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28 terms

Shock

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Hypovolemic Shock
Occurs when too little circulating blood volume causes a decrease in Mean Artirial Pressure, which causes a need for oxygen
Causes of Hypovolemic Shock
Acute blood loss (internal or external), or dehydration
Sign and Symptoms of Hypovolemic Shock
Increased Respirations, Heart Rate, Potassium, Creatnine, BUN, lactic Acid and SVR (could be normal)
Decreased CVP, PAP (could be normal), PAWP, Cardiac Output/Index, Pulse pressure, Unrinary Output, hemaglobin, Hematocrit, Blood pressure, pH,
Treatment for Hypovolemic Shock
Oxygen therapy, Fluid replacement and Drug therapy: Drugs that increase venous return, increase cardiac contractility, and perfusion by dialating coronary artiers
Drug Choices for Hypovolemic Shock
Dopamine, norepinephrine, phenylephrine: vasoconstrictors, they increase the workload of the heart and oxygen consumption but increase peripheral resistence and increase venus return to the heart and its contractility
Dobutamine/milarone: increase muscle cell contraction and stimulates beta 1 receptors
nitroprusside: increases blood flow by dialating the coronary arteries
Cardiogenic Shock
The heart muscle is unhealthy and pumping is directly impaired, so oxygenated blood cannot circulate.
Signs and symptoms of Cardiogenic shock
Inceased heart rate, respiratory rate, PAP, PAWP.
Decreased systolic BP, urinary output, pulse pressure, cardiac output/index, oxygen saturation
Causes of Cardiogenic Shock
from any condition that causes left ventricle dysfunction and decreases cardiac output. Most common cause is MI
Treatment of Cardiogenic Shock
Diuretics to keep the patient "dry"
doputamine/milarone: to increase contractility of the heart
Digoxin- decreases blood pressure, and makes the heart pump more effectively
phenalnephrine or neosnephrine: use for MI's
Nitroglycerine: vasodialator that decreases venus return and decrease the workload of the heart.
Intra Aortic Baloon pump: let the heart rest and decrease the oxygen consumption
Do not use dopamine in Cardiogenic shock because it increases the workload and uses more oxygen
Obstructive Shock
Casued by problems that impair the ablility of a normal heart muscle to pump effectively, the heart remains normal but outside conditions prevent either adequate filling or adequate contraction
Causes of Obstructive Shock
pulmonary hypertension, tension pneumothorax, pericarditis, cardiac tamponade, Pumonary embolis
Distributive Shock
Occurs when blood volume is not lost from the body but is distributed to the interstitial tissues where it cannot circulate
Casues of Distributive Shock
nerual induced loss of vascular tone due to trauma to head or spine, chemical induced loss of vascular tone due to sepsis, anyphylaxsis, capillary leak, opiods and sedatives.
Initial/early shock
-decrease MAP of 10 mmHg
- Compensatory mechanisms do a good job at maintaining oxygenated blood to vital organs: vasoconstriction and increased heart rate keep MAP and Cadiac Output up
Nonprogressive/compensatory shock
- Decrease in MAP of 10-15 mmHg
- Kidney Compensatory mechanisms kick in and release Renin, Aldosterone, ADH, epinephrine, Norepinephrine
-tissue hypoxia occurs in non vital organs and kidneys
-no permanet damange yet
Symptoms of Eary/Initual Shock
Increased Heart rate, lactic Acid, blood pressure
Symptoms of Nonprogressive Shock
increased thirst, anxiety, restlessness, tachycardia, increased respirations, decreaed urine output, decreased systolic blood pressure and increased diastolic (narrowing pulse pressure), cool extremities, 2-5% decrease in pulse ox,
Progressive/intermediate shock
-decrease MAP of 20 mmHg
-compensatory mechanisms are functioning but cannot deliver enough oxygen to vital organs
- vital organs become hypoxic and less vital organs become anoxic and ischemic
Symptoms of Progressive/intermediate shock
severe thirst, deeper anxiety, confusion, rapid weak pulse, low BP, pallow to cyanosis of mucous membranes and nailbeds, cool, moist skin.
pulse ox decreased 5-20%, decreased pH, and increased lactic acid and potassium
Refactory/ irreversable Shock
To much death and tissue damage has occured. Vital organs have had overwhelming amount of damage. The body cannot respond effectivly to intervensions and shock continues
Symptoms of Refactory/Irreversable Shock
Rapid loss of concousness, non palpable pulses, cold mottled and dusky extremities, slow shallow resps, and unmeasureable oxygen saturation
ADH
increases water reabsorption and urine concentration
Aldosterone
Affects reabsorption by regulating sodium retention and helps control potassium secretion
Renin
regulates Blood pressure when there is a decline in extracellular fluid volume
CVP
represents preload, so if CVP is low that means the tank needs to be filled. decreased fluid volume.
PAWP
gets the pressure on the left side of the heart
SVR
systemic vascular resistence. and increase indicates that the left ventricle is not pumping all the blood out
PAP
right ventricle afterload