Shock and Sepsis PDF

Sepsis/Shock  · -  Shock Types Hypovolemic · Cardiogenic · · Distributive ↳ Anaphylactic septic ↳ eurogenic  Shock Phases 1) Decreased Cardiac Output and RAAS Activation...

Sepsis/Shock  · -  Shock Types Hypovolemic · Cardiogenic · · Distributive ↳ Anaphylactic septic ↳ eurogenic  Shock Phases 1) Decreased Cardiac Output and RAAS Activation 2) Increased Sns Activation 3) Brincreases (initially) Heart Rate increases (initially) 4) Lactic Acidosis occurs 5) vasodilation occurs wl increased permeabilitation) 6) Hypotension Failure organ Death Medical Management Perfusion Tissue To Improve and Perseve deficit · shock-restore fluid · In Hypovolemic shock-optimize Cohe Squeeze) In cardiogenic · CO shock-fill the tank +Optimize · In distributive  Shock Hypovolemic loss state or massive fluid caused by blood loss states Examples 1-Hemornage Trauma - Burns 2- Dehydration Athletic - Activity , it is best to replace what was lost When managing will need blood not 10 fluids If the patient was bleeding - of they are in shock phase they be hypotensive, will be up , may tachycardic , lactic acd have decreased arime output /prevenal cause ( (Prevenal Acute Kidney Injury) due to perfusion clammyskihtachycardiaput Signs Symptoms; cool anxiety  Hypovolemic Shock Management 10 fluids Crystalloids = · Example : -Normal Saline 0. 9% A Plasmalyte Type - (Preferred over Us) Burnt pts Lactated Ringers - - · Colloids Examples volume in intravascular ( - Albumin ladds BloodProducts · Example: Packed Red Blood Cells - Massive Transfusion Protocol - Pt thats bleeding , don't give fluids , it will lead to coagulopathy  Hypovolemic Shock Management IV us po choose under certain circumstances Jams ,vomiting condition in which , intubated or any po is not feasibleuse IV they've received zofran po If vomiting but ; use 1 )Poor man's. cardiac output-urine output cuse foley no pee no bueno (may need extra volume = expansion 2)Passive raise determines fluid responsiveness leg - -Takewaitminragphe responsive GO TO 17 3) Hemodynamic Monitoring Give fluids if lost Vigieo monitoring (artenal line Give blood if - lost - stroke volume variation , CVP  Il HypovolemicShock Denydration ilBurns slisleeding volume, v - Hemorrhage ~ ~ Espe ~ ~ HR - Drink fluids Parkland Formula Give Blood I replace fluids MTP-DTXacid IV fluids to LTEG demonstrate they - Cratio 42: / can tolerate po clook at urine output) and can pee - complications coagulopathya  Shock Cardiogenic - A result of failure of the heart forward to effectively pump blood The end result Decreased Tissue Perfusion I Circulatory Failure most common cause is post MI Other causes: Cardiac tamponade,PE, septal rupture , valvular heart disease Manifestations SBP-Gommty · cool pale, moist skin · offeart Rate->100ppmurine output