oxygenation quiz

treatment for septic shock

measure lactate and blood cultures, fluids and antibiotics, norepinephrine

goal in septic shock

raise map >65 mmHg

compensatory stage of shock

body activates compensatory mechanism to maintain perfusion; fight for flight; releases stores of glucose, retains water, HR and RR increase, decrease in blood flow, diaphoresis

refractory stage of shock

unable to compensate; severe hypoxia with ischemia and necrosis, worsening acidosis, SIRS and MODs

optimize oxygen delivery

oxygen therapy, fluid resuscitation (lactated ringers and normal saline) , central line (dont fluid overload)

decrease oxygen consumption

decrease total body work (decrease WOB) , reduce pain and anxiety (analgesic and sedatives) , maintain normothermia (watch for shivering), maintain normal serum glucose levels

cardiogenic shock diagnosis

SBP <90 mmHg for >30 mins

increased wedge >15 mmHg

decrease CI <2.2

anaphylactic shock s/s

hypotension, upper airway obstruction, flushing, hives, iching, cramping, cough, runny nose, nasal congestion, hoarseness, dyspnea, stridor, wheezing

anaphylactic shock treatment

remove the antigen, promote tissue perfusion, maintain airway, administer oxygen, epinephrine

progressive stage of shock

compensatory mechanisms fail (rapid and shallow respirations, dysrhythmias, ischemia, lethargy, changes in LOC, AKI, liver enzymes increase, stress ulcers, GI bleed)

first organ affected in progressive stage of shock

kidneys

pH

7.35-7.45

paCO2

35-45 mmHg

HCO3

22-26 mEq/L

paO2

80-100 mmHg

base deficit

-2 to +2

saO2

80-100%

mild hypoxemia

60-75 mmHg

moderate hypoxemia

45-59 mmHg

severe hypoexmia

<45 mmHg

respiratory acidosis defining characteristics

pH <7.35, paCO2 >45 mmHg

respiratory acidosis cause

hypoventilation (respiratory depression, decreased ventilation, low v/q ratio- pulmonary edema, atelectasis, COPD)

s/s of respiratory acidosis

tachycardia, hypertension, anxiety, irritability, confusion, shallow rapid breathing, pale, cyanotic, SOB

respiratory alkalosis defining characteristics

pH >7.45 and paCO2 <35 mmHg

respiratory alkalosis causes

hyperventilation (fear, anxiety, pulmonary embolism)

s/s of respiratory alkalosis

tachypnea, tachycardia, numbness, tingling, loss of LOC, rapid, deep respirations

metabolic acidosis defining characteristics

pH <7.35, HCO3 <22

causes of metabolic acidosis

DKA, severe diarrhea, renal failure, shock

clinical manifestations of metabolic acidosis

drowsiness/coma, decreased BP, bradycardia, nausea/vomiting, diarrhea, abdominal pain, deep rapid respirations, headache

metabolic alkalosis defining characteristics

pH >7.45, HCO3 >26

causes of metabolic alkalosis

severe vomiting, excessive GI suctioning, diuretics, excessive use of antacids

clinical manifestations of metabolic alkalosis

tachycardia, hypotension, dysrhythmias, numbness, tingling, confusion, restlessness, ineffective breathing, N/V/D

EtCO2 normal value

35-45 mmHg

lactic acidosis

serum lactate >5 + arterial pH <7.35

fluid replacement

central line to obtain CVP, dont fluid overload!

uncompensated

Either the CO2 or the HCO3 will be normal (only one abnormal)

partially compensated

nothing is normal

fully compensated

pH is normal