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Flashcards in shock Deck (69)
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1

what is shock

Impaired O2 delivery/utilization

Increased O2 consumption

asymmetry in supply and demand

2

why do we care about shock

hypo-perfusion

When it becomes irreversible (cells start to die) > multi-organ failure and death

3

what decreases supply

Pump failure

Decreased total blood volume

Poor vascular tone (vessels can’t be leaky)

4

What can increase demand?

Exercise
Infection
Meds/toxins
Hypermetabolic states (hyperthyroidism, pregnancy, anemia)

5

poor vascular tone

leaky blood vessels

6

kidney failure looks like

increase in Cr

fluid retention
(urine output is decreased)

might need a catheter

7

loss of perfusion to the brain looks like

altered mental state
agitation
loc
confusion
intracerebral bleeding
coma

8

loss of perfusion to the lungs can result in

acute respiratory distress

9

drugs that cause shock

prescription medications
toxins

10

BP

CO times SVR (systemic vascular resistance)

11

co

SV (amt of blood you are pushing out)

times HR

12

anaphylaxis and toxins have a direct effect on

SVR (systemic vascular reserve)

13

What happens when we don’t have O2

We go through the process of fermentation. We get a build up of lactate

14

what happens when you get a lactic acid build up?

You get lactate build up bc it disrupts the electrolyte balances in the cell. We see influx of Ca++ and it triggers a process called apoptosis.

15

respiratory complications of

tachypnea
SOB
can go into ARDS
(lungs fill with fluid and lungs are crying bc they are not getting enough oxygen),

16

The normal blood lactate concentration in unstressed patients is

0.5-1 mmol/L.

something around 2

17

Early sign shock

MAP decreased 10 mmHG

effective compensation

O2 is still getting to vital organs and

increased heart rate

18

what are compensatory signs

MAP down 10-15 mm Hg
increased RENIN and ADH

-->vasoconstriction

decreased PP
increased HR
decreased pH
restless
apprehensive

19

progressive signs (intermediate)

decreased MAP 20 mm Hg

tissue organ hypoxia
decreased UO
decreased pH
weak rapid pulse

sensory changes

20

refractory signs irreversible

excessive cell organ damage

multisystem failure and decreased pH

21

this is where you start to see cellular damage. Kidneys start to fail

Progressive signs of shock

22

Coagulation of shock

PT/INR will be elevated, DIC is present (purpura, INR will be through the roof)

23

effect on kidneys

decreased urine output, get creatinine

24

cardiac markers of shock

tachycardia, chest pain, EKG disturbances

25

Liver effects

hypotensive, LFTs (AST/ALT in the 1000s --> this is shock liver), bilirubin and albumin can be high

26

your vascular tone is failing (leaky blood vessels)

i. Distributive shock

27

Distributive shock what is happening

Something is telling them to dilate and it causes leakage of nutrients into the interstitium. So even though your blood volume is good, your blood vessels are leaky so they are not getting the nutrients

SUPPLY

28

hypovolemic

not enough gas in your tank. Pump is working and vascular tone is good but don’t have enough volume

SUPPLY

29

Cardiogenic shock

DEMAND

pump failure can't get the blood where it needs to be

NO FLUIDS

fluid in lungs--> need to intubate--> sedation drops pressure--> coding

30

obstructive shock

SUPPLY
everything is working but there is something blocking and you're not getting O2