Shock 1

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Shock 1
2013-03-03 13:45:19

Adult MedSurg 2
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  1. How might you get hypovolemic shock?
    • Dehydration
    • Bleeding (internal and external)
    • THIRD SPACING (Burns, Ascites, Surgery)
  2. 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.
  3. 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.
  4. What are some etiologies of cardiogenic shock?
    • Acute MI
    • Myocarditis
    • Cardiomyopathy
    • myocardial contusion
    • **all have high mortality rates.
    • **all have contractility issues, either by surrounding pressure or dysfunctional tissue.
  5. 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.
  6. 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.
  7. Rhythm associated Shock
    • Heart blocks (3rd degree)
    • Very fast tachycardia
    • Fibrillation
    • Extra blood left in Lt ventricle-->pulmonary edema (crackles). 
    • Will have normal CVP, but very high PAD/PACWP.
  8. SnSs of Lt ventricular dysfunction
    • Dyspnea on exertion
    • PND (paroxysmal nocturnal dyspnea)
    • Orthopnea
    • Tachypnea

    • Basilar Rales
    • Pulmonary Edema
    • S# gallp 
    • Plural effusion
    • Chayne stokes respos
  9. Vasogenic shock
    (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.
  10. Anaphylactic shock
    • Antigen/antibody rxn--> massive systemic vasodilation--> death in minutes due to decreased organ perfusion. 
    • Histamine rxn will also cause constriction of bronchioles-->^WOB
  11. What are some etiologies of anaphylactic shock
    • allergies to anything, ie...
    • bugs
    • drugs
    • shell fish
    • latex
  12. SnSs of anaphylactic shock
    • conjunctivitis, periorbital edema
    • runny nose
    • stridor
    • shock
    • asthma
    • GI edema/vomiting/diarrhea
    • Itching/redness on skin
    • peripheral edema
  13. Treatment of anaphylactic shock?
    • Airway!
    • Fluids. Start a second IV.
    • Epi epi epi
    • Corticosteroids-->reduce inflammation
    • Benadryl. Safe even in elderly. 
    • Can also give decahedron and the salu's.
  14. What is toxic shock?
    Here's a clue: