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109 ch. 15

Shock

QuestionAnswer
Definition of shock tissue perfusion is inadequate to deliver O2
what are three components affected by shock pump, vascular tree, blood volume
Classifications of shock hypovolemic, cardiogenic, septic, neurogenic, anaphylactic
what is hypovolemic decr intravascular volume due to fluid loss
what is cardiogenic impairment or failure of myocardium
what is septic shock overwhelming infection causing hypovolemia
what is neurogenic shock loss of sympathetic tone causing relative hypovolemia, warm skin b/c no SNS
what is anaphylactic shock severe allergic reaction producing overwhelming systemic vasodilation, hypovolemia
what is cellular effect of shock fluid surrounds cell and Na leaks into cell then water and K leaks out
what happens in anaerobic metabolism produce lactic acid, cells swell, incr permeability, impaired Na/K pump, cell death
How does BP respond to shock barorecepters, kidneys: angiotension I to II = vasoconstriction, aldosterone (hold Na & H2O), ADH(hold H2O)
How do you get MAP 2xDBP + SBP/3 SV = 50-70 PP = DBP-SBP
three stages of shock compensatory, progressive, irreversible
what is compensatory shock SNS causes vasoconstriction (cool to touch), incr HR, incr heart contractility. Blood shunted causing clammy skin, decr urine, acidosis, resp incr to cause resp alkalosis
What happens wtih progressive stage of shock DBP decr, then SBP decr, confusion, lungs begin to fail, dysrhythmias, ischemia
MAP below 65 means GFR not fx so acute renal failure, DIC- clotting everywhere, organs fail(MODS), can't survive
Tx for shock fluid replacement(crystalloid, colloid), nutritional support, vasoactive therapy, modified trendelenburg
what is primary goal for cardiogenic shock oxygenation drugs: dobutamine, nitro, dopamine
septic, neurogenic, anaphylactic shock all constitute circulatory shock
what is last thing to change in shock pts when declining pupils last to change in neuro changes
what is typical order of events for changes lungs, hepatic/renal dysfx(7-10d), hematological, cardiovascular, neurological
Created by: palmerag