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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
increased CO, decreased CVP/PAWP, decreased SVR Septic shock
What do you do for septic shock fluids and a vasopressor
decreased CO, increased CVP/PAWP, increased SVR Cardio shock
what do you do for cardio shock amirodione, milrinone
decreased CO, decreased CVP/PAWP, decreased SVR Anaphylaxic shock
what do you do for anaphylxic shock antihistimines, epinephrine
decreased CVP/PAWP, decreased CO, decreased SVR neurogenic shock
what do you do for neurogenic shock give fluid volume, and a vesopressor
decreased CO, decreased CVP/PAWP, increased SVR hypovolemic shock
what do you do for hypovolemic shock give volume
Created by: dnoyes