T10 Shock

• What are early manifestations of cardiogenic shock?

  Hypotension, tachycardia, narrowed pulse pressure, increased myocardial oxygen consumption.
• What are signs of cardiogenic shock on physical assessment?

  Pulmonary congestion, tachypnea, pallor, cool and clammy skin, anxiety, confusion, agitation, increased pulmonary wedge pressure, decreased renal perfusion and output.
• What is absolute hypovolemia?

  Loss of intravascular fluid volume.
• What is relative hypovolemia?

  Third spacing.
• How much total blood volume does the body compensate for if 15% is the limit?

  750 mL.
• When does loss of autoregulation in the microcirculation with irreversible tissue destruction occur with hypovolemic shock?

  When loss is more than 40% total blood volume.
• When can compensatory mechanisms fail and blood products are needed for hypovolemic shock?

  When loss is greater than 30%.
• What is poikilothermia?

  Inability to regulate body temperature where you take the environment's temperature.
• What are the main organisms that cause sepsis?

  Gram negative and positive bacteria.
• What are signs are associated with increased hypotension and MODS with sepsis?

  Persistently high cardiac output and a low systemic vascular resistance beyond 24 hours.
• What is abdominal compartment syndrome?

  Increased pressure within the abdomen that compresses the inferior vena cava.
• What are other signs of obstructive shock?

  Jugular vein distention and pulsus paradoxus.
• What are the 4 stages of shock?

  Initial, compensatory, progressive, refractory.
• What happens in the compensatory stage of shock?

  Impaired GI motility due to decreased blood flow.
• What happens to the cardiac system in progressive shock stage?

  Dysrhythmias, possible MI, deterioration of the cardiovascular system.
• What happens to the respiratory system in progressive shock stage?

  Fluid from pulmonary vasculature goes to interstitium and alveoli. (Pulmonary edema, bronchoconstriction leads to decreased functional capacity).
• Is there a single study to determine shock?

  No.
• How many mL of isotonic fluid is given per mL of blood loss?

  3.
• What is the best indicator of cerebral blood flow?

  Patient's neurologic status.
• What position should patients not be in during shock?

  Trendelenburg or head down.
• Due to poor peripheral circulation, where would you not want to use a pulse oximeter on a shock patient?

  Finger.
• What are signs during shock that may indicate the need for advanced pulmonary management?

  Rising PaCO2 with a persistently low PaO2 and pH.