shock

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Braddk1
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145336
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shock
Updated:
2012-04-03 04:49:57
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shock
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shock exam 3
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  1. two criterian that must be met before shock can be diagnosed is
    • a reduction in mean systemic b/p
    • clinical evidence of hypoperfusion of vital organs
    • earliest sighn is agitation and restlessness
    • decreased uop and mentation and b/p
    • cool clammy skin
    • increased pulse
  2. what is the formula for map
    dbp(2)+sbp
  3. what happens in the initial stage of shock
    • increased sns stim
    • mild vasoconstriction and increase in hr
  4. what happens in the compensated or nonprogressive stage of shock
    • organs still adequately perfused because of compensatory mech
    • decrease in map 10-15 degress from baseline continued decrease in bp
    • activation of raas and resulting decreased uop

    • moderate vasoconstriction with still increase in hr
    • blood shunted to heart and vital organs
  5. what happens in the decompensated or progressive stage of shock
    • underperfusion of organs and compensatory mech fail
    • map decreased by over 20 from baseline
    • anoxia
    • hypoxia
  6. what happens in the irreversible or refratory shock stage
    • severe hypoxia and ischemia
    • mods
    • death
  7. wha is hypovolemic shock
    volume loss
  8. compare and contrast absolute vs relative volume loss
    absolute is going outside the body

    ie: frank bleeding,diarrhea or vomiting,diuresis,loss of plasma through skin (burns)

    • relative is staying inside
    • as in third spacing, internal volume loss and fluid shifting
  9. what is the order of the cascade of hypovolemic shock
    • decreased
    • circulating volume --preload(venous return)-- stroke volume--co--cellular 02 supply--tissue perfusion
  10. what is the classification system of hypovolemic shock
    class I-IV
  11. what is class I
    volume loss up to 15% or 750ml

    • charecterized by
    • anxiety
    • restlessness
    • poss be asymptomatic
  12. what is class II
    • beginning of changes in vs
    • blood loss of 15-30% or 750-1500ml
    • characterized by
    • decreased preload
    • apprehension/ restlessness
    • pallor/diaphoresis
    • delayed cap refill
    • decreased uop
    • increased hr >100and rr 20-30
  13. what is class III
    • volume loss of 30-40% or 1500-2000 ml
    • characterized by
    • decreased b/p, and increased hr and rr and uop
    • delayed cap refill
    • anxious and confused
  14. what is class IV
    • hemorrahage
    • volume loss of greater than 40% and 2000ml
    • mods
    • irreversible shock
  15. how do you tx hypovolemic shock
    • blood - prefer prbc
    • (can use whole blood but rarely used due to allergic reactions)
  16. what is cardiogenic shock
    • pump failure
    • low co and hypotension
    • low uop
    • decreased peripheral pulses
    • cool clammy skin
    • ms changes
  17. causes of cardiogenic shock
    • ischemia, structural problems and dysrhythmias
    • MI
    • will hear crackles
    • likely within 48 hours of MI
  18. what is the cascade cycle in cardiogenic shock
    decreased heart fnxn--decreased co--decreaded b/p and hypoperfusion with hypoxemia--decreased in blood supply and further dysfunction--compensatory mech increase b/p--creates increased oxygen demand and work of the heart
  19. s/s of cardiogenic shock
    pulmonary edema, peripheral edema and jvd, mottlling of skin
  20. assesment findings with cardiogenic shock
    • L ventricle ejection fraction <30%
    • hypotension
    • increased rr
    • crackles resulting from pulmonary congestion
    • decreased uop
    • restlessness, agitation, confusion
  21. what needs to be done to reach the goal of restoring blood flow in cardiogenic shock
    • thrombolytics
    • angioplasty
    • coronary revascularization
    • iabc to increase perfusion and decrease afterload (inflates durin diastole and deflates during systole)
  22. what drugs are given with cardiogenic shock
    • pos inotrope
    • dobutamine (preferred because no much chrono effect)
    • dopamine
    • vasoactive
    • nitro - decrease preload (blood coming back to heart)
  23. distributive shock develops as a result of...
    vasodilation without an increase in intravascular volume
  24. 3 types of distributive shock
    septic, anaphlatic and neurogenic
  25. what is the differing charecteristic in septic shock
    infection
  26. 2 of the following assesment vitals and or labs must be met to be declared in sepsis
    icreased b/p, hr, rr, wbc
  27. what is sepsis with hypotension
    • b/p<90 despite fluid resuscitaion
    • scant urination
    • change in ms
  28. what is the cascade of events in septic shock
    microbes invade--endotoxins release cytokines initiating inflamm response--damages vessel triggering coag cascade and thrombi--fibrinolysis is interupted blocking blood flow--also increased cap perm creating edema
  29. what are the 2 states of septic shock
    early-hyper and late-hypo dynamic state
  30. what assesment findings during early-hyperdynamic state
    • normal to high co
    • high temp
    • tachypnea
    • hypotension to normotension
    • vasodilation and b/p is barely maintained
  31. what assesment findings during late hypodynamic state
    • low perfusion, co,
    • ms changes
    • clammy pale skin
    • tachycardia
    • pulmonary congestion
    • central cyanosis
  32. what is the overall goal with septic shock
    • filling the tank and constricting the vessels 1st
    • eliminating hte source of infection
  33. filling the tank and constricting the vessels in septic shock is done with
    • iv fluids ie
    • ns,lr
    • vasoconstrictors
    • dopamine
  34. what is the cascade of events from anaphylactic shock
    allergic reaction--mast cells and histamine--increased vasc perm--edema and bronchoconstriction
  35. clinical manifes of anaphlactic shock
    • priurtis, sneezing/coughing, wheezing uticaria, angioedema,restlessness
    • BAD - stidor, bronchospasm and laryngeal edema
  36. more resulting from anaphlactic shock
    increased cap perm--pooling of blood in periphery-- decrease co and b/p--decrease in svr
  37. management of anaphlactic shock
    • abc'c
    • epi
    • volume expansion
    • vasoconstrictor agents
    • antihistamines
    • bronchodilators
    • corticosteriods
  38. pathophys of neurogenic shock
    • loss of sympathetic tone--massive vasodilation--
    • decreased venous return,sv,co, oxygen supply, tissue perfusion
  39. what is the differing characteristic with neurogenic shock
    BRADYCARDIA
  40. poikilothermia happens in neurogenic shock as a result of loss of vasomotor tone, define this
    pt assumes temp of environment
  41. presenting s/s with neurogenic shock include
    hypotension, hypothermia, decreased uop, ms changes, increased cap refill time
  42. tx of neurogenic shock
    • stabilize spine
    • abc's
    • fluid resusitation
    • vasoconstrictors
    • atropine for bradycardia
    • warming blankets for hypothermia

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