Term
|
Definition
complex syndrome of decreased blood flow to body tissues resulting in cellular dysfunction and eventual organ failure
-when demand for oxygen overcomes supply-anerobic metabolism |
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Term
DO2 (def)
and normal value |
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Definition
oxygen delivery---- measured in arterial blood
the amount of 02 transported to tissues each minute!
(ml/min)
normal arterial DO2: 1000ml/min |
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Term
D02
major manipulatable components
and their NORMAL values |
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Definition
CO (4-8 l/min)
Hgb (12-16 or 14-18)
Sa02 (arterial oxygen sat) normal 90+ |
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Term
SaO2
what is it and how to we manipulate it? |
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Definition
arterial oxygen saturation
the measurement of oxygen bound to Hgb
97% of oxygen in blood
-to improve apply NC to drive A--a gradient |
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Term
|
Definition
can be relative hypoxia related to dec Hgb
to improve administer blood products |
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Term
|
Definition
oxygen consumption
the amount of oxygen consumed by the tissues in ONE MINUTES
250 ml/min |
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Term
oxygen extraction
is dependent on what? |
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Definition
energy needs
see oxyhemoglobin dissociation curve |
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Term
| oxyhemoglobin dissociation curve measures what |
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Definition
|
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Term
oxyhemoglobin dissociation curve
shift to the left |
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Definition
decreased oxygen consumption
causes oxygen to hold on to Hgb
this occurs in decreased metabolic states
-ie: hypothermia, alkalosis, dec Co2 |
|
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Term
oxyhemoglobin dissociation curve
shift to the right |
|
Definition
increased o2 consumption
causes oxygen to fall RIght off heme
occurs in increased metabolic states
-acidosis, fever, high CO2 and carbon monoxide |
|
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Term
| what do you need to measure VO2? |
|
Definition
arterial blood gas (ABG)
mixed venous blood
this compares original o2 content with end content |
|
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Term
| that are three methods used to assess VO2 |
|
Definition
serum lactate levels
base deficit
mixed venous sat monitoring and central venous 02 sat |
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Term
serum lactate
normal value |
|
Definition
< 2 mmol
higher levels= higher mortality |
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Term
base deficit
normal value and background |
|
Definition
-2 mmol (metab aci) to +2 mmol (metab alk)
this is the amount of base required to titrate 1 L of arterial blood to a normal pH
-calculate via ABG
-base is Bicarbonate |
|
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Term
|
Definition
mixed venous oxygen saturation
normal: 65-75% |
|
|
Term
low SvO2
value
means?
treatment? |
|
Definition
< 65%
means cells are extracting (using) too much 02
or
not enough is being delivered
-ie fever
administer blood |
|
|
Term
|
Definition
>75%
means cells are extracting (using) less o2
or
too much delivery is occuring |
|
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Term
|
Definition
central venous 02 saturation
normal 70-80%
5% higher than Sv02 to account for the mixing of atrial and coronary sinus blood
--- the heart is not included in this value
-drawn by central |
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Term
| factors that increase consumption |
|
Definition
-shift to the right
HYPERVENTILATION
inc temp
trauma
sepsis
hyperthyroidism
muscle activity
agitation |
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Term
| factors that decrease V02 |
|
Definition
-shift to the left
hypoventialation
dec temp
sedation
hypothyroidism
inactivity |
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Term
|
Definition
|
|
Term
| hypovolemic shock includes what shock states? |
|
Definition
septic shock
neurogenic shock
and
anaphylactic shock |
|
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Term
|
Definition
-fluid volume decrease or
-increase of intravascular compartment in proportion to fluid volume |
|
|
Term
hypovolemic shock
causes of loss |
|
Definition
-blood loss: trauma, GI and intercranial hemmorhage
-plasma loss: increased permeability: sepsis, burns, acidosis, peritonitis
-extra cellular loss: V, D, heat stroke
-decreased intake: NPO or no access |
|
|
Term
|
Definition
tachycardia
narrow pulse pressure: hypotension
inc RR and depth
dec u/o
pale, cool, clammy skin
delayed cap refill |
|
|
Term
| what are the three stages of hypovolemic shock classification? |
|
Definition
compensated
uncompensated and
irreversible |
|
|
Term
stages of hypovolemic shock classification
compensated |
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Definition
|
|
Term
stages of hypovolemic shock classification
uncompensated |
|
Definition
Sx
-decreased CO
-hypotension |
|
|
Term
| stages of hypovolemic shock classification |
|
