types of shock and MODS

hypovolemic shock definition

inadequate intravascular fluid volume , decrease preload stroke volume CO

patho and hemodynamics of hypovolemic shock

decreased preload, MAP, perfusion, organ function

compensatory: high SVR HR and low SvO2

symptoms of hypovolemic shock

tachycardia

tachypneic

hypotension

cool clammy skin

delayed cap refill

oliguria

AMS

diminished pulses

narrow or wide pulse pressure

complications of hypovolemic shock

AKI

ischemic gut

triad of death

MODS

triad of death

hypothermia

acidosis

coagulopathy

pulse pressure

distance between systolic and diastolic

40 is normal

narrow pulse pressure

vessels constrict

wide pulse pressure

vessels dilate

medical management hypovolemic shock

control source

rapid balanced fluid resus

vasopressors only after volume resus if hypotension persists

hemorrhagic shock management

permissive hypotension until hemostasis, MTP

massive transfusion protocol

1 unit PRBC 1 unit FFP and 1 unit plt

non hemorrhagic management

isotonic crystalloids

LR for burns and trauma

nursing management for hypovolemic shock

ABCs, 2 large bore ivs, I&Os, MAP, UO, lactate, hgb, coags

warm prevent hypoterhm, ongoing fluids, frequent reassessment

rapid balanced fluid ressu

dont replace blood with fluid replace with blood but initially use fluid unitl certian point

hypotension is a lack of fluid so do not use

vasoconstrictors

cardiogenic shock causes

acute MI, decomp acute HF, arrhythmias, emchanical complications, myocarditis, and cardiomyopathy

cardiogenic definition

pump failure, inadequate CO despite adequate preload

hemodynamics of cardiogenic shock

low contractility CO CI SvO2 tissue perfusion MAP organ function

high preload SVR HR O2 demand myocard ischemia

pulmonary edema

s/s cardiogenic shock

hypotension, tachycardia, bradyarrhthmia, cool clammy skin, JVD, crackles, chest pain, dyspnea, AMS

complications of cardiogenic shock

acute pulmonary edema, renal failure arrhythmias MODS, high mortality

medical management of cardiogenic shock

revascularization for AMI

treat arrhythmias

be cautious with diuretics

mechanical circulatory support when refractory IABP and Impella etc.

early cardiogenic shock management

hypertension dobuatmine or cautious vasodilators

nsg managment cardiogenic

ECG, strict IO, weights, oxygen vent support, titrate drips, labs, pulmonary edema, arrhytjmias

obstructive shock definition

physical obstruction to cardiac inflow outflow

decreased CO

causes of obstructive shock

massive PE (increase PVR and RV failure)

cardiac tamponade (impaired diastolic filling)

tension pneumo (increase intrathoracic pressure decrease venous return)

hemodynamics of obstructive shock massive PE

HIGH HIGH afterload

low SV CO tissue perfusion organ function

hemodynamics cardiac tamponade and tension pneumo

LOW preload, SV CO TP OF

normal or loa PAOP

PE obstructive symptoms

dyspnea

sudden sharp pleuritic chest pain on deep breaths

tamponade symptoms

muffled heart sounds, pulsus paradoxus

tension pneumo symptoms

severe unilateral chest pain, absent breath soudns, tracheal shift

complications of obsutrctive shock

cardiac arrest (PEA)

RV failure

respiratory failure

PE medical management

thrombolysis or thrombectomy

anticoags

tamponade medical management

emergent pericardiocentesis/pericardial window

tension PTX

immediate needle decompression —> chest tube

supportive medical management obstructive shock

O2 cautious fluids for RV preload vasopressors

pulsus paradoxus

during inspiration bp should go down but with this it goes down in an exaggerate way that the BP will drop 10 points or more

which way does trachea shifts in pneumo

away from affected side

definition distributive shock

maldistribution of blood flow from decreased SVR and relative hypovolemia

hallmark hemodynamics of distributive shock

high/normal CO early

decrease SVR

high SvO2 early

neurogenic shock cause

loss of sympathetic tone after acute spinal cord injury, anesthesia, brainstem injury

hemodynamics neurogenic shock

low BP HR SVR CO from reduced preload

unopposed vagal tone

s/s neurogenic shock

warm dry skin (not clammy) h

low BP HR hypothermia motor sensory deficits

complications neurogenic shock

secondary spinal cord ischemia

organ hypoperfusion

medical management neurogenic shock

spinal immobilization

judicious fluids

vasopressors for MAP targets

nsg management neurogenic shock

maintain spinal precautions

temp management

prevent DVT and pressure injury

monitor for autonomic dysregulation

anaphylactic cause

IgE mediated

rapid systemic hypersensitivity after exposure

hemodynamics anaphylactic shock

massiva vasodilations increase permeability, bronchoconstriction / laryngeal edema , decrease breathing, low MAP, low tissue perfusion, low organ function

low SVR and preload, bronchospasm and airway edema, CO may be normal or high initially

s/s anaphylactic shock

urticaria, angioedema, wheeze/stridor, hypotension, Gi cramps, flushing, syncope

complications of anaphylactic shock

airway obstruction

refractory shock

biphasic reaction

medical management of anaphylactic shock

highflow O2 IM epi airway management aggressive fluids antihistmaine CCS inhlaed B2 agonist

refractory medical managmeent

epi infusion vasopressors

septis definition

dysregulated host response to infection leading to life threatening organ dysfunction

septic shock definition

subset of sepsis

profound circulatory cellular and metabolic abnormalities with greater risk of mortality than sepsis

systemic infection patho

massive vasodilation decreased MAP tissue perfusion and organ function

early (warm) hemodynamics

high HR

fever

low SVR normal or high CO

warmness

wide pp

lactate over 2

late (cold) hemodynamics

high HR

cold skin

thready pulse

low CO

low preload

low MAP

narrow pulse

septic shock s/s

suspected confirmed infectoin

fever or hypothermia

tachycardia

hypotension

tachypnea

ams

oliguria

coplications of septic shock

ARDS

AKI

DIC

metabolic acidosis

inability to utilize O2

MODS

septic shock hour 1 bundle

obtain cultures

broad spectrum abx

30 mL/kg crystalloid hypotension or lactate above 4

measure lactate

apply vasopressors to maintain map above 65

qSOFA

quick sepsis related organ failure assessment

qSOFA criteria

2 or more:

AMS

fast respiratory rate

low blood pressure