Shock TEST ONLY.docx

Shock Shock (âCO âBP âresistance) State of circulatory failure that impairs tissue perfusion and leads to cellular hypoxia Ineffective perfusion resulting in organ dmg vital to survival Irreversible cellular injury results from prolonged shock Categories of Shock Low cardiac output shock (Hypovo...

Shock Shock (âCO âBP âresistance) State of circulatory failure that impairs tissue perfusion and leads to cellular hypoxia Ineffective perfusion resulting in organ dmg vital to survival Irreversible cellular injury results from prolonged shock Categories of Shock Low cardiac output shock (Hypovolemic, Obstructive, Cardiogenic) Distributive shock (Septic, Anaphylactic, Neurogenic) Low Cardiac Output Shock Hypovolemic shock Cardiac causes leading to myocardial pump failure (MI, arrythmias) Extracardiac obstructive (cardiac tamponade) Hypovolemic Shock Low volume due to blood loss or fluid loss Rapid heart rate Rapid breathing Dilated pupils Pale, cool skin Sweating After ~2hrs of severe shock, may be irreversible even w volume replacement Treatment of Hypovolemic Shock: Replacement of fluid and or blood Obstructive Shock 2 types: Impaired cardiac filling constrictive pericarditis cardiac tamponade (impaired filling due to decreased compliance) >>>> Increased cardiac afterload (R or L side) Large PE Aortic dissection (decrease in lumen size) Cardiogenic Shock Due to failure of heart to pump blood Acute MI Acute myocarditis Arrhythmias Cardiomyopathies, dilated Chronic ischemic heart dz Symptoms: Weak, irregular/slow pulse Diagnosis: Increased BUN/creatinine from renal hypoperfusion Impaired liver perfusion increases liver enzymes Distributive Shock Most common pathologic shock Due to decreased peripheral vascular resistance Septic shock: associated with systemic inflammation Anaphylactic shock Neurogenic shock Septic Shock Causes: Gram-positive (Streptococcal and Enterococcus) Gram-negative bacteria Viruses Fungi Symptoms: Flush, red skin Septic Shock causes multiple organ failure: Kidneys, liver, lungs, heart Tx: Replace fluid and antibiotic Anaphylactic Shock symptoms: release of mediators cause acute vasodilation, increased vascular permeability, smooth muscle spasm Symptoms come quickly: Itching, hives and skin redness Bronchospasm and respiratory distress Laryngeal edema and obstruction Vomiting, abdominal cramps, diarrhea SHOCK distributive type (hypotension, tachycardia) Neurogenic Shock Occurs in trauma to the spinal cord or the brain Low blood pressure is an early sign Normal heart rate (can be elevated) Types of Shock Hypovolemic Shock Cardiogenic Shock Obstructive Shock Distributive Shock â blood volume resulting from internal/external fluid loss Tx: fluid replacement Blood transfusion Ventricular failure Factors: Acute MI end stage cardiomyopathy advanced valvular dz cardiac arrhythmias Tx: Underlying cause (heart transplant/treatment) Pericardial Tamponade Factors: pulmonary embolism cardiac tamponade tension pneumothorax Inflammatory mediators disrupt blood flow: Severe sepsis Anaphylaxis Neurogenic shock Tx: Sepsis: Antibiotics Fluid replacement Anaphylaxis: Allergy meds Neurogenic: Anti-inflamm. (steroid) Surgery Quiz Which of the following laboratory findings fits with a diagnosis of cardiogenic shock? Decreased liver enzymes Increased white blood cells Increased blood urea nitrogen and creatinine levels Decreased red blood cells, hemoglobin, and hematocrit c A patient who has a septic shock. Which of the following is an appropriate treatment for this patient? a. Steroid b. Large amounts of fluid replacement c. Epinephrine d. Administration of nitrates and β-adrenergic blockers b