Definition
loss of >25% of vascular volume
-ischemia and acidosis
-reperfusion injury |
|
|
Term
| how much fluid volume loss induces hypotension? |
|
Definition
20% fluid volume loss
at 25% loss the patient will have vital organ function loss |
|
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Term
|
Definition
two of following
-T < 36 (96.8) or >38 (100.1)
-HR >90
-RR >20 or PaC02 <32
-WBC >12,000 or <4,000 |
|
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Term
|
Definition
sepsis manifestations with organ involvement
-hypoperfusion and hypotension
lactic acidosis
dec u/o
MS changes |
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Term
|
Definition
refractory hypotension
perfusion abnormalities
--- progresses slowly |
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Term
| Septic Shock Manifestations |
|
Definition
tachycardia and hypotension
high CO low SVR
wide pulse pressure
bounding pulses
fever
crackles
inc Svo2
dec CVP- dec preload |
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Term
|
Definition
sepsis-related organ failure assessment
looks at lungs, heart, kidney, liver and coagulation
- increase in number of organs involved increases change of death |
|
|
Term
|
Definition
multi organ dysfunction syndrome
two or more organs impaired
-from UNCONTROLLED inflammatory/immune response
---perfusion imbalance |
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Term
|
Definition
distributive shock
imbalance btwn SNS & PNS
---above T6 injury |
|
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Term
|
Definition
SCI above T6
spinal anesthesia
interruption of o2 to medulla
depressive Rx
severe emotional stress or pain |
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Term
|
Definition
dec bp and SVR/afterload
dec CO, CVP
excessive brady (no tachy)
neuro dysfunction
warm and dry skin
Poikiothermia |
|
|
Term
|
Definition
taking on the temperature of the environment
dec ability to maintain body temp |
|
|
Term
| determining factor or key distinguisher of neurogenic shock? |
|
Definition
bradycardia
there is no SNS compensation of reflex tachycardia |
|
|
Term
anaphylactic shock
is not distributive. true or false? |
|
Definition
false
anaphylactic shock is distributive |
|
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Term
|
Definition
tachycardia (compensation) and dec BP
wheezing and stridor
erythema and pruitis
dec: CVP, PAWP, CO, SVR
-possible low grade temp |
|
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Term
|
Definition
anemia
hemorrhage
carbon monoxide poisoning |
|
|
Term
| Obstructive shock example 1? |
|
Definition
pulmonary embolism
-pulm artery is blocked causing
--dec preload to left heart, dec co and dec Do2
--V/Q mismatch |
|
|
Term
| Obstructive shock example 2? |
|
Definition
tension pnuemothorax
increased intrathoratic pressure causes dec in venous return (preload), causing dec CO and dec DO2 |
|
|
Term
| Obstructive shock example 3? |
|
Definition
cardiac tamponade (blood in pericardium)
increased intracardiac pressure causes dec venous return causing dec co and dec do2 |
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|
Term
|
Definition
|
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Term
|
Definition
acute MI (5-10%)
ventricular septal defect
cardiomyopathy
free wall rupture? |
|
|
Term
|
Definition
SBP >90
tachycardia
dysrhythmias: PVC leading to Vtach
dec CO
inc RR and crackles
weak, thready pulse
diminished heart sounds
dec u/o |
|
|
Term
| shock common compensatory mechanisms sx |
|
Definition
inc HR
inc RR
inc glycolysis (inc blood sugar)
dec U/o and peristalsis
dec blood to internal organs
cool skin and diaphoresis |
|
|
Term
shock common compensatory mechanisms
RAAS |
|
Definition
increase SNS
k excretion and h2o/NaCl retention (aldosterone)(ADH) |
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Term
| shock physcial exam should include |
|
Definition
heart and resp rates
LOC
and cap refill |
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|
Term
| general shock treatment goals |
|
Definition
optimize oxygen delivery (Do2)
decrease oxygen consumption (Vo2) |
|
|
Term
general shock treatment
optimizing oxygen delivery |
|
Definition
supplemental 02
IVF and blood products
positive inotropic agents (dobut)
vasoactive Rx
trendelenberg position
revascularize myocardium
glucose monitoring
feed the gut (NG/OG) |
|
|
Term
general shock treatment
decreasing oxygen consumption |
|
Definition
dec WOB: intubation and mechanical vent
pain and anxiety control
hyperthermia treatment
neuromuscular blockers |
|
|
Term
|
Definition
digoxin (inc Ca to inc contractility) inc co and hr
dobutamine
milrinone (inc filling) |
|
|
Term
|
Definition
epinepherine (B>A)
norepinepherine (A>B)
dopamine (2-3 renal, 5-10 moderate, >10 heart)
vassopresin ( |
|
|
Term
stages of shock
1- initial |
|
Definition
decreased CO is evident
decreased tissue perfusion is evident
vitals= mechanisms activated |
|
|
Term
stages of shock
2- compensation |
|
Definition
neuroendocrine responses activated
ie RAAS |
|
|
Term
stages of shock
3- progressive shock |
|
Definition
compensation failure
poor perfusion of oxygen to tissues
-hypoxia, cell death, organ dysfunction/failure |
|
|
Term
stages of shock
4- refractory shock |
|
Definition
final stage
poor perfusion despite intervention
hypoxia ----> organ failure and death
refractory to treatment |
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