Card Set Information
Adult MedSurg 2
How might you get hypovolemic shock?
Bleeding (internal and external)
THIRD SPACING (Burns, Ascites, Surgery)
What amount of fluid do you have to lose before shock becomes a risk?
~15% (40% is scary)
Problem is found in preload (ventricles are not filling adequately because there simply isn't enough circulating volume.
Stuff to know about CO
CO= HR x SV
[SV consists of preload (rt/lt, after load (rt/lt, and contractility] Preload and afterload can be measured by a Swangans catheter.
If v SV-->v CO.
Rt. Preload aka "end diastolic volume" (EDV) = 2-8ish. During this period ventricles are filling.
Lt. preload aka PA/PAD = 4-12.
PAD= pulmonary artery diastolic. Pressure should equal pressure in lt ventricle during diastole.
CVP= central venous pressure. should equal Rt ventricle pressure during diastole.
Low CVP, low PAD/PACWP, low anything means low volume.
What are some etiologies of cardiogenic shock?
**all have high mortality rates.
**all have contractility issues, either by surrounding pressure or dysfunctional tissue.
What are some inflow problems associated with cardiogenic shock?
mitral and tricuspid valve stenosis
idiopathic hypertrophic subaoritc stenosis with filling defect.
Tight ring of tissue preventing outflow of blood, which means it also cannot fill.
outflow problems associated with cardiogenic shock?
Aortic and pulmonic stenosis
: prevents emptying into lungs
mitral insufficiency (esp in the setting of AMI secondary to papillary muscle rupture or dysfunction). Valve will not close.
Ventricular septal defect
: holy heart.
Air embolism. Creates foam in Rt atrium/ventricle--> 80% v CO.
Rhythm associated Shock
Heart blocks (3rd degree)
Very fast tachycardia
Extra blood left in Lt ventricle-->pulmonary edema (crackles).
Will have normal CVP, but very high PAD/PACWP.
SnSs of Lt ventricular dysfunction
Dyspnea on exertion
PND (paroxysmal nocturnal dyspnea)
Chayne stokes respos
(aka Distributive shock)
Is an afterload issue (rt heart pushes against lungs PVR), Lt heart pushes against systemic vascular resistance.)
Decreased systolic vascular resistance.
^Vascular space without a change in blood volume.
Antigen/antibody rxn--> massive systemic vasodilation--> death in minutes due to decreased organ perfusion.
Histamine rxn will also cause constriction of bronchioles-->^WOB
What are some etiologies of anaphylactic shock
allergies to anything, ie...
SnSs of anaphylactic shock
conjunctivitis, periorbital edema
Itching/redness on skin
Treatment of anaphylactic shock?
Fluids. Start a second IV.
Epi epi epi
Benadryl. Safe even in elderly.
Can also give decahedron and the salu's.
What is toxic shock?
Here's a clue: