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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)
- mortality 10-31%
- 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?
- Acute MI
- myocardial contusion
- **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?
- pericardial tamponade
- tension pneumothorax
- 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?
- pulmonary embolism
- 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)
- Basilar Rales
- Pulmonary Edema
- S# gallp
- Plural effusion
- 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...
- shell fish
SnSs of anaphylactic shock
- conjunctivitis, periorbital edema
- runny nose
- GI edema/vomiting/diarrhea
- Itching/redness on skin
- peripheral edema
Treatment of anaphylactic shock?
- Fluids. Start a second IV.
- Epi epi epi
- Corticosteroids-->reduce inflammation
- Benadryl. Safe even in elderly.
- Can also give decahedron and the salu's.
What is toxic shock?
Here's a clue: