthermia or hypothermia
hypotension

flushed warm skin early on,
mottled/cyanotic in late stages
AMS

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14
Q

What is obstructive shock?

A

a condition that obstructs forward blood flow. The volume is adequate, the heart is not damaged, and the vessels are of a normal size with adequate resistance. However, an obstruction is not allowing the blood to move forward.

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15
Q

What is Cardiogenic shock?

A

caused by ineffective pump function of the heart. The patient has an adequate blood volume and vessel tone; however, hypoperfusion results from the inability of the heart to contract effectively typically due to the left ventricle being damaged

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16
Q

What are common causes of cardiogenic shock?

A

cute myocardial infarction (heart attack), congestive heart failure, abnormal cardiac rhythm, infection, or overdose on drugs that depress the pumping function of the heart such as beta blockers or calcium channel blockers

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17
Q

What is metabolic shock?

A

described as a dysfunction in the ability of oxygen to diffuse into the blood, be carried by hemoglobin, off-load at the cell, or be used effectively by the cell for metabolism.

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18
Q

What is the body’s immediate response to shock?

A

Sympathetic nerve stimulation leading to:
Increase in heart rate
Increase in force of ventricular contraction (stroke volume)
Vasoconstriction
Stimulation of the release of epinephrine and norepinephrine from the adrenal gland

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19
Q

What are the stages of shock?

A

compensatory followed by decompensatory

20
Q

What is compensatory shock?

A

organ and gland stimulation to maintain normal bp, and perfuse vital organs

21
Q

What is Decompensatory shock?

A

advanced stage of shock where the body can no longer compensate and maintain blood pressure, or perfusion of the vital organs

22
Q

What are the s/s of compensatory shock

A

anxiety
normal BP
Mild tachycardia (>100 bpm)
thready pulse in extremities
Slight-to-moderate tachypnea (20–30/minute)
Pale, cool skin; skin is moist

23
Q

what are the s/s of decompensatory shock?

A

AMS
hypotension
Marked tachycardia ( at 140 and higher, the pt is dire); may progress to bradycardia
pulse is weak/absent
Air hunger (tachypnea/hyperpnea)
progresses to respiratory failure
white waxy cold skin

24
Q

What are the s/s of hypovolemic shock?

A

decreased bp
narrowing pulse pressure
tachycardia
tachypnea
pale, cool, clammy skin
poor/unobtainable spo2
anxiety
delayed capillary refill
weak/absent peripheral pulse
decreased urine output

25
Q

what are the s/s of cardiogenic shock?

A

decreased bp
narrowing pulse pressure
tachycardia or bradycardia
tachypnea
pale, cool, clammy skin or cyanotic/mottled
decreased spo2
anxiety
JVD/peripheral edema (Right side failure)
crackle/rales upon auscultation (left side failure)
weak/absent peripheral pulse
decreased urine output

26
Q

What are the s/s of distributive shock?

A

decreased bp
tachycardia with anaphylaxis/sepsis
bradycardia associated with spinal cord injury
tachypnea associated with anaphylaxis/septic
normal respiratory rate neurogenic
anxiety
weak/absent peripheral pulses

Skin signs:
normal to flushed skin- sepsis
warm flushed skin- neurogenic
warm flushed skin with hives- anaphylaxis
mottled/cyanotic- late stage of shock

27
Q

what are the s/s of obstructive shock?

A

decreased bp
pulsus paradoxus(tension pneumothorax, paricardial tamponade)
narrow pulse pressure
tachycardia
tachypnea
pale cool clammy skin
decreased spo2 reading
anxiety
jvd (tension pneumothorax, paricardial tamponade)
weak/absent peripheral pulse
decreased urine output

28
Q

what is the normal systolic bp of kids less than 10?

A

70 mmHg plus two times the age in years is a lower limit of normal.

29
Q

what are the three phases the patient goes through following cardiac arrest that lead to biological death?

A

electrical phase, circulatory phase, metabolic phase

30
Q

what is the electrical phase?

A

begins immediately upon cardiac arrest and ends 4 minutes afterward. During this early and initial phase, the heart still has a good supply of oxygen and glucose; therefore, aerobic metabolism is maintained with continued energy production for cell function and prevention of mass production of acid. During this phase, the heart is in a good physiological condition for resuscitation

31
Q

What is the circulatory phase?

A

begins at 4 minutes following the cardiac arrest and lasts through 10 minutes following the cardiac arrest. During this phase, the oxygen stores are reduced and the myocardial cells shift from aerobic to anaerobic metabolism. This results in very little energy production for cell function, in addition to the production of acid. heart is less prepared for defibrillation and is less prone to restarting

32
Q

What is the metabolic phase?

A

begins 10 minutes after cardiac arrest. At this point the heart is starved of oxygen and glucose and has a large amount of acid buildup. The tissues are ischemic and may begin to die. The chances of survival drop dramatically during this phase. Because of the lack of glucose and ATP, the sodium/potassium pump fails, allowing sodium to enter and stay within the cell. The sodium attracts water inside the cell.

33
Q

What are the shockable rhythms?

A

V fib and v tac

34
Q

What is a v fib rhythm?

A

disorganized cardiac rhythm that produces no pulse or cardiac output

35
Q

what is a v tac rhythm?

A

a very fast heart rhythm that is generated in the ventricle instead of the sinoatrial node in the atrium. Because the pumping is so rapid, the heart does not refill properly and cardiac output is sharply reduced. This rhythm can easily degenerate into ventricular fibrillation.

36
Q

What are non shockable rhythm?

A

Asystole and Pulseless electrical activity

37
Q

What is asystole rhythm?

A

the absence of electrical activity and pumping action in the heart. This often registers on a monitoring screen as a flat or nearly flat line; hence, the term “flatline” is often used for asystole

38
Q

What is Pulseless electrical activity rhythm?

A

heart has an organized rhythm, but either the heart muscle is so weakened that it fails to pump, or the heart muscle does not respond to the electrical activity, or the circulatory system has lost so much blood that there is nothing to pump

39
Q

What are the three indications for ROSC?

A

A pulse is felt after the AED indicates a no shock advisory.
Patient regains spontaneous breathing.
The patient begins to move

40
Q

Adult ventilation rate?

A

10-12/minute
1 every 5-6 sec

41
Q

child/infant ventilation rate?

A

12-20/minute
1 every 3-5 sec

42
Q

neonatal ventilation rate?

A

40-60/minute
1 every 1-1.5 sec

43
Q

adult cpr ratio

A

30/2
100-120 compressions/minute

44
Q

child/infant cpr ratio

A

30/2 - 1 responder
15/2- 2 responder
100-120 compressions a minute

45
Q

neonatal cpr ratio

A

3 compressions to 1 ventilations

Emt Side Notes (7 decks)

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