NP certification

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Author:
northlover
ID:
54805
Filename:
NP certification
Updated:
2010-12-10 12:28:59
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Shock states
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shock states
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  1. Hypovolemic shocks causes
    • 1. Internal/external bleedings
    • 2. Burns
    • 3. DKA/HHNK
    • 4. Severe dehydration
    • 5. Others
    • Results from a loss of greater than 20% of circulating blood volume
  2. Hypovolemic Shock Laboratory /Diagnostics
    • 1. Decreased CO/CI (normal 4-8 l/min/2.5-4 l/min)
    • 2. Decreased CVP (central venous pressure, normal 0-6)
    • 3. Decreased PCWP (pulmonary cappillary wedge pressure, normal 6-12)
    • 4. Increased SVR (normal 800-1200)
    • 5. Decreased SVO2 (mixed venous saturation, N. 60-80%))
  3. Hypovolemic shock management
    • 1. fluid resusciation
    • 2. PRBCs when indicated by Hgb/hct
  4. Cardiogenic Shock
    A loss of effective contractile function results in impaired cardiac output, impaired oxygen delivery, and reduced tissue perfusion
  5. Cardiogenic Shock causes
    • 1. Acute MI- most common cause
    • 2. Ventricular aneurysm
    • 3. Dysrhythmia
    • 4. Pericardial tamponade
    • 5. Hypoxemia
    • 6. Pulmonary edema
    • 7. Acute valvular regurgiation
    • 8. Acute VSD
  6. Cardiogenic shock diagnostics
    • 1. Decreased CO/CI
    • 2. Increased CVP (0-6)
    • 3. Increased PCWP (6-12)
    • 4. Increased SVR (800-1200)
    • 5. Cecreased SV02 (60-80)
  7. Cardiogenic shock management
    • 1. Careful administration of fluids
    • 2. Vasopressor support (dobutamine, dopamine, etc)
    • 3. Nirtorglycerin IV if ischemia present
  8. Distributive shock
    • Three forms of schock characterized by vasodilation, decreased intravascular volume, reduced peripheral vascular resistance, and loss of capillary intergrity.
    • Distributive shock may be septic, anaphylactic, and neurogenic
  9. Septic Shock
    Caused by infective organisms which invade the bloodstream and alter vascular tone. Hypovolemia develops as a result of blood pooling in the microcirculation
  10. Septic Shock laboratory/diagnosics
    • 1. Blood cultures
    • 2. Increased CO/CI (4-6/2.5-4)
    • 3. Decreased CVP )0-6)
    • 4. Decreased PCWP (6-12)
    • 5. Decreased SVR (800-1200)
    • 6. Decreased SV02 (60-80)
  11. Septic Shock management
    • 1. fluid resuscitation is mainsaty of treatment (crystallooid)
    • 2. Vasopressor agents (Dobutamine, Levophed, etc.0
  12. Anaphylactic shock laboratory /diagnostics
    • Ig .e mediated reaction that occurs shortly after exposure to an allergen
    • 1. Decreased CO/CI
    • 2. Decreased CVP (0-6)
    • 3. Decreased PCWP (6-12)
    • 4 Decreased SVR (800-1200)
    • 5. Decreased SVO2 (60-80)
  13. Anaphylactic shock management
    • 1. Maintain airway
    • 2. Diphenhydramine 25-75 mg IM (adult)
    • 3. Epinephrine 0.3-0.5 mg sq or IM for respiratory distress, stridor, wheezing, etc.
    • 4. Crystalloids for volume expansion
    • 5. Intravenous glucocorticosteroids as needed
    • 6. Inhaled beta agonist for bronchospasm
  14. Neurogenic Shock - loss of peripheralvasomotor tone as a result of spinal cord injury, regional anesthesia, etc.
    Laboratory/diagnostics:
    • 1. Decreased CO/CI
    • 2. Decreased CVP (0-6)
    • 3. Decreased PCWP (6-12)
    • 4. Decreased SVR (800-1200)
    • 5. Decreased SVO2 (60-80)
  15. Neurogenic shock management
    • 1. Maintain airway
    • 2. Cristalloids for volume expansion
    • 3. Vasopressors as needed to maintain blood pressure
  16. Obstructive Shock - inadequate cardiac output as a result of impaired ventricular filling. Causes:
    • 1. Massive pulmonary embolus- most common
    • 2. Tension pneumothorax
    • 3. Acute cardiac tamponade
    • 4. Obstructed valvular disease
    • 5. Disease of pumonary vasculature
  17. Obstructive Shock laboratory/Diagnostics
    • 1. Decreased CO/CI
    • 2. Increased CVP
    • 3. Increased SVR (800-1200)
    • 4. Increased SVO2
    • 5, Decreased PCWP
    • Treatment: Maintain blood pressure while initiating treatment of underlying cause
    • 2. Fluid administration with use of vasoconstrictors (norepinephrine, dobutamine)

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