Shock TEST ONLY PDF

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

Shock Shock (âCO âBP âresistance) • State of circulatory failure that impairs tissue perfusion and leads to cellular hypoxia o Ineffective perfusion resulting in organ dmg vital to survival o Irreversible cellular injury results from prolonged shock • Categories of Shock o Low cardiac output shock (Hypovolemic, Obstructive, Cardiogenic) o Distributive shock (Septic, Anaphylactic, Neurogenic) Low Cardiac Output Shock o Hypovolemic shock o Cardiac causes leading to myocardial pump failure (MI, arrythmias) o Extracardiac obstructive (cardiac tamponade) Hypovolemic Shock • Low volume due to blood loss or fluid loss o Rapid heart rate o Rapid breathing o Dilated pupils o Pale, cool skin o 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: o Impaired cardiac filling § constrictive pericarditis § cardiac tamponade (impaired filling due to decreased compliance) >>>> o 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 o Acute MI o Acute myocarditis o Arrhythmias o Cardiomyopathies, dilated o Chronic ischemic heart dz • Symptoms: Weak, irregular/slow pulse • Diagnosis: o Increased BUN/creatinine from renal hypoperfusion o Impaired liver perfusion increases liver enzymes Cardiac Tamponade • Beck’s Triad: o Hypotension o Muffled heart sounds o Jugular venous distension (JVD) 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: o Gram-positive (Streptococcal and Enterococcus) o Gram-negative bacteria o Viruses o 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: o Itching, hives and skin redness o Bronchospasm and respiratory distress o Laryngeal edema and obstruction o Vomiting, abdominal cramps, diarrhea o 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 â blood volume resulting from internal/external fluid loss Tx: fluid replacement Blood transfusion Cardiogenic Shock Obstructive Shock Distributive Shock Ventricular failure Factors: • Acute MI • end stage cardiomyopathy • advanced valvular dz • cardiac arrhythmias Pericardial Tamponade Factors: • pulmonary embolism • cardiac tamponade • tension pneumothorax Inflammatory mediators disrupt blood flow: • Severe sepsis • Anaphylaxis • Neurogenic shock Tx: Underlying cause (heart transplant/treatment) 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? a. Decreased liver enzymes b. Increased white blood cells c. Increased blood urea nitrogen and creatinine levels d. 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