Hypotension and shock

hypotension-and-shock

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519005

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Regarding hypotension

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Explanation

Hypotension is state of low blood pressure with systolic blood pressure <90 mmHg (relative hypotension with >30mmHg below baseline, or mean arterial pressure <65. Shock is a physiologic state characterized by a significant reduction of systemic tissue perfusion (“decreased perfusion”), resulting in decreased oxygen delivery to the tissues & organ injury (e.g. brain, kidneys, liver, etc.)

Is a state of low blood pressure with systolic blood pressure

Relative hypotension with........below baseline

Mean arterial pressure

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..........is a physiologic state characterized by a significant reduction of systemic tissue perfusion (“decreased perfusion”), resulting in decreased oxygen delivery to the tissues & organ injury (e.g. brain, kidneys, liver, etc.)

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Explanation

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Types of shock

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Explanation

Types of Shock: 1. 3. Hypovolemic* – due to loss of fluid or blood 2. Cardiogenic* – due to decreased cardiac contractility Septic* - due to infection 4. Anaphylactic – due to allergic reaction 5. Obstructive – due to decreased blood flow to the left ventricle as in cardiac tamponade or PE 6. Endocrine - Adrenal Insufficiency, pituitary failure etc End SHOCA

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The three most common types of shock are

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Explanation

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The clinical presentations/cardinal features of shock are

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Explanation

Clinical presentation: Cardinal findings in all shock presentations  Hypotension – Absolute (systolic blood pressure <90 mmHg) or relative (a drop in systolic blood pressure >40 mmHg), which is why a patient may be in shock with a high or normal blood pressure.  Oliguria –From shunting of renal flow to other vital organs, intravascular volume depletion, or both.  Change in mental status – A continuum from agitation confusion/delirium/obtundation/coma.  Cool, clammy skin – Compensatory peripheral vasoconstriction redirects blood from the periphery to the vital organs (heart, brain, splanchnic). However, in early distributive shock or terminal shock the skin may be flushed or hyperemic skin due to failure of compensatory vasoconstriction  Metabolic acidosis – Increased lactate production from anaerobic metabolism when shock progresses to circulatory failure and tissue hypoxia, along with decreased clearance of lactate by the liver, kidneys, and skeletal muscle. CHOMa

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In management of shock usually need .......IV cannulas........gauge

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Explanation

Management In shock, the management depends entirely on the type of shock!!! Shock is ALWAYS an emergency and must be treated rapidly. Direct at most likely underlying cause; see other topics (GI bleeding, fever, meningitis, pneumonia, MI, etc). Usually need:  **2 large IV cannulas – 18 gauge (green) or greater**   **Aggressive colloid (NS or LR) fluid resuscitation for hypotension – especially in hypovolemic + septic shock (may require > 10L!!!)** **Packed red blood cells if bleeding/hypovolemic shock**  Foley catheter and monitoring of urine output  Frequent monitoring of vital signs Intubation if in respiratory distress  Stop any antihypertensives or diuretics. If pressors (dopamine, epinephrine, neosynephrine, etc), if shock is present despite aggressive fluid resuscitation and pressors are available  If septic: search for source & start empiric antibiotics based on likely type of infection. Give IV fluids  If hypovolemic: IV fluids, check electrolytes, fix underlying condition (e.g. diabetic ketoacidosis), send for type & crossmatch for urgent transfusion if hemorrhage (hemorrhage is the most common cause of hypovolemic shock).  If cardiogenic: IV fluids may be harmful, IV lasix and or dopamine may help, fix the underlying problem (e.g. valve replacement).  If outflow obstruction suspected: IV fluids, urgent ECG, CXR to confirm, thrombolysis for PE, chest tube for tension pneumothorax, percardiocentesis for tamponade.  If anaphylactic: IV fluids, subcutaneous epinephrine 0.3ml 1:1000 solution if severe, antihistamines, & corticosteroids may help.  If adrenal insufficiency: give hydrocortisone 100mg TDS x 5/7

