Cardiogenic Shock +
What are the causes of cardiogenic shock?
diastolic or systolic dysfunction
structural abnormalities
dysrhythmias
What are the two types of hypovolemic shock?
absolute and relative
What are the causes of anaphylactic shock?
contrast media
blood products
vaccines
food
insect bites
latex
What are the causes of neurogenic shock?
spinal injury above T6
anesthesia
drugs
hypoglycemia
pain
What are the causes of septic shock?
infection
indwelling catheter
invasive procedures
What are the manifestations of cardiogenic shock?
tachycardia
increased respirations
low bp
crackles
cool/clammy
Narrow pulse pressure
slow cap refill
anxiety/confusion/agitation
hemorrhage
GI bleed
surgery
vomiting
diabetes insipidus
What are the manifestations of anaphylactic shock?
chest pain
tachycardia
anxiety/confusion/dizziness
impending doom
flushed
swelling
hives
angioedema
wheezing/stridor
respiratory distress
What are the causes of Obstructive shock?
cardiac tamponade
SVC syndrome
pulmonary embolism
What are the manifestations of septic shock?
low bp
tachycardia
+/- temperature
increased respiratory rate
warm/flushed
How is pulmonary embolism diagnosed?
d-dimer
spiral CT
V/Q ventilation/perfusion scan
ECG- ST,T changes
What are the causes of relative hypovolemic shock?
burns
ascites
sepsis
fractures
bowel obstruction
What are the s/s of Pulmonary embolism?
Chest pain
blood tinged sputum
SOB
cough
crackles/wheezing
low bp
tachycardia
increased respiratory rate
What are the manifestations of neurogenic shock?
BRADYCARDIA
low bp
low respiratory rate
+/- temperature- takes on temp of environment
dry skin
paralysis
*** occurs within 30min of injury/can last up to 6wks
What is septic shock characterized by?
PERSISTANT HYPOTENSION DESPITE FLUID REPLACEMENT!
What are the medications given for pulmonary embolism?
Lovanox--- 1st
Fibrinolytic (tpa)
unfractionated IV Heparin
Coumadin (for at least 3 mo)
analgesia
What are the manifestations of Hypovolemic shock?
tachycardia
high respiratory rate
decreased output
cool/clammy
confusion/agitation/anxiety
*replace fluid if volume lost 30% or greater
What are the interventions for pulmonary embolism?
Rapid Response
02/intubation
HOB up
ABG's
heparin therapy
HgB, PTT,INR
IVC filter
pulmonary embolectomy
What are the risk factors of pulmonary embolism?
immobilization
surgery
obesity
fractured long bone- fat embolism
pregnancy
heart failure
age
hx
What are the 3 major pathophysiologic effects of septic shock?
Vasodilation
maldistribution of blood flow
myocardial dysfunction
What are the stages of shock?
Initial- lactic acid build up, 02 required
compensatory- body tries to compensate change
progressive- cool/clammy
refractory- imminent death
When do you give vasopressins?
When the patient is not responding to fluids
- vasopressin cause severe vasoconstriction and can cause pts to lose limbs
What are the drug alerts for Vasopressin?
maintain 60-65 MAP
given with norepinepherine
infused slow/do not titrate
use caution with CAD
What is anasarca?
Massive fluid leakage (profound edema everywhere)
What type of organism is the most common cause of septic shock?
bacteria