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shock - Coggle Diagram
shock
hypovolemic shock (VOLUME)
hemorrhage
GI loss (vomiting, diarrhea)
DI
hyperglycemia
diuresis
common causes
fistula drainage
plasma loss through burns
clinical manifestations
RR increase, anxiety, cool, clammy, increase in HR, decrease in SV & UO
if loss is >30%, blood volume is replaced
management
STOP fluid loss then RESTORE circulating volume
fluid resuscitation is calculated using a 3:1 rule (3mL of isotonic crystalloid for every 1mL of estimated blood loss)
normal saline, 0.9 saline chloride, LR, &blood products
assess hGb, HCT, e+, VBG, ABG (pH, lactic)
cariogenic shock (PUMPING)
compromised cardiac output
mortality rates 60%
address immediately & provide early interventions
causes
MI
cardiomyopathy
blunt cardiac injuries
severe systemic or pulmonary hypertension
cardiac tamponade
myocardial depression from metabolic problems
patho
pump problems
primary ventricular ischemia, structural problems, dysrhythmias
lead to decreased cellular oxygen supply, decreased tissue perfusion, and impaired cellular metabolism
early manifestations
tachycardia, hypotension, narrowed pulse pressure, increased o2 consumption
physical assessment
tachypnea, pulmonary congestion/increased pulmonary pressure, pallor and cool, clammy skin, decreased capillary refill time, anxiety, confusion, agitation
decreased renal perfusion and urinary output
management
restore blood flow to heart by restoring balance between o2 supply and demand
hemodynamic monitoring, continue to assess, CVP will be elevated, SER elevated, decrease in CO and index, increased PA pressure
drug therapy
inotropic drugs to improve pumping ability
norepinephrine, dopamine, dobutamine
nitrates administered with mild hypertension
circulatory assist device
septic shock (DISTRIBUTIVE)
SIRS
inflammatory response that affects the whole body
SEPSIS
documented or suspected infection
SEVERE SEPSIS
complicated by organ dysfunction
SEPTIC SHOCK
inadequate tissue perfusion due to hypotension despite fluid resuscitation that results in hypoxia
patho
invading microorganisms
cause chain reaction
results in decreased tissue perfusion and impaired cellular metabolism
most commonly caused by gram negative bacteria, but can be caused by a fungus, virus or parasyte
exaggerated response by body
vasodilation with widespread response
hyper metabolic response causes increased cellular respiration and catabolism and metabolic acidosis
inadequate blood blow esp to peripheries
formation of micro clots
microcirculation blood flow is decreased
leads to MI, with decreased EF and V dilation
decreased in systemic vascular resistance
clinical manifestations
tachypnea, hyperventilation
results in respiratory alkalosis initially but quickly flips to metabolic acidosis
85% chance of developing respiratory failure
decreased UP, altered near status, GI dysfunction, GI bleeding, paralytic ileum
management
fluid replacement to restore fluids
administer antibiotics
hemodynamic monitoring
MAP, CVP
vasopressor drugs- norepinephrine is gold standard
stress ulcer prophylaxis- proton pump inhibitor
DVT prophylaxis w/ meds &nonpharm
keep glucose in normal range
normal CVP 1-5 (if reading is high volume is high, if reading is low volume is low)