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What are the types of shock??
- Cardiogenic Shock
- Obstructive Shock
- Hypovolemic Shock
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Cardiogenic Shock is caused by
a weakened heart, usually due to an MI or cardiomyopothy
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Obstructive shock is due to a??
Mechanical obstruction to blood flow
examples: PE, cardiac tamponade, tension pneumothorax
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Hypovolemic shock is due to
Traumatic blood loss or severe dehydration
this leads to decreased venous return causing decreased CO2--> hypoxic cell injury--> progressive shock
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How can you restore normal BP in hypovolemic shock??
Administer isotonic fluid
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What are some diagnostic features of cardiogenic shock??
- -Decreased CO as a result of left ventricular dysunction
- -Elevated left ventricular end-diastolic pressure
- -S3 heart sounds
- -Pulmonary edema
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What are the sympathetic activations in Cardiogenic shock??
- -Increased HR
- -Vasoconstruction
- -Narrow pulse pressure
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What are the classic features in Hypovolemic shock
- -low cardiac output
- -low intracardiac pressures
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What are the symptoms in Hypovolemic shock??
- -elevated HR
- -vasoconstriction
- -increased myocardial contractility
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Distributive shock is due to ...??
excessive vasodilation
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What are the types of Distributive Shock??
- Anaphylactic Shock
- Neurogenic Shock
- Septic Shock
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Anaphylactic Shock
Precipitated by severe allergic reaction (severe form of Type I hypersensitivity reaction)
develops w/in 2-3 min of exposure
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Anaphylactic shock is a result of ...???
Excessive mast cell degranulation in response to antigen
there is a release of vasodilatory mediators (histamine) into the circulation by mast cells which results in severe hypotension
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What are the signs and symptoms of Anaphylatic shock
- Urticaria
- Bronchoconstriction
- Stridor
- Wheezing
- Itching
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What are the treatments for Anaphylactic shock??
Maintain airway patency w/ the use of
- epinephrine
- antihistamines
- vasopressors
- fluids to restore BP
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Neurogenic shock is due to ..??
Damage to CV center in medulla, by brain trauma, spinal cord injury, high spinal anesthesia, and drug overdose
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Neurogenic Shock is a result from
loss of sympathetic activation of arteriolar smooth muscle
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Septic shock results from..??
A severe systemic inflammatory response to infection
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What are the common causes of Septic Shock??
- Gram-negative and positive bacteria
- fungal infections
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What happens in Gram-negative shock?
Endotoxins in bacterial cell walls stimulate massive immune system activation
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Septic shock from any organism is characterized by..???
The release of large numbers of immune mediators (cytokines) resulting in widespread inflammation
clotting cascade, complement system, and kinin system are activated as part of the immune response
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What happens in septic shock when there is widespread inflammation??
- -peripheral vasodilation w/hypotension
- -maldistribution of blood flow w/ cellular hypoxia
- -increased capillary permeability w/ edema
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What are the characteristics that happen initially during septic shock??
abnormally high CO resulting from immune-mediated vasodilation and sympathetic activation of the heart.
pt usually febrille, pink, and warm
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What is the most potent vasodilator in spetic shock??
Nitric oxide
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What does hemodynamic monitoring due during shcok states??
Helpful for assessing CO, volume status, oxygen delivery, and oxygen consumption
pressures usually monitored include right atrial pressure, pulmonary artery pressure, and left atrial pressure
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Hemodynamic monitoring is used to..??
guide managment of cardiac preload, afterload, and contractility to optimize cardiac output, while minimizing cardiac workload
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What are the complications of shock..??
- Acute Respiratory Distress Syndrome (ARDS)
- Disseminated Intracascular Coagulation (DIC)
- Acute Renal Failure
- Multiple Organ Dysfunction Syndrome
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What happens in ARDS
when decreased O2 in lungs we get an immune mediated response associated w/ septic shock.
When this happens you have an infection triggoring a neutrophill migration into the pumonary capillaries secreting inflammatory mediators
Causing protein rich inflammatory exudate coating the walls of the alveoli inhibiting gas exchange this happens very quickly
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What is a complication w/ DIC
Spontaneous intracranial hemorrhage is a disastrous complication
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What happens in Actue Renal Failure
kidneys undergo prolonged periods of hypoperfusion, leading to hypoxic cellular damage in 15-20 min
ATN may develop
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What is Actue Tubular Necrosis (ATN)
epithelial cells that line the tubules--> cells start to die--> if you can resotre O2 concentration in the blood w/in an hour you can reverse ATN
if you don't release O2 these cells will slough off and obstruct the kidney tubules leading to dialysis
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Multiple Organ Dysfunction Syndrome
Lack of O2 causes organs to fail usually in sepsis and septic shock!!
- -dysfunction of two or more systems
- -body may loose the ability to maintain hemeostasis
- -mortality rate depends on severity
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