Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Shock, etc
Week 9
| Term | Definition |
|---|---|
| Shock patho | LIFE THREATENING condition with circulatory system cannot meet O2 tissue demands. Main components include CO, oxygenation, MAP (2xdiastolic) +systolic/3 |
| Initial stage of shock | compensation with mild vasoconstriction and subtle HR increase, MAP decreases 5-10 below baseline |
| Compensatory stage of shock | Increase in vasoconstriction, RR/HR go up, low BP, decreased urine output and increased BGL, mild acidosis/hyperkalemia, MAP decreases 10-15 below baseline |
| Progressive stage of shock | Compensation failed, moderate acidosis and hyperkalemia, vital organs are hypoxic, MAP decrease 20 below baseline |
| Refractory stage of shock | cell death, irreversible damage, multi system organ failure |
| A-line | small catheter in artery, continuous BP monitoring, easy access to arterial samples, not used for fluids, allen test before, monitor for bleeding (keep in view) |
| Pulmonary Artery Catheter | Swan Ganz, inserted in large vein and threaded through right atria and ventricle (sits in pulmonary artery). hemodynamic monitoring, blood samples/infusions, measures CVP/PAP/PAWP/CO. Level transducer with phlebostatic axis/ Zero system. Chest xray done |
| Pulmonary artery pressure | BP of pulmonary artery. systolic 15-30, diastolic 4-12. Low: normal/hypovolemia (vasodilation). High: pulmonary HTN, R HF |
| Cardiac Output | 4-8 liters/min. Low: MI, shock. High: early septic shock, hypervolemia, hyperthermia |
| Central Venous Catheter | central line in vena cava, infuse fluids/meds, TPN, transvenous pacemaker insertion. CVP monitoring 2-6 range. Low: hypovolemia. High: R HF, pneumothorax, pulmonary HTN, tamponade |
| Labs and Diagnostics for shock | ABGs, venous O2 sat, lactate (anaerobic metabolism, normal 0.3-2.6), CBC, chemistries (liver/renal/glucose) |
| Inotropic agents | MILRINONE, DOBUTAMINE. Strengthen cardiac contractility, increase CO, constant hemodynamic monitoring, admin with vasopressor |
| Vasopressors | DOPAMINE, NOREPI. Strengthen cardiac contractility, increase CO, influence kidney perfusion (monitor urine output), given through central line |
| Pituitary hormone / Vasopressin | Causes vasoconstriction, systemic vascular resistance; continuous titratable infusion. Monitor urine output, given in central line |
| Sympathomimetics | EPI. rapid acting bronchodilator and increases HR/CO |
| Vasodilator | SODIUM NITROPRUSSIDE. treats cardiogenic shock, decreases CO/afterload. Need a-line and is titratable. If BP does not increase in 10 min at 10mcg/kg/min discontinue med. Protect from sunlight |
| S/S of cardiogenic shock | Acute MI symptoms then progresses to hypotension, decreased LOC/urine output, weak pulses, pale and cool skin, decreased bowel sounds, SOB, crackles |
| Cardiogenic shock labs | EKG, echo, CT, cardiac enzymes (troponin, BNP), cardiac catheterization, chest xray, ABG, chemistries, lactate |
| Treatment for cardiogenic shock | stabilize O2, increase BP/CO. Give oxygen via nonrebreather mask, vasopressors (increase BP/cardiac work) nitroglycerin and nitroprusside (decrease afterload/preload). Morphine, fent, intra-aortic balloon pump, VAD, Aline |
| Initial hypovolemic shock s/s | increased HR, restless and confused, decreased urine output, weak pulses, sluggish refills, decreased BS, hyperglycemia |
| Failure (hypovolemic shock s/s) | lethargy, hypotension, acidosis, anuria, cyanotic/cold skin, weak/absent pulses, dysrhythmias, coma, severe hypotension progression, necrotic/cold extremities, organ failure |
| Labs for hypovolemic shock | ABG, H and H, chemistries, lactate |
| Treatment for hypovolemic shock | Airway with nonrebreather, fluid resuscitation, goal MAP above 50, large bore IV access, fix bleeding (FAST exam), CT |
| Obstructive shock | CARDIAC TAMPONADE / PE. symptoms of cardiac tamponade: Beck's triad (muffled heart sounds, low pulse pressure, signs of R HF) |
| Treatment for obstructive shock | airway (intubate or NRB mask), vasoactive meds, pericardiocentesis for cardiac tamponade (needle in pericardial sac or echo), post procedure chest xray. PE: anticoags, thrombolytics, thrombectomy, embolectomy |
| Distributive shock | Result of disease that causes widespread vasodilation. SEPTIC, NEUROGENIC, ANAPHYLACTIC. |
| Neurogenic shock (distributive) | Spinal cord injury (above t6), regional spinal anesthesia or brain injury. Causes disruption in Sympathetic NS. |
