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Shock Decreased perfusion - Coggle Diagram
Shock
Decreased perfusion
Cardiogenic
Low flow d/t pump disfunction
Mortality rate 60%
Clinical manifestations
Early
Tachycardia
Hypotension
Narrowing pulse pressure
/\ myocardial O2 consumption
Pulmonary congestion
Pale, cool, clammy skin
\/ capillary refill, peripheral pulses
Anxiety, confusion, agitation
/\ pulmonary pressure
Management
Restore blood flow to myocardiam
Restore balance between O2 supply/demand
Treat underlying cause
Hemodynamic monitoring
/\ CVP, SVT, PA pressure
\/ CO, CI
Drug therapy
Inotropic- /\ ability to pump
Norepinephrine, dopamine, dabutamine
Circulatory assistive devices
Distributive
3 types:
Septic
severe sepsis + refractory hypotension
exaggerated response by the body
vasodilation + systemic inflammation
Clinical manifestations
Tachypnea/hyperventilation (resp. failure 80%)
leads to resp alkalosis that develops to metabolic acidosis
\/ urinary output
Altered mental status
GI disfunction (bleeding, paralytic ileus, /\ risk of ulcers d/t /\ metabolism
/\ metabolic state --> /\ cellular respiration & catabolism
Cardiac dysfunction (\/ EF --> vent. dilation, /\ CO [compensate], \/ systemic vascular resistance
Hypotension, \/ perfusion
Further \/ BP
Management
Treat underlying cause
antibiotics (usually start with broad spectrum)
Fluid replacement to restore perfusion
Hemodynamic monitoring (\/ CVP, MAP ≥ 65)
Vasopressor drug therapy
norepinephrine
, vasopressin
Blood glucose WNL (promote healing \/ food for bacteria)
Stress ulcer prophylaxis (PPI, H2 blockers)
DVT prophylaxis (pharm and non-pharm)
Neurogenic
Not covered
Anaphylactic
Not covered
Hypovolemic
Most common type
Caused by a loss of circulating volume
Clinical manifestations
/\ HR
\/ BP
cool, clammy skin
rapid, shallow breathing
anxiety
\/ perfusion, urine output
Management
fluid resucutation (3:1)
loss ≥30% --> blood replacement
Stop loss.
Treat underlying cause
Obstructive
Not covered