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Shock

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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  


   






 
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Created by: dnoyes