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Shock
| 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 |
| 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
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