| Neurogenic shock (distributive) s/s | hypotension, bradycardia, peripheral vasodilation, warm/dry skin, decreased resp rate |
| Neurogenic shock (distributive) treatment | correct primary cause and treat hypotension/bradycardia. Fluids, vasoactive meds, atropine, transcutaneous/transvenous pacing |
| Neurogenic shock (distributive) nursing interventions | vasoactive meds with vitals q1-2hrs, hemodynamic monitoring, intake/output q1-2hrs, assess at least q4hrs, raise HOB slowly (orthostatic hypotension), thromboembolism precautions |
| Anaphylactic shock (distributive) | severe reaction. Widespread histamine release, dilation of veins and smooth muscle contraction. Common triggers are food, meds, and abx |
| Symptoms of anaphylactic shock | SOB, wheezing/stridor, cyanosis, confusion, hypotension, cool/clammy skin, weak pulses, edema, flushing, urticaria, angioedema, tachy |
| Treatment for anaphylactic shock | Remove trigger, do not induce vomiting, IM epi is first treatment. Airway, oxygen, intubation. IVF, antihistamines, corticosteroids, bronchodilators |
| Septic shock (distributive) | Life threatening organ dysfunction caused by dysregulated host response to infection. Amplified and uncontrolled inflammatory response (systemic inflammation / vasodilation) |
| symptoms of septic shock (distributive) | vasodilation - early: tachycardia, bounding pulses, warm/flushed skin, febrile, may have normal BP, confusion, decreased urine output. Late: cool/pale skin, weak/thready pulse, hypothermia, hypotension, coma, lethargy, anuria |
| treatment for septic shock | First hr: 30mL/kg of fluids over 3 hrs (decreases mortality). Norepi added if needed. Labs (lactate, 2 BLOOD CULTURES, CBC, coag, CMP, ABG). abx within 1 hour of identification and MAP over 65 |
| Disseminated intravascular coag (DIC) | condition that puts you at risk for clotting and bleeding at same time. Decreased fibrinogen, increased fibrin, increased d-dimer/PT/APTT, treat cause. Fluid replacement and clotting factors (fresh frozen plasma/platelets) |
| Multiple Organ Dysfunction Syndrome (MODS) | multiple causes (including sepsis). Two or more organs are failing, first seen is lungs (ARDS), then renal, hepatic and GI. Control infection, O2, vascular volume |
| Septic shock assessment | metabolic profile, lactate, coag, skin, bleeding, ABGs, oxygen sat, urine output, VS, neuro status |
| Septic shock nursing interventions | infection control, oxygen, prepare/assist with intubation, fluids, cultures, vasoactive, mouth care, supportive care |
| Triage | sorting of patients based on need for treatment, ABCD, most commonly used is Emergency Severity Index (ESI) in ED (3 or 5 levels, lower is more critical) |
| Primary Trauma assessment | immediately on arrival: ABCDE, full PPE for yourself. Open airway, cspine, oxygen, intubation, hemorrhage (volume resusc), 2 large bore IVs (IO if not), fluids, LOC/GCS |
| Exposure priority interventions | remove clothing for physical exam (preserve evidence), prevent hypothermia (warmed fluid/blankets) |
| Secondary trauma survery | stable vitals - head to toe, interventions (FAST exam, foley catheter, gastric tube) |
| Blunt trauma | (does not break skin). Acceleration: sudden increase. Deceleration: moving then abrupt stop. Compression: pressed between two immovable forces. Shearing: sliding |
| Penetrating trauma | Object penetrates trauma (weapon or glass), classified with amount of energy. Extent of damage based on characteristics of object |
| Thoracic injuries | Life threatening (aorta, heart/lungs). Blunt cardiac: myocardial contusion, cardiac rupture, sternal fracture, broken ribs. Blunt pulmonary: rib fractures (3+ ribs in 2+ areas is flail chest), hemothorax (blood enters pleural space), pulmonary contusion |
| Abdominal injuries | Blunt abd: FAST exam. Compression: sandwich the vertebral column. Shearing: rapid deceleration can cause tears/ruptures. Pelvic fractures: stable vs unstable, GU issues as well (bladder rupture) |
| Activated charcoal | admin via GI tract (drink or NG/OGtube). ONLY WITHIN 60 MIN OF INGESTION. Side effects: abd pain, n/v, constipation/diarrhea. Aspiration precautions. Not for caustic agents, bowel obstruction, no airway, prolonged time |
| Eye irrigation | flush out eye with water/saline, morgans lens if indicated, check pH (should be neutral when you stop flushing) |
| Skin irrigation | identify contamination. remove pt from source and dispose of clothing. Wash hair/nails, wear PPE, use soap and water |
