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What are the six types of Shock?
- Cardiogenic
- Septic
- Hypovolemic
- Neurogenic
- Anaphylactic
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What are the three phases of Shock
- Compensatory
- Progressive
- Irreversible
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What do the Chemoreceptors do?
- Respond to changes in O2 in blood
- Control cardiac output
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What are the three compensatory mechanisms
- Increase respiratory rate, tidal volume and Cardiac output
- Kidneys activate the Renin-Angiotensin system due to decreased blood flow
- Brain releases anti-diuretic hormone
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What is the "Classic" sign of hypovomic shock
Decreased urine output
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What would we expect to see in on the ABG of a shock patient
- Acidosis
- electrolyte imbalances
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What percentage of MI patients develop Cardiogenic shock?
20-40%
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What percent of infarcted tissue in the L ventricle will cause cardiogenic shock?
40%
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What are the treatment priorities for Cardiogenic Shock?
- Rate
- Rhythm
- BP (Volume, Pump/Vascular tone)
- Improve oxygenation
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Two causes of Pulmonary Edema?
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How do you treat Pulmonary Edema?
- IV/O2/Monitor
- Volume-
- Fluid Challenge
- Vasopressors
- Pump-
- Norepinephrine 0.5-30 mcg/min
- Dopamine 5-15 mcg/kg/min
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What causes Septic Shock?
- Severe infection causing blood to pool
- Usually bacterial,but may be caused from virus, fungal, rickettsial infection
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Treatment for Septic Shock includes what?
- Antibiotics
- Large amounts of fluid
- Dopamine
- Respiratory support
- Drain abscesses/replace catheters
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How much volume loss is needed to see hypovolemia?
15-20% (500ml-1500ml)
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Class I Hemorrhage
0-15% loss
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Class II Hemorrhage
15-30% loss
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Class III Hemorrhage
30-40% loss
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Class IV Hemorrhage
>40% loss
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What are the four areas a life-threatening hemorrhage can occur?
- Chest
- Abdomen
- Thighs
- Outside the body
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What is the treatment for hemorrhagic shock?
- Maximize O2 delivery
- Control further bleeding
- Fluid resuscitation
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What is the main precaution with fluid resuscitation?
Hypothermia
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What is the treatment of choice for Anaphlyaxis?
Epinephrine 1:1,000
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What causes Neurogenic Shock
An injury or insult to the Reticular Activating System (RAS) and spinal cord
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What precaution should be considered prior to administering vasoconstrictive drugs to a shock patient?
Ensure volume is adequately restored.
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What are the indications to administering Solu-Medrol in neurogenic shock?
<8 hours post injury
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What is the dosage of Solumedrol for a spinal injury?
- 30 mg/kg over 15 minutes
- Followed by a maintenance infusion of 5.4 mg/kg over the next 23 hours
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How do you calculate MAP?
- 1-2-3 Method
- 1 systolic + 2 diastolic / 3
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What should the MAP be maintained at?
60>
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