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circulatory shock state resulting from severe allergic reaction producing an overwhelming systemic vasodilation and relative hypovolemia
anaphylactic shock
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messenger substances that may be released by a cell to create an action at a site or be carried by bloodstream to a distant site before being activated; also called cytokines
biochemical mediators
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shock state resulting from impairment or failure of the myocardium
cardiogenic shock
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intravenous solutions that contain molecules that are too large to pass thru capillary membranes
colloids
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electrolyte solutions that move freely btw the intravascular compartment and interstitual spaces
crystalloids
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shock state resulting from displacement of blood volume creating a relative hypovolemia and inadequate delivery of oxygen to the cells; also called distributive shock
circulatory shock
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shock state resulting from decreased intravascular volume due to fluid loss
hypovolemic shock
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shock state resulting from loss of sympathetic tone causing relative hypovolemia
nuerogenic shock
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circulatory shock state resulting from overwhelming infection causing relative hypovolemia
septic shock
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overwhelming inflammatory response in absence of infection causing relative hypovolemiaand decreased tissue perfussion
systemic inflammatory response syndrome (SIRS)
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What are the three stages of shock
compensatory, progressive and irreversible
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In the compensatory stage of shock what are the clinical findings for BP, HR, Resprations, Skin, urinary output, LOC, and acid base balance
Normal BP, >100 BPM, >20 RR, cold & clammy skin, decreased output, confusion, resp. alkalosis
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In the Progressive stage of shock what are the clinical findings for BP, HR, Resp. status, skin, urinary output, LOC, acid-base balance
Systolic <80-90, >150BPM, rapid shallow resp. & crackles, mottled & petechaie skin, output = 0.5ml/kg/h, lethargy, metabolic acidosis
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In the irreversible stage of shock what are the clinical findings for BP, HR, Resp. status, skin, urinary output, LOC, acid-base blance
BP requires mechanical or pharm. support, HR is erratic or asystole, requires intubation for breathing, skin is jaundice, anuric requires dialysis, unconcious, profound acidosis
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what are sympathomimetics used for in shock?
improve contractility, increase stroke volume, increase cardiac output
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what are vasodilators used for in shock?
reduce preload and afterload, reduce oxygen demand of heart
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what are vasoconstrictors used for in shock?
increase blood pressure by vasoconstriction
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What are some external risk factors for hypovolemic shock?
trauma, surgery, vomiting diarrhea, diuresis, diabetes insipidus
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what are some internal risk factors for hypovolemic shock?
hemorrhage, burns, ascites, peritonitis, dehydration
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what is the proper positioning for a patient in shock?
modified trendelenburg (lower extremities elevated 20 degrees, knees straight, trunk is horizontal and head is slightly elevated)
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what is the first line of treatment for cardiogenic shock?
- supplemental oxygen
- controlling chest pain
- providing selected fluid support
- admin. vasoactive meds
- controlling HR w/ meds or by transthoracic or IV pacemaker
- mechanical cardiac support if needed
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