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Shock States
General Shock Questions :
Clinical Presentation
General Sepsis Questions
Sepsis cont:
100
A syndrome of inadequate supply of oxygen and nutrients to the cells due to impaired tissue perfusion.
What is "Shock"
100
Hypotension Altered mental status Tachycardia decreased CVP Prolonged capillary refill Dry muscus membranes Poor Skin Turgor Concentrated Urine/Oliguria
What is clinical Presentation of Hypovolemia
100
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
100
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"?
100
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 or positive fluid balance hyperglycemia >120
What is Sepsis?
200
Hypovolemic Cardiogenic Distributive Obstructive
What is the Classification of Shock
200
Rapid fluid device available in the ICU, Surgery, and ICU Warms fluid and blood Can infuse up to 950ml/minute
What is Rapid infuser?
200
Massive vasodilation leading to an increase in size of the vascular compartment in proportion to the fluid volume. Neurogenic Anaphylactic Septic Massive vasodilation leading to an increase in size of the vascular compartment in proportion to the fluid volume.
What is Distributive Shock?
200
advanced age compromised immune function chronic illness invasive interventions malnutrition surgical procedures sequential infections
What is "Who is at risk for Sepsis"?
200
Inadequate organ perfusion Dysfunction of two or more organ systems
What is Severe Sepsis?
300
Widespread inflammation that occurs in patients with diverse disorders such as: infection Trauma Shock Pancreatitis Ischemia
What is SIRS Systemic Inflammatory Response
300
Loss of forward movement of blood systolic dysfunction: heart failure, value disorders diastolic dysfunction: Heart failure, value disorders decreased ventricular wall motion = AMI decreased stroke volume decreased cardiac output pulmonary congestion hypoxemia
What is Cardiogenic Shock
300
systemic release of mediators hypersensitivity reaction masssive vasodilation Anxiety Edema Increased respiratory rate
What is Anaphylactic Shock
300
Elevate HOB at least 30 degrees Daily sedation vacations Peptic Ulcer Prophylaxis Deep Vein Thrombosis Prophylaxis
What is Ventilator Associated Pneumonia (VAP )Bundle
300
cough, change in sputum Nausea/vomiting or diarrhea. abdominal pain Dysuria, frequency New murmur/change in murmur Headache, change in LOC drainage changes in wound
What are some clinical assessment signs and symptoms of sepsis?
400
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
400
Equipment Device that can be placed in the Cath Lab, Surgery, or ICU to improve cardiac ouptut and contractility Height of patient is important when inserting Need to assess and monitor tissue perfusion distal to insertion site
What is Intra-aortic Ballon Pump
400
Massive Pulmonary embolism Cardiac Tamponade Muffled heart sounds Pulsus paradoxus
What is Obstructive Shock
400
avoid unnecessary catheterization asesptic technique hand hygiene chlorthexidine skin antisepis reduction of MRSA
What are some Prevention Strategies for Sepsis?
400
Develops in response to severe sepsis Extensive increased capillary permeabilty
What is MODS?
500
Loss of circulating volume
What is Hypovolemic Shock
500
Dobutamine Dopamine Levophed Neosynephrine Vasopressin Nitroglycerin Nitroprusside (Nipride)
What are the medications used to treat Shock?
500
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)?
500
quality partnership committed to improving the safety of surgical care Prophylactic antibotics with obne hour Prophylactic antibotics discontinued within 24 hours and 48 for Cardiac surgery
What is Surgical Care Improvement Project (SCIP)?
500
Occurs in 1% of all hospitalized patients Trigger- excessive activation of coagulation cascade Trauma
What is DIC?