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Hypovolemic shocks causes
- 1. Internal/external bleedings
- 2. Burns
- 3. DKA/HHNK
- 4. Severe dehydration
- 5. Others
- Results from a loss of greater than 20% of circulating blood volume
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Hypovolemic Shock Laboratory /Diagnostics
- 1. Decreased CO/CI (normal 4-8 l/min/2.5-4 l/min)
- 2. Decreased CVP (central venous pressure, normal 0-6)
- 3. Decreased PCWP (pulmonary cappillary wedge pressure, normal 6-12)
- 4. Increased SVR (normal 800-1200)
- 5. Decreased SVO2 (mixed venous saturation, N. 60-80%))
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Hypovolemic shock management
- 1. fluid resusciation
- 2. PRBCs when indicated by Hgb/hct
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Cardiogenic Shock
A loss of effective contractile function results in impaired cardiac output, impaired oxygen delivery, and reduced tissue perfusion
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Cardiogenic Shock causes
- 1. Acute MI- most common cause
- 2. Ventricular aneurysm
- 3. Dysrhythmia
- 4. Pericardial tamponade
- 5. Hypoxemia
- 6. Pulmonary edema
- 7. Acute valvular regurgiation
- 8. Acute VSD
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Cardiogenic shock diagnostics
- 1. Decreased CO/CI
- 2. Increased CVP (0-6)
- 3. Increased PCWP (6-12)
- 4. Increased SVR (800-1200)
- 5. Cecreased SV02 (60-80)
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Cardiogenic shock management
- 1. Careful administration of fluids
- 2. Vasopressor support (dobutamine, dopamine, etc)
- 3. Nirtorglycerin IV if ischemia present
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Distributive shock
- Three forms of schock characterized by vasodilation, decreased intravascular volume, reduced peripheral vascular resistance, and loss of capillary intergrity.
- Distributive shock may be septic, anaphylactic, and neurogenic
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Septic Shock
Caused by infective organisms which invade the bloodstream and alter vascular tone. Hypovolemia develops as a result of blood pooling in the microcirculation
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Septic Shock laboratory/diagnosics
- 1. Blood cultures
- 2. Increased CO/CI (4-6/2.5-4)
- 3. Decreased CVP )0-6)
- 4. Decreased PCWP (6-12)
- 5. Decreased SVR (800-1200)
- 6. Decreased SV02 (60-80)
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Septic Shock management
- 1. fluid resuscitation is mainsaty of treatment (crystallooid)
- 2. Vasopressor agents (Dobutamine, Levophed, etc.0
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Anaphylactic shock laboratory /diagnostics
- Ig .e mediated reaction that occurs shortly after exposure to an allergen
- 1. Decreased CO/CI
- 2. Decreased CVP (0-6)
- 3. Decreased PCWP (6-12)
- 4 Decreased SVR (800-1200)
- 5. Decreased SVO2 (60-80)
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Anaphylactic shock management
- 1. Maintain airway
- 2. Diphenhydramine 25-75 mg IM (adult)
- 3. Epinephrine 0.3-0.5 mg sq or IM for respiratory distress, stridor, wheezing, etc.
- 4. Crystalloids for volume expansion
- 5. Intravenous glucocorticosteroids as needed
- 6. Inhaled beta agonist for bronchospasm
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Neurogenic Shock - loss of peripheralvasomotor tone as a result of spinal cord injury, regional anesthesia, etc.
Laboratory/diagnostics:
- 1. Decreased CO/CI
- 2. Decreased CVP (0-6)
- 3. Decreased PCWP (6-12)
- 4. Decreased SVR (800-1200)
- 5. Decreased SVO2 (60-80)
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Neurogenic shock management
- 1. Maintain airway
- 2. Cristalloids for volume expansion
- 3. Vasopressors as needed to maintain blood pressure
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Obstructive Shock - inadequate cardiac output as a result of impaired ventricular filling. Causes:
- 1. Massive pulmonary embolus- most common
- 2. Tension pneumothorax
- 3. Acute cardiac tamponade
- 4. Obstructed valvular disease
- 5. Disease of pumonary vasculature
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Obstructive Shock laboratory/Diagnostics
- 1. Decreased CO/CI
- 2. Increased CVP
- 3. Increased SVR (800-1200)
- 4. Increased SVO2
- 5, Decreased PCWP
- Treatment: Maintain blood pressure while initiating treatment of underlying cause
- 2. Fluid administration with use of vasoconstrictors (norepinephrine, dobutamine)
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