1Shock syndrome patho
cardiovascular system fails to supply oxygen according to demand due to circulatory compnents leading to hypoperfusion and release of inflammatory mediators
2How do we diagnose Shock
A change in VS, especially a MAP<60 mm Hg accomapnied by evidence of hypoperfusion
3What are s/s of hypoperfusion
decreased urine output, rise in liver enxymes, BUN and Cr, tachypnea, hypoxemia, blood in bodily excretions, hypoglycemia
4Stages of Shock are...
Compensatory, Progressive, Refractory
5Compensatory S/S
increase in heart rate and contractility, vasocontriction
ADH leads to water and sodium retention
gluticosteroids by adrenal cortex cause High BGL
6Progressive S/S
previous stage doesnt meet oxygen demands so...
cells become anaerobic which has a by product of lactic acid
vasodilation, tissue edema
7refractory S/S
MODS (irreversible), death
8Types of Shock
cardiogenic, hypovolemic, obstructive, distributive
9Most common form of shock
hypovolemic
10examples of hypovolemic shock
hemorrhage, dehydration, burns
11treatment of hypovolemic shock
-admin isotonic fluids FIRST such as NS
-admin crystalloid solution, blood, colloid solution
-follow 300 mL of NS for every 100 mL of blood lost
12examples of cardiogenic shock
MI, arrhythmias, valve or septal issue, cardiac surgery
13treatment of cardiogenic shock
Inotropic agents increase contractility
Vasopressors increase BP
14Example of inotropic MED
dobutamine
15example of vasopressor
nitroprusside
16What mechanical devices can increase CO
intra-aortic balloon pump and ventricular assist devices
17how does cardiogenic shock lead to hypoperfusion
contractility decreases so blood remains in chambers, this lowers CO and ejection fraction. BP drops so reflex vasoconstriction kicks in, which decreases perfusion in pulmonary capillaries and lowers ox perfusion
18Examples of obstructive shock
cardiac tamponade, tension pneumo, PE
19treatment of obstructive shock
pericardiocentesis, needle thoracentesis, TpA
20how does obstructive show cause hypperfusion
decreased ventricular filling followed by low CO, low BP
21Examples of distributive shock
neurogenic, anaphylactic, septic
22treatment of anaphylactic shock
EPINEPHRINE
REMOVE ANTIGEN
23epinephrine admin and IR
0.2-0.5 mg IM in thigh q5-15 min anterolateral thigh
IR: bronchodilation, vasoconstriction, contractility
24neurogenic shock patho
imbalanced sympathetic/parsympathetic stimulation leads to vasodilation which decreases CO
25common location of neurogenic shock injury
C3 C4 C5
26treatment of neurogenic shock
traction/surgery to stabilize injury, treat hypoglycemia
27how does septic shock lead to hypoperfusion
microorganism initiate inflammatory response which causes massive vasodilation. lactic acid builds up
28treatment of septic shock
antibiotics, NOREPINEPHRINE
29dx for septic shock
2 blood cultures, urine, sputum, and wound cultures to start antibx within ONE HOUR
30MODS def
is the progressive dysfunction of two or more organ systems as a result of an uncontrolled inflammatory response to severe illness or injury
31most common causes of MODS
sepsis and septic shock
32what interventions decrease oxygen demand
sedation, paralytics, antipyretics, analgesics, cooling measures
33What labs to watch in shock
ABGs, lactic acid, hgb, hct, BUN, Cr, liver enzymes, electrolytes