Shock

what is the big sign on distributive shock

Massive vasodilation

what shocks fall under the umbrella of distributive shock

sepsis, anaphylaxis, neurogenic shock

how much fluid is given to a pt in septic shock

30 ml/kg/hr

what does SIRS stand for

systemic inflammatory response syndrome

what does SIRS indicate

possible sepsis

what are s/s of sepsis

persistent hypotension, hypoperfusion, hypothermia, tachypnea

what labs should be drawn for sepsis

lactate, ABG, and procalcitonin

what is a normal lactate level

<2

what causes a lactate level to increase

anerobic cellular respiration/metabolism

what antibiotics are used to treat septic shock

carbapenems

what is used if MAP is low in septic shock

Norepi!

what is the push dose for norepi

1:10,000 in 9 ml NS

what is the max norepi amount

45 mcg

why is hydrocortisone used in septic shock

decrease inflammation and catecholamines

what are s/s of anaphylactic shock

angioedema, blocked airway, rash, hypotension, tachycardia

what is anaphylaxis

histamine release in response to an allergen

how is anaphylaxis treated

EPI, LR, monitor airway, albuterol, and steroids

what steroids are used to block histamine 1 in anaphylaxis

diphenhydramine

what steroids are used to block histamine 2 in anaphylaxis

famotidine

what is the most important med to give in anaphylaxis

Epi

what is the epi dose for anaphylaxis

0.5 ml 1:1000 IM

what are s/s of neurogenic shock

bradycardia and hypotension

how long does neurogenic shock last

4-6 weeks

what causes neurogenic shock

SC injury at T6 and above

how is neurogenic shock treated

2 L isotonic fluids and norepi

what do you do if norepi is not working in neurogenic shock

dopamine

why dont we like dopamine

decrease HR and narrow therapeutic index

what is the max dopamine we can use in neurogenic shock

20 mcg

what do the ventricles look like in cardiogenic shock

they are really tired

what is the #1 cause of cardiogenic shock

MI

what are s/s of cardiogenic shock

Low BP, pale, diaphoretic, JVD, chest pn, modeled skin, crackles, pulmonary edema

what are our priorities with cardiogenic shock

increase CO and perfusion

how is cardiogenic shock treated

phosphodiesterase inhibitor, beta 1, furosemide, fluids

what is the max amount of fluids given to cardiogenic shock pts

250 ml

what phosphodiesterase inhibitor is used in cardiogenic shock

milrinone

in cardiogenic shock what do we pair milrinone with

norepi

what beta 1 agonist is used in cardiogenic shock

dobutamine

why would we give furosemide in cardiogenic pts

decrease preload but just be careful

what will we do if we want to reduce preload in cardiogenic shock

titrate norepi down

how will we know if tx of cardiogenic shock is working

increase in UO and BP

what can cause obstructive shock

tension pneumo, cardiac tamponade, pulmonary emboli

how is a tension pneumo treated

needle decompression, chest tube, finger thoracotomy

what can cardiac tamponade cause if left untreated

cardiogenic shock

what are s/s of cardiac tamponade

becks triad: muffled heart tones, bradycardia, hypotension

how is cardiac tamponade treated

pericardiocentesis

how will we know if tx of cardiac tamponade was effective

BP increases, JVD decreases, CVP is normal, heart tones are heard more clearly

what is the treatment of a pulmonary emboli

alteplase and TNK

what needs to be monitored for if a thrombolytic is given

bleeding and angioedema

what is the big goal with hypovolemic shock

fix the cause

what are causes of hypovolemic shock

burns, bleeding, DKA, DI

how do you treat hypovolemic shock caused by burns

bigtime fluid resuscitation

how do you treat hypovolemic shock caused by bleeding

blood products 1:1:1 and crystalloid

how do you treat hypovolemic shock caused by DKA or DI

fluids

what are s/s of hypovolemic shock

high HR, low BP, vasoconstriction

How is hypovolemic shock diagnosed

CBC, BUN, CR, ABG, fast exam

what fluids are used to treat a non-hemorrhagic hypovolemic shock

isotonic fluids