Shock
What are the Stages of shock? (hint 3) How do you diagnose?
Compensatory- sympathetic nervous system and RAAS are activated
Progressive- tissues become hypoxic, cells switch to anaerobic metabolism, lactic acid build up and metabolic acidosis develop
Irreversible- organ damage occurs
Diagnose by CBC, cultures, EKG, hemodynamic monitoring
What is the concentration of Vitamins K and Na within the ICF and ECF? How is fluid regulated?
ICF = high K+
ECF = high Na+
Fluid is regulated by thirst.
What is the cardiac conduction system (*and bpm rates)?
SA Node (60-100 bpm) --> AV node (40-60) --> HIS (40-60) --> R&L bundle branches (20-40) --> Purkinje fibers (20-40)
How long can your brain last without O2?
3 minutes!!!
What is multisystem organ failure?
Inflammation or injury to 2 or more organs
A result of CRITICAL illness, hypoperfusion
What is cardiogenic shock and how do you treat it?
Inadequate cardiac pumping from L ventricle.
NEED immediate revascularization (cardiac cath or CABG)
What are the -tonic solutions and where does the water go? Also examples of each & uses.
Hypotonic (into cell); ex: 0.45% NS; used cellular dehydration & diabetes ketoacidosis
Hypertonic (out of cell); ex: 3% NS, D50W; used in hypovolemia, peritoneal dialysis
What are the ECG components and what they do?
P-wave: depolarization of artia, followed by contraction
QRS: 3 waves, depolarization ventricle, followed by contraction
T-wave: repolarization of ventricles
What are the differences between Hypoxemia, Hypoxia, and hypercapnia?
Hypoxemia: decreased O2 in arterial blood
Hypoxia: low O2 in TISSUES
Hypercapnia: Increase CO2 in blood
What is a heart block?
delay or interruption of conduction through AV node
2nd or 3rd degree block results in P wave that do not conduct
3rd degree, no association btwn atrial and ventricular conduction (pacemaker indication)
What is hypovolemic shock and its manifestations?
Inadequate blood/plasma volume and typically occurs when the volume is reduced by 15-20%.
Decreased preload, decreased ventricular filling and SV, and decreased CO --> decreased organ and tissue perfusion.
What are the normal ranges of Sodium & Postassium lab values?
Sodium: 135-145 mEq/L
Potassium: 3.5-5.0 mEq/L
-cardiac pt 3-4 mEq/L
What is used to treat asystole?
PRIOR to treatment confirm pulselessness & in second lead
NOT shockable rhythm
Treat underlying cause
CPR & EPI
What is difference between pleural effusion and pneumothorax and their treatments?
P.Eff: Accumulation of fluid between parietal and visceral pleura
Treated by FLUID DRAINAGE
PNEU: collection of AIR outside lung within pleural cavity
Treated by chest tube
No ventricular contraction & no CO
immediate defibrillation & ACLS
Initiate CPR until defibrillator is available
HR 300-600
What are the subcategories of distributive shock and their causes? (bonus if you know treatments)
Septic- systemic infection causes vasodilation and vascular collapse
- ABX, O2, surgery
Anaphylactic- IgE elevated from allergic rxn
-Epi & call 911
What are the normal lab values for phosphate & magnesium?
Phsophate: 2.5-4.5 mg/dL
Magnesium: 1.5-3.5 mEq/L
How do we treat A-Fib and describe it?
Chaotic electrical activity, loss of atrial kick, HIGH risk for clot
Treatment: rate control: 180-200 have to get antiarrhythmic, anticoags, DC cardioversion, ablation
What is a Tension pneumothorax? Dx & treatments?
Progressive rise in intrapleural pressure causing collapses of the lung and shifts mediastinum.
MEDICAL EMERGENCY
Dx/T: DO NOT WAIT FOR CHEST XR & chest tube (IMMEDIATELY)
What is Atelectasis pathophysiology & causes?
Collapsed part or all of lung which is caused by blockage of the air passages (bronchioles/ bronchus) or by pressure on the lung
Causes: anesthesia, ventilator, pneumonia
What is the criteria for SIRS? What is key for detecting sepsis?
Temp >38C or <35C
HR >90 BPM
RR >20 Breath/m or PCO2 <32mmHg
WBC > 12,000 cell/mm3 or 4,000 cells/mm
Sepsis= early recognition
What is the SIADH pathophysiology and causes?
Failure of the negative feedback system that regulates the release and inhibition of ADH causing the body to retain too much water & Hyponatremia (loss of sodium)
Caused by CNS issues (seizure meds)
What is V-tach and how do we treat it?
Rapid rate, wide QRS, may be pulseless, deteriorate into V-fib
Treat:
Hemodynamically stable- meds
Hemodynamically unstable: cardioversion
Pulselessness: CPR, defibrillation
What falls under COPD umbrella? What are important manifestations for each term?
Special notes: pulse ox 88-92%; NO uncontrolled O2
Chronic bronchitis: "blue bloaters"; cyanosis, hypercapnia, polycythemia, edema
Emphysema: "pink puffers"; wheezing, chest tightness, tachypnea, hypoxia, anorexia
Asthma: extrinsic (IgE, can grow out) & intrinsic (after age 35); SOB, wheezing, tachypnea, coughing, chest tightness
What is the etiology of Cardiac arrest?
Hypovolemia
Hypoxia
Hydrogen Ions (acidosis)
Hyper or hypo kalemia
Hypoglycemia
Hypothermia
Toxins
Tamponade
Tension pneumothorax
Thrombosis or coronary artery or pulmonary artery
Trauma