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Resuscitation, Shock, and Blood Products
Terms in this set (36)
What is a SVO2?
Where is it drawn from?
What does it represent?
SVO2 = Mixed venous oxygen saturation
Where is an SVO2 drawn from?
Distal port of a PA catheter
What does an SVO2 represent?
-Average O2 extracted from Hgb throughout the body
What is a normal SVO2?
Which means that the body uses 25% of O2 under normal conditions
What is the vicious cycle of the initial stage of shock?
-Decreased microcirculatory flow = decreased O2 delivery = hypoxia = hypoxic cells want more O2 = O2 stores consumed = anaerobic metabolism = lactic acid production
Lactic acid production is happening and we haven't even seen the Signs/Sx yet.
What is an early marker of shock?
Begins to rise before obvious clinical signs.
How is the vicious cycle continued in compensatory shock?
DO2 ↓↓ =↑↑ VO2 = already oxygen depleted environment =↑↑↑↑ lactic acid
What are the 3 types of shock compensation?
-Neural = baroreceptors = autonomic
-Chemical = chemoreceptors
-Hormonal = RAAS, ADH, Cortisol, Epi/NorEpi from Adrenal Medulla
In what stage of shock will acidosis, hyperkalemia, and climbing lactate be seen?
What is the triad of signs indicated decompensatory shock?
MAP 20 below baseline
Altered mental status
We all know to think about excessive vasodilation in septic shock, but what else do we need to remember?
Altered blood flow to the capillary + inflammation = micro clots
What 3 physiologic functions are disrupted in liver damage?
1. Inability to detoxify
2. Inability to clot
3. Inability to create protein with oncotic force
What 4 criteria are used to diagnose cardiogenic shock?
1. Sustained SBP < 90 x30+ min
2.MAP 30 mmHg below baseline or < 65mmHg
3. CI < 2.0
4. PCWP > 18
What three assessments can help you diagnose cardiogenic shock?
1. Clinical presentation
What is the most common cause of cardiogenic shock?
LV failure due to AMI
What are the 5 major determinants of myocardial oxygen consumptons?
4. Myocardial wall tension
What is the neurogenic shock triad?
What are the MAP goals of neurogenic shock?
85 - 90 mmHg
What clinical assessment findings indicate neurogenic shock?
-Ability to flex, but not extend elbow
-Grimace to pain above, but not below clavicle
-Hypotension with bradycardia
What is your treatment plan for neurogenic shock?
SpO2, O2, EKG, IV,
Atropine 0.5 mg
Levophed 2-20 mcg/min or
Neo 5 - 200 mcg/min
Why is Epinephrine a first-line agent in the treatment of anaphylaxis?
In addition to B2 bronchodilation, how else does Albuterol benefit patients in anaphylactic shock?
Why do we use corticosteroids to treat anaphylaxis (3)?
1. Stabilizes capillary membrane
2. Reduces inflammatory response
3. Prevents delayed reaction
What is SIRS criteria?
1. Temperature <96.8 or >100.4
2. RR > 20 or PaCO2 < 32
3. HR > 90
4. WBC <4k, >12k, or >10% immature band forms
What is qSOFA?
2. RR > 20
3. SBP > 100
What is the definition of septic shock?
Fluid unresponsive hypotension that requires the use of a vasopressor to maintain a MAP > 65 and a serum lactate > 2
Is fever always associated with infection?
No, 10% of patients are hypothermic.
What are indications that your septic patient has entered DIC?
-Bloody ooze from mucous membranes
-Bloody ooze from IV, foley
-Low H & H
What is the definition of ALI/ARDS?
-Acute onset respiratory failure
-Bilateral pulmonary infiltrates on CXR
-PCWP < 18
-PaO2/FiO2 < 300 (ALI)
-PaO2/FiO2 < 200 (ARDS)
Indication for PRBCs in the medical patient?
Hgb < 7
What are two considerations when performing fluid resuscitation in the septic shock patient?
-Consider addition of PRBC if Hgb < 7
What is your management plan for septic shock?
-SpO2, O2, EKG, IV x2, Vitals
-ABX within 1 hour (defer until adequate perfusion)
-NS 30 ml/kg
-Consider blood if Hgb < 7
-MAP < 65: Levo
-Vaspopressin: pure vasoconstrictor, non-inotrope, non-chronotrope
-Epinephrine: increased MAP, CI, SV, SVR, and HR
What has been removed from PRBCs?
-250 ml of platelet rich plasma
-70% of leukocytes
Increases O2 carrying capacity of the blood
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