Shock

Help

Question

Answer

a clinical condition that results in inadequate cellular perfusion

Shock

oxygenation of tissues is dependent on

adequate oxygen delivery

the amount of oxygen consumed by the tissues per min

oxygen consumption

adequate tissue oxygenation depends on a balance between

O2 delivery and consumption

when O2 demand exceeds the supply

inadequate cellular persusion, anarobic metabolism and cell death occur

what happens during anaerobic metabolism

lactic acid production so check lactate levels

to maintain O2 consumption when O2 demands are high the body will

increased O2 delivery and increase extraction of delivered O2 resulting in decreased SvO2

represents ozygen use from all tissue beds of the body

mixed venous oxygen SvO2

normal SvO2

60-80%

venous blood is the

blood that comes back to the right heart

low SvO2

less than 60

decreased O2 supply compared to demand resulting in

low Hgb, hemorrhage, low CO, and low SaO2

increased O2 demand

fever pain stress, shivering seizures

treatment for decreased O2 supply or increased O2 demand

increase O2 supply, transfusion, increased CO, increased supp O2, PEEP, reduce demand

high SvO2

greater than 80

increased O2 supply

high FiO2, high CO

Decreased O2 demand

hypothermia, anesthesia, hypothyroid

tissues unable to use oxygen (main reason for high SvO2)

sepsis or toxins

treatment for high SvO2

reduce FiO2, wean inotropic agents, warm pt, treat sepsis, increase O2 supply, reposition PA cath

types of shock

ypovolemic, cardiogenic, anaphylactic, neurogenic, septic

inadequate circulating volume, (blood loss, dehydration, fluid shifts)

hypovolemic shock

management of hypovolemic shock

restore circulating blood volume (crystalloids, colloids, blood products), resolve cause of volume loss, gain IV access (warm IV fluids)

failure of heart to pump blood efectively

cardiogenic shock

cause of cardiogenic shock

primarily left vent MI, structural problems(papillary muscle or vent septal reupture), dysrhythmias

What physical findings will you see with cardiogenic shock

increased heart rate, and resp rate, cool moist skin, narrow pulse pressure, low urine output decreased mentation, dyspnea, crackles decreased SaO2

management of cardiogenic shock

increase O2 delivery, PA cath, manage fluid status but DONT overload, diuresis, afterload reduction aiwth amrinone, use inotrope to improve contractility and decrease afterload, mechanical support

distributive shock, maldistribution of all blood, massive dilation

anaphylactic shock

S&S of anaphylactic shock

generalized erythema, urticaria, hives, hypotension, dyspnea, wheezing, laryngeal edema, stridor, decreaed LOC, unresponsiveness

management of anaphylactic shock

prevention, remove antigen, oxygen, fluid replacement, antihistamines, steroids, epinephrine, norepinephrine, levothed, dopamine, epinephrine, comfort for dermatologic manifestations

neurogenic shock

distributive shock, disruption of SNS, lack of sympathetic tone

presentation: bradycardia, warm day skin, hypotension, hypothermai

neurogenic shock

What would you give for neurogenic shock

vasoconstrictor

consequence of the inability to maintain end organ perusion and oxygenation, resulting in injury and organ failure

multiple organ dysfunction syndrome

treatment for oxygen deficit

oxygenate, infuse, perfuse

How to maximize the cardiac index

optimize preload with crystalloids or colloids or titrate to improve CI