| Poisoning / overdose (Opioid) | identify and call Poison Control (800-222-1222). S/S: pinpoint pupils, hypotension, resp depression, seizures, decreased LOC. Give NALOXONE. No resp/pulse: CPR, AED. When recovered, referral for substance abuse |
| Poisoning / overdose (salicylates/aspirin) | Acid base disturbance, hypoglycemia and dehydration. Early: tachypnea, tinnitus, N/V. Severe: hypothermia, AMS, pulmonary edema, rhabdo. Labs (abg, lactate, charcoal, bicarb, glucose). Hemodialysis, reassess, monitor urine pH q2hrs |
| Poisoning / overdose (Tylenol) | acute is over 150mg. no symptoms 1-3 days after ingstion. First 24 hours: N/V, RUQ pain. 24-72 hrs: vomiting. 72-96 hrs: renal/liver failure. Labs (preg, CBC, liver, coag, chem). Treat with charcoal, NAC, antiemetics |
| Poisoning / overdose (benzos) | will see CNS/ resp depression, ataxia, AMS, barbiturate blisters. Labs (med levels, tox screen, glucose, ABG, preg). Treat with FLUMAZENIL and naloxone if opioids included. Charcoal can be given, hemodialysis, supportive care for resp depression |
| Poisoning / overdose (TCA) | LIFE THREATENING. anticholinergic side effects (dry, red, hot, blind, mad) |
| Poisoning / overdose (SSRIs) | unremarkable; serotonin syndrome (hyperthermia, diaphoresis, clonus, hypertonia, tremor, muscle rigidity leading to rhabdo). Treat with fluids, charcoal, antiarryhtmics, vasopressors, supportive care. EKG/cardiac monitor, resp/hemodynamic monitor |
| Poisoning / overdose (beta blockers) | Will see bradycardia, hypotension, arrhythmias, hypothermia, hypoglycemia, seizures, cardiogenic shock. Labs (glucose, cardiac enzymes, EKG/ABG, chest xray) GLUCAGON is antidote. fluids, atropine, magnesium, bicarb, benzos (seizures), dialysis |
| Poisoning / overdose (alcohol) | watch for withdrawal. Elimination is 100mg/kg/hr for 70kg person. head CT if injured, fluids, thiamine (to prevent seizures), benzos, supportive |
| Mild hypothermia | 89.6 - 95F. Sympathetic NS compensates (vasoconstriction). Shivering, increase in BP/HR/RR, hyperglycemia, mild confusion, ataxia, diminished fine motor |
| Moderate hypothermia | 82.4 - 89.6F. Compensation starts to fail, violent shivering then stops, worsening AMS/coma, dilated pupils, decrease VS, arrhythmias, lactic acidosis, hypokalemia |
| Severe hypothermia | Below 82.4F. Body shuts down, compensation fails. Decreased CO/arterial pressure. Severe hypotension, muscle rigidity and death |
| Treatment of hypothermia | oxygen/intubation, cardiac monitoring, IVs, EKG, remove from cold/remove wet clothes, warm blankets/lamp, ECMO, warmed fluids |
| Cardiopulmonary bypass / extracorporeal membrane oxygenation (ECMO) | blood is pumped outside of body to a machine, removes CO2 and sends rewarmed oxygenated blood to the body. Allows for rest but not a cure |
| Frostbite treatment | prevention, warm environment, remove wet clothing, warm water, don't walk on frostbitten feet, severe may result in amputation. |
| Hyperthermia | Body temp 103F, young/old at risk (as well as fever, diabetes, PAD, HTN, substance abuse, athletes). |
| Heat exhaustion | Temp higher than 100.4F and lower than 104F. Profuse sweating leading to excessive sodium/water loss, fatigue, weakness, dizziness, headache, n/v, muscle cramps. |
| Heat stroke | MEDICAL EMERGENCY. Greater than 104F. Stopped sweating, s/s of heat exhaustion with neuro symptoms (seizure, AMS, coma). Can lead to pulmonary edema, rhabdo, dysrhythmias, renal failure, shock, MODS |
| Hyperthermia treatment | move pt to cool area, fluids, sponge bath, ice packs to axilla/groin, cooling blanket/fan. Submerge in tepid water |
| Snake bites | Neurotoxic effects of venom (block acetylcholine). Weakness, paralysis, destroys RBCs, edema, erythema within 30-60 min; bullae within 8 hours and causes DIC/compartment syndrome |
| Treatment for snake bites | consultation. Do not apply tourniquet, no ice/alcohol, wound care is same for all: clean and tetanus update. Abx not recommended. Monitor for tissue edema, give IVF, antivenin |
| Spider bites | Brown recluse, black widow and hobo spider. Treatment depends on spider type. Cleanse wound, elevate, cold compress, wound care, tetanus update |
| Drowning | Initial treatment: restore O2/ventilation, treat hypoxia, maintain neuroprotection/cardiac stability, hypothermia is common. Slow, active rewarming. Intubation, CPR/O2, IV |
Created by:
user-2007851