Shock States
A syndrome of inadequate supply of oxygen an nutriens to the cells due to impaired tissue perfusion.
What is "Shock"
Hypotension, Altered mental status, Tachycardia, Prolonged capillary refill, Dry muscus membranes, Poor Skin Turgor, and Concentrated Urine
What is clinical Presentation of Hypovolemia
hypotension bradycardia temperature regulation hypothermia flaccid paralysis below level of injury bowel and bladder dysfunction decreased CVP, PWCP (preload = volume) decreased SVR ( afterload = reistance)
What is Neurogenic Shock
This partnered with the Institute for healthcare Improvement (IHI) to incorporate its "bundle concept" into the diagnosis and treatment of patient's with sepsis, severe sepsis and septic shock.
What is "The Surviving Sepsis Campaign"?
Development of SIRS in the presence or presumed presence of infection usually have at least two of the following: chills, hypotension, decreased skin perfusion, impaired capillary refill or mottling, decreased urinary output, significant edema, hyperglycemia
What is Sepsis?
Hypovolemic, Cardiogenic, Distributive, Obstructive
What is the Classification or types of Shock
Rapid fluid device used for volume replacement
What is Belmont?
Massive vasodilation leading to an increase in size of the vascular compartment in proportion to the fluid volume. Neurogenic, Anaphylactic, Septic
What is Distributive Shock?
advanced age, compromised immune function, chronic illness, invasive interventions, malnutrition, surgical procedures, sequential infections
What are risk factors for sepsis?
Inadequate organ perfusion, Dysfunction of two or more organ systems
What is Severe Sepsis?
Widespread inflammation that occurs in patients with diverse disorders
What is SIRS Systemic Inflammatory Response
Loss of forward movement of blood (ex:heart failure, MI) Decreased stroke volume, decreased cardiac output, pulmonary congestion, hypoxemia
What is Cardiogenic Shock
systemic release of mediators hypersensitivity reaction masssive vasodilation. Anxiety, Edema, Increased respiratory rate
What is Anaphylactic Shock
Elevate HOB at least 30 degrees, Daily sedation vacations, oral care, Peptic Ulcer Prophylaxis, Deep Vein Thrombosis Prophylaxis
What is Ventilator Associated Pneumonia (VAP) Bundle
cough, change in sputum, Nausea/vomiting or diarrhea, abdominal pain, Dysuria, frequency, Headache, change in LOC, drainage changes in wound
What are some clinical assessment signs and symptoms of sepsis?
Temperature - Less than 96.8F or greater than 100.4 Tachycardia - Heart rate greater than 90 bpm Tachypnea - Respirations greater than 20 per min or PACO2- Less than 32 mmHg WBC- Less than 4,000 or greater than 12.000 or greater than 10% bands 2 OR MORE DON'T IGNORE
What is SIRS Criteria
elevated lactate, elevated WBC, altered mental status, fever
What are signs of sepsis?
Massive Pulmonary embolism, Cardiac Tamponade, Muffled heart sounds, Pulsus paradoxus
What is Obstructive Shock
avoid unnecessary catheterization, asesptic technique, hand hygiene
What are some Prevention Strategies for Sepsis?
Develops in response to severe sepsis. Extensive increased capillary permeability
What is MODS (multi organ dysfunction syndrome)?
Loss of circulating volume
What is Hypovolemic Shock
Dobutamine, Dopamine, Levophed, Neosynephrine, Vasopressin, Nitroglycerin, Nitroprusside (Nipride)
What are the medications used to treat Shock/vasoactive medications?
Progressive dysfunction of two or more organ systems as a result of an uncontrolled inflammatory response to severe illness or injury. Most common in Sepsis or Septic Shock
What is MODS (Multiple Organ Dysfunction Syndrome)?
30mL/kg
What is initial fluid resuscitation volume for adults?
Occurs in 1% of all hospitalized patients. Trigger- excessive activation of coagulation cascade, Trauma (what we try to prevent with keeping trauma patients warm)
What is DIC?