Shock Sepsis MODS DIC / Hemodynamic notes

What is shock and its primary definition?

Shock is a life-threatening condition where tissue perfusion is inadequate to deliver oxygen and nutrients for cellular function, leading to cell dysfunction and death.

What is Multiple Organ Dysfunction Syndrome (MODS)?

MODS is the presence of altered function of two or more organs in an acutely ill patient requiring interventions to support continued organ function, often resulting from shock.

What are the common types of shock classifications?

Shock can be classified as hypovolemic, cardiogenic, obstructive, or distributive.

What is the primary physiologic response common to all types of shock?

Common physiologic responses include hypoperfusion of tissues, hypermetabolism, and activation of the inflammatory response.

What happens to cells during shock?

Cells lack adequate blood supply leading to anaerobic metabolism, resulting in low energy yields, acidosis, and potential cell death.

What role do catecholamines play in shock states?

Catecholamines are released during stress states, causing hyperglycemia and insulin resistance to provide glucose for cellular metabolism.

What are the three stages of shock progression?

The stages of shock progression are compensatory, progressive, and irreversible.

What vital signs indicate hypotension in a patient at risk for shock?

A systolic BP of 100 mm Hg or lower, or a drop in systolic BP of 40 mm Hg from baseline, or a MAP of 65 mm Hg or less.

How does the body maintain blood pressure during shock?

The body uses complex neural, chemical, and hormonal feedback systems, including the release of catecholamines.

What is the significance of mean arterial pressure (MAP)?

MAP must exceed 65 mm Hg for adequate tissue perfusion and cellular metabolism.

What is the initial management approach for hypovolemic shock?

Correct the underlying cause of fluid loss quickly and restore intravascular volume.

What fluids are commonly used for fluid resuscitation in shock?

Isotonic crystalloid solutions like 0.9% sodium chloride and lactated Ringer’s solution.

What is the '3:1 rule' in fluid resuscitation for hypovolemic shock?

For every 1 mL of blood loss, 3 mL of crystalloid solution should be administered.

How does septic shock differ from other types of shock?

Septic shock is caused by widespread infection leading to circulatory and cellular metabolism abnormalities, resulting in high mortality.

What is anaphylactic shock and its primary cause?

Anaphylactic shock is caused by a severe allergic reaction leading to systemic vascular dilation and capillary permeability.

What common treatments are administered during anaphylactic shock?

Intramuscular epinephrine to restore vascular tone, along with antihistamines and possibly corticosteroids.

What is Disseminated Intravascular Coagulation (DIC)?

DIC is a systemic syndrome characterized by microthromboses and bleeding due to an overreaction of the coagulation cascade.

What are the nursing interventions for patients with shock?

Monitoring vital signs, administering fluids and medications, and providing emotional support to patients and families.

What is the role of nutritional support in managing shock?

Nutritional support helps meet the increased metabolic needs of patients in shock, often requiring more than 3000 calories daily.

A patient, admitted a day ago after a MI is complaining of SOB. Crackles are auscultated in bilateral lung bases. Hemodynamic data is as follows:

BP = 100/60 mmHg; HR = 112 beats/min; PAP = X/24 mmHg;

PAWP = 20 mmHg; CVP = 12mmHg; cardiac index (CI = 2 L/min/m²

A diuretic has just been administered. Which mediation may also be initiated?

A. Nicardipine

B. Phenylephrine

C. Dobutamine

D. Atropine

C. Dobutamine.

Lets first look at the values that tell us about volume. An increased PAP and PAWP indicate the volume on the LEFT side is high. THE CVP is elevated; the volume on the RIGHT is high. The CI is low BUT there is adequate volume so the heart is not pumping blood forward; indicating a contractility issue. This is pump failure, so a priority is to improve contractility. Dobutamine is a positive inotrope; the drug will increase the heart’s pumping (contractility) ability.

A patient is brought to the ED after sustaining a traumatic injury. The patient’s skin is pale and clammy. Capillary refill is greater than 3 seconds. A central line is placed in the right internal jugular (IJ) vein. Hemodynamic measurements are;

BP = 80/50; HR = 122 beats/min; CVP = mmHg

Which agent is indicated for this patient’s hypoperfusion?

A. Vasopressor

B.Vasodilator

C.Plasma expander

D. Positive inotrope

C. Plasma expander.

The first consideration in hypoperfusion is always whether volume is adequate. The CVP is low → the volume on the right is LOW (barely normal). Low? Yes: the CVP is on the low end of normal. Consider your gas tank. If you were going on a trip would you want to”fill” up or just get one gallon of “gas”? You want the tank to be “full”. Fill at least to 6 knowing that 8 mmHg is better. The patient is volume depleted and needs more volume. The best answer is a plasma expander → a fancy way of saying IV lfuids/blood/albumin. Sometimes exam wording is more complicated than needed.