Therapeutics - Shock 1

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Author:
kyleannkelsey
ID:
289322
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Therapeutics - Shock 1
Updated:
2014-11-15 23:31:00
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Therapeutics Shock
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Therapeutics - Shock
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Therapeutics - Shock
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  1. What are the classical findings of Shock?
    • “Low” BP
    • Tachycardia
    • Cool, clammy skin (not in distributive/septic shock)
    • Warm, flushed skin (distributive shock)
    • Altered mental status
    • Oliguria
    • Metabolic Acidosis
  2. What constitutes shock?
    • MAP < 60 mm Hg or
    • SBP < 90 mm Hg
    • (Relative for patient)
  3. In the presence of Low BP and the HR is too fast/slow, what is the likely eitiology?
    Pump/heart problem
  4. In the presence of Low BP and the Stroke Volume (SV) is low, what is the likely eitiology?
    • Fluid problem = not enough fluid
    • Could also be a pump/heart problem
  5. In the presence of Low BP and the SVR is low, what is the likely eitiology?
    Container/systemic problem
  6. What should you monitor for (labs) if a person has shock?
    Hemoglobin, WBC, platelets, PT/PTT/INR, electrolytes, ABG, Ca, Mg, BUN, Cr, LFTS, bilirubin, lactate, toxicology screen, cardiac enzymes
  7. What is the basic framework to the clinical approach for Shock treatment?
    • Monitor hemodynamics and enhance perfusion:
    • -Stop any adverse medications
    • -Control heart rhythm
    • -IV fluid
    • -Vasopressors and/or inotropes
    • Ensure O2 delivery:
    • -Protect airway
    • - Minimize consumption
    • Pain control, sedation, paralytic:
    • - Support with mechanical ventilation if needed
    • Identify (and treat) the source
    • Monitor for developing organ failures
  8. What is a normal Systolic blood pressure (SBP)?
    108-140 mm Hg
  9. What is a normal Mean arterial pressure (MAP)?
    80-100 mm Hg
  10. What is a normal Heart rate (HR)?
    60-100 beats/min
  11. What is a normal Cardiac output (CO)?
    4-7 L/min
  12. What is a normal Cardiac index (CI)?
    2.8-3.6 L/min/m2
  13. What is a normal Ejection fraction (EF)?
    50-70%
  14. What is a normal Diastolic blood pressure (DBP)?
    70-90 mm Hg
  15. When performing hemodynamic monitoring of a shock patient are BP, HR, oxygen saturation sufficient in sepsis?
    • No, need MAP
    • Need to monitor S/S of hypoperfusion
  16. What type of line, used to measure MAP, can also be used to deliver medications?
    Pulmonary aterial catheter and Central venous catheter
  17. What type of line, used to measure MAP, cannot also be used to deliver medications?
    Arterial line
  18. What can an arterial line be used to assess?
    • Continuous blood pressure monitoring (MAP)
    • Line used for blood draws, ABGs, not to administer meds
  19. What can a Central venous catheter be used to monitor?
    • Marker of volume status and systolic return to heart
    • Validity in sepsis questioned
    • Can administer fluids and vasoactive agents
    • Assess changes in fluid status
  20. What is a Quinton catheter?
    Non-tunneled central venous catheter
  21. What is a Hickman or Groshong catheter?
    Tunneled central venous catheter
  22. Which type of line can be used to assess the type of shock?
    Pulmonary Artery Catheter
  23. What does CV measure and what is a normal value?
    • Right heart preload
    • 2-6 mm Hg
  24. What does the Pulmonary capillary wedge pressure (PCWP) measure?
    • Left heart preload
    • 8-12 mm Hg
  25. What does Pulmonary vascular resistance (PVR) measure?
    • Right heart afterload
    • 80-120 dynes/s/cm-5
  26. What does Systemic vascular resistance (SVR) and what is a normal value?
    • Left heart afterload
    • 800-1200 dynes/s/cm-5
  27. What hemodynamic effects does Hypovolemic shock present with?
    • Decreased: Preload/PCWP, CO/Pump function, Mixed venous O2 saturation/tissue perfusion
    • Increased: SVR
  28. What cardiogenic effects does Hypovolemic shock present with?
    • Decreased: CO/Pump function, Mixed venous O2 saturation/tissue perfusion
    • Increased: Preload/PCWP and SVR
  29. What cardiogenic effects does Hypovolemic shock present with?
    • Decreased: Preload/PCWP and SVR
    • Increased: CO/Pump function, Mixed venous O2 saturation/tissue perfusion
  30. Why do the peripheries feel warmer in Distributve shock?
    Increased CO and decreased SVR (dilation) leads to well perfused peripheries
  31. What is the goal MAP when treating patient with shock?
    > 60 mm Hg
  32. What is the goal PCWP when treating patient with shock?
    15 - 18 mm Hg
  33. What is the goal Cardiac Index (CI) when treating patient with shock?
    • > 2.1 (cardiogenic/obstructive shock)
    • > 4.0 - 4.5 (septic/hemorrahgic shock)
  34. What is the goal Hemoglobin when treating patient with shock?
    > 10 g/dL
  35. What is the goal SaO2 when treating patient with shock?
    > 92%
  36. What is the goal SvO2 when treating patient with shock?
    > 60%
  37. What is the goal PaO2 when treating patient with shock?
    > 60 mm Hg

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