Shock
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| a clinical condition that results in inadequate cellular perfusion | Shock
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| oxygenation of tissues is dependent on | adequate oxygen delivery
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| the amount of oxygen consumed by the tissues per min | oxygen consumption
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| adequate tissue oxygenation depends on a balance between | O2 delivery and consumption
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| when O2 demand exceeds the supply | inadequate cellular persusion, anarobic metabolism and cell death occur
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| what happens during anaerobic metabolism | lactic acid production so check lactate levels
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| 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
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| represents ozygen use from all tissue beds of the body | mixed venous oxygen SvO2
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| normal SvO2 | 60-80%
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| venous blood is the | blood that comes back to the right heart
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| low SvO2 | less than 60
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| decreased O2 supply compared to demand resulting in | low Hgb, hemorrhage, low CO, and low SaO2
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| increased O2 demand | fever pain stress, shivering seizures
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| treatment for decreased O2 supply or increased O2 demand | increase O2 supply, transfusion, increased CO, increased supp O2, PEEP, reduce demand
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| high SvO2 | greater than 80
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| increased O2 supply | high FiO2, high CO
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| Decreased O2 demand | hypothermia, anesthesia, hypothyroid
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| tissues unable to use oxygen (main reason for high SvO2) | sepsis or toxins
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| treatment for high SvO2 | reduce FiO2, wean inotropic agents, warm pt, treat sepsis, increase O2 supply, reposition PA cath
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| types of shock | ypovolemic, cardiogenic, anaphylactic, neurogenic, septic
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| inadequate circulating volume, (blood loss, dehydration, fluid shifts) | hypovolemic shock
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| management of hypovolemic shock | restore circulating blood volume (crystalloids, colloids, blood products), resolve cause of volume loss, gain IV access (warm IV fluids)
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| failure of heart to pump blood efectively | cardiogenic shock
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| cause of cardiogenic shock | primarily left vent MI, structural problems(papillary muscle or vent septal reupture), dysrhythmias
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| 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
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| 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
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| distributive shock, maldistribution of all blood, massive dilation | anaphylactic shock
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| S&S of anaphylactic shock | generalized erythema, urticaria, hives, hypotension, dyspnea, wheezing, laryngeal edema, stridor, decreaed LOC, unresponsiveness
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| management of anaphylactic shock | prevention, remove antigen, oxygen, fluid replacement, antihistamines, steroids, epinephrine, norepinephrine, levothed, dopamine, epinephrine, comfort for dermatologic manifestations
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| neurogenic shock | distributive shock, disruption of SNS, lack of sympathetic tone
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| presentation: bradycardia, warm day skin, hypotension, hypothermai | neurogenic shock
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| What would you give for neurogenic shock | vasoconstrictor
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| consequence of the inability to maintain end organ perusion and oxygenation, resulting in injury and organ failure | multiple organ dysfunction syndrome
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| treatment for oxygen deficit | oxygenate, infuse, perfuse
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| How to maximize the cardiac index | optimize preload with crystalloids or colloids or titrate to improve CI
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| increased CO, decreased CVP/PAWP, decreased SVR | Septic shock
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| What do you do for septic shock | fluids and a vasopressor
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| decreased CO, increased CVP/PAWP, increased SVR | Cardio shock
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| what do you do for cardio shock | amirodione, milrinone
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| decreased CO, decreased CVP/PAWP, decreased SVR | Anaphylaxic shock
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| what do you do for anaphylxic shock | antihistimines, epinephrine
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| decreased CVP/PAWP, decreased CO, decreased SVR | neurogenic shock
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| what do you do for neurogenic shock | give fluid volume, and a vesopressor
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| decreased CO, decreased CVP/PAWP, increased SVR | hypovolemic shock
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| what do you do for hypovolemic shock | give volume
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