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Flashcards in shock states Deck (33)
1

what is SIRS?

unchecked out of control systemic response of inflammatory/immune system- warning sign of what is to come

2

SIRS criteria

diagnosis: 2+ presentHR gt 90RR gt 20 -or- PaCO2 lt 32T lt 36 -or- gt 38leuk- WBC lt 4k -or- gt 12k- OR gt 10% immature neutrophilsin high risk pts that can't be explained by other causes

3

SIRSinsult → pathophysiology x4

peripheral vasodilationcapillary permeabilitymicrovascular clottingcellular activation

4

what is shock?

broad categoryinitiated by insult → inadequate tissue perfusion comp to cell metabo reqs → cellular hypoxia + end organ dysfxn

5

what is compensated shock?

relatively stable may see early s/s shockcompensatory mechanisms: moderately effectivecause:- rapidly corrected = minimal residual effects- not corrected → uncompensated

6

what is MODS? x3

uncompensated shock worsens → MODSinvolves 2+ organ systems (that weren’t previously failing)altered organ function in acutely ill patientsorgan system homeostasis cannot be achieved without interventioncompensatory mechanisms from compensated shock NO LONGER ADEQUATE

7

geriatric population & shock

- progression rapid- reduced compensatory mechanisms- pre-existing comorbs (renal failure, lung disease, cardiomyopathy) INTERVENE STATE

8

present in every type of shock

inadequate tissue perfsuion & cellular hypoxia

9

hemodynamic goals of therapy for shock x7

- MAP gt 60- CVP 8-12- CI gt 2.1- UOP gt 0.5 mg/kg/hr- SaO2 gt 92%- SVO2 gt 70- serum lactate lt 2 mmol/L

10

hypovolemic shock causes

- ABL/ongoing hemorrhage- non-hemorrhage fluid depletion-- GI (v/d)-- burns-- polyuria-- aggressive pharm diuresis-- insensible losses

11

can lose how much via insensible losses + how?

1L/day; diaphoresis, open burn wounds, vents

12

hypovolemic shock is

loss or redistribution of volume... (blood, plasma, or other body fluids) which result in decreased intravascular volume

13

obstructive shock is

mechanical obstruction impacting the cardiovascular system... that decreases ventricular filling and/or emptyingend result: ↓ CO, tissue perfusion, O2 delivery

14

obstructive shock causes

↓ ventricular filling =- cardiac tamponade- tension pneumothorax- vena cava compression/thrombus- atrial mass or thrombus↓ ventricular emptying- PE (saddle embolism = sitting across either/both arteries)

15

saddle embolism is

thrombus sitting across either/both arteriescauses ↓ ventricular emptying → obstructive shock

16

cardiogenic shock is

occurs when heart fails as a pump↓ contractility → ↓ SVwhich leads to ↓ CO, BP → ↓ tissue perfusion

17

cardiogenic shock causes

MI !!!!!!!!HFrEF exacerbation (ischemic v nonischemic)dysrhythmias (poor O2 at first, can exacerbate cardiogenic shock states)LV outflow tract obstruction (hypertrophic obstructive cardiomyopathy, muscle/tumor overgrowth is pretty uncommon)

18

#1 cause of cardiogenic shock

MI

19

neurogenic shock is...

typically results from SCI w damaged symp pathways, usually seen in injuries T6 or higher- higher injury = greater symptoms- common in trauma or neuro patients↓ symp of organs distal to injury = stimulated by PS toneresults: bradycardia, massive vasodilation, inability to regulate body temp (hypothermia)EASIEST SHOCK TO SPOT

20

anaphylactic shock is...

life threatening allergic reaction **resulting in IgE mediated response** or mast cell (non-IgE degranulation)- occurs following reexposure to specific antigen- immediate response causing release of histamines, prostaglandins, vasoactive mediatorsresults: massive vasodilation, capillary permeability, constriction of non-vascular smooth muscle (RESPIRATORY!!)triggers: drugs, foods, other (see lecture)s/s: see lecture

21

*SEPSIS *

SIRS likely s/t infection; positive cultures add to validity but not required

22

*SEVERE SEPSIS*

sepsis + at least 1 sign of hypoperfusion or organ dysfunction (new, not explained by other etiology)

23

*SEPTIC SHOCK*must know definition + pathophys/results

severe sepsis associated with refractory hypotension (BP lt 90/60) despite adequate fluid resus and/or serum lactate gt 4.0---release: endotoxins trigger overzealous release of inflammatory mediators (cytokines, interleukins, tumor necrosis factor, complement system)results: systemic vasodilation, widespread endothelial injury, activation of coagulation cascade

24

septic shock pathophys + results

release: endotoxins trigger overzealous release of inflammatory mediators (cytokines, interleukins, tumor necrosis factor, complement system)results: systemic vasodilation, widespread endothelial injury, activation of coagulation cascade

25

inflammatory response: goal of vasodilation

increase availability of - nutrients (O2, glucose)- neutrophils, macrophages, and their mediatorsto injured area

26

inflammatory response: goal of microvascular permeability

increase availability of - nutrients- cells- mediatorsto injured area

27

inflammatory response: goal of coagulation

- minimize blood loss- wall off injury

28

inflammatory response: goal of cellular activation

WBCs -->- phagocytosis foreign debris + cells- wound microdebridement

29

SIRS mediators: inflammatory cells

neutrophilsmacrophagesmast cellsendothelial cellsplatelets

30

SIRS mediators: biochemical mediators

- tumor necrosis factor (TNF)- interleukins- platelet activating factor- arachidonic acid metabolites prostaglandins, leukotrienes, thromboxanes- toxic oxygen radicals- proteases

31

SIRS mediators: plasma protein systems

- complement system- kinin- coagulation- fibrinolysis

32

organ dysfunction and SIRS

ORGAN DYSFUNCTION STARTS EARLY

33

SIRS mediators x3

biochemical mediatorsinflammatory cellsplasma protein systems