Shock Flashcards

Imbalance of cellular O2 delivery and cellular O2 demand which results in impaired tissue perfusion which may cause SBP <90 with tachycardia or bradycardia and altered mental status.

Inital, Compensatory, Progressive, Refactory

Decreased CO/Tissue perfusion which leads to anerobic metabolism which leads to small amount of energy/lactic acid peroduction, which leads to increased cellular damage.

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Prolonged decreased tissue perfusion, peripheral blood pooling, decreased vital organ perfusion, acidosis. Unresponsive to therapy, irriversable. MODS: failure of two or more body systems CV- Ventricular Failure CNS- SNS failure=vasodialtion=capillary pooling, increased capillary permeability, microemboli Hematologic- DIC Pulmonary- ARDS, Resp failure Renal -ATN GI- failure gut organs= release gram negative bacteria into system

Inadequate circulating fluid volume in intravascualr space, most common form of shock, absolute- external loss of fluid relative- internal shifting of fluid within body

CO maintained, symptom free, approximately 750ml

750-1500 ml loss. CO decreases, tachycardia, narrow pulse pressure (VC), RR/depth increase, ABG: resp alkalosis, hypoxemia, UO decreases, skin pale, cool, capilary refill > 3 sec altered LOC

1500-2000 ml loss, tachycardia, dysrhythmias, ABG: resp & metabolic acidosis, hypoxemia, resp. distress, oliguria, BUN & Creatinine increase, skin; ashen, cold, clammy marked delayed cap refill and lethargy

>2000 ml loss, severe tachycardia, hypotension, peripheral pulses absent, no cap refill, skin: cyanotic, mottled, diaphoretic, unresponsive.

Decresed CO/CI Decreased CVP/RAP Decreased PAP, PAOP Decreased SVO2 Increased SVR

Medical- Stop source of fluid loss and replace ciruclating volume with crystalloid (NS, D5W, D51/2), colloid (albumin, dextran, hestran), or autotransfusion nursing- prevention, I/O, daily wts, minimize fluid loss (limit blood sampling, secure connection of lines, direct pressure to bleeding sites), enhance fluid replacement (large bore IV, rapid administration of fluids, trendelenburg, monitor for fluid overload)

Failure of heart to pump effectivly 6-20% of AMI 72-84% mortality, ventricular ischemia, sturctural, dysrhythmias.

Decreased pump, decreased SV=decreased CO= decreased Cellular O2 Supply= ineffective tissue perfusion, LHF=pulmonary edema=impaired gas exchange=decreased O2 of arterial blood= impaired tissue perfusion