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Aggressive colloid NS or LR fluid resuscitation for hypotension especially in

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Explanation

Intubation if in respiratory distress  Stop any antihypertensives or diuretics. If pressors (dopamine, epinephrine, neosynephrine, etc), if shock is present despite aggressive fluid resuscitation and pressors are available  If septic: search for source & start empiric antibiotics based on likely type of infection. Give IV fluids  If hypovolemic: IV fluids, check electrolytes, fix underlying condition (e.g. diabetic ketoacidosis), send for type & crossmatch for urgent transfusion if hemorrhage (hemorrhage is the most common cause of hypovolemic shock).  If cardiogenic: IV fluids may be harmful, IV lasix and or dopamine may help, fix the underlying problem (e.g. valve replacement).  If outflow obstruction suspected: IV fluids, urgent ECG, CXR to confirm, thrombolysis for PE, chest tube for tension pneumothorax, percardiocentesis for tamponade.  If anaphylactic: IV fluids, subcutaneous epinephrine 0.3ml 1:1000 solution if severe, antihistamines, & corticosteroids may help.  If adrenal insufficiency: give hydrocortisone 100mg TDS x 5/7

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Packed Red blood cells if bleeding

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Stop any............or............ If pressors (dopamine, epinephrine, neosynephrine, etc), if shock is present despite aggressive fluid resuscitation and pressors are available

Fill in the blanks

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search for source & start empiric antibiotics based on likely type of infection. Give IV fluids

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Explanation

 Intubation if in respiratory distress  Stop any antihypertensives or diuretics. If pressors (dopamine, epinephrine, neosynephrine, etc), if shock is present despite aggressive fluid resuscitation and pressors are available  If septic: search for source & start empiric antibiotics based on likely type of infection. Give IV fluids  If hypovolemic: IV fluids, check electrolytes, fix underlying condition (e.g. diabetic ketoacidosis), send for type & crossmatch for urgent transfusion if hemorrhage (hemorrhage is the most common cause of hypovolemic shock).  If cardiogenic: IV fluids may be harmful, IV lasix and or dopamine may help, fix the underlying problem (e.g. valve replacement).  If outflow obstruction suspected: IV fluids, urgent ECG, CXR to confirm, thrombolysis for PE, chest tube for tension pneumothorax, percardiocentesis for tamponade.  If anaphylactic: IV fluids, subcutaneous epinephrine 0.3ml 1:1000 solution if severe, antihistamines, & corticosteroids may help.  If adrenal insufficiency: give hydrocortisone 100mg TDS x 5/7

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IV fluids, check electrolytes, fix underlying condition (e.g. diabetic ketoacidosis), send for type & crossmatch for urgent transfusion if hemorrhage

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(0/0)

Explanation

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IV fluids may be harmful, IV lasix and or dopamine may help, fix the underlying problem (e.g. valve replacement).

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(0/0)

Explanation

519017

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IV fluids, urgent ECG, CXR to confirm, thrombolysis for PE, chest tube for tension pneumothorax, percardiocentesis for tamponade.

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Explanation

519018

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Hypotension and shock

Question 1 of 1

Time Left

Regarding hypotension

Fill in the blanks

(0/0)

Explanation

..........is a physiologic state characterized by a significant reduction of systemic tissue perfusion (“decreased perfusion”), resulting in decreased oxygen delivery to the tissues & organ injury (e.g. brain, kidneys, liver, etc.)

Fill in the blanks

(0/0)

Explanation

Types of shock

Fill in the blanks

(0/0)

Explanation

The three most common types of shock are

Select the correct answer(s).

(0/0)

Explanation

The clinical presentations/cardinal features of shock are

Fill in the blanks

(0/0)

Explanation

In management of shock usually need .......IV cannulas........gauge

Fill in the blanks

(0/0)

Explanation

Aggressive colloid NS or LR fluid resuscitation for hypotension especially in

Select the correct answer(s).

(0/0)

Explanation

Packed Red blood cells if bleeding

Select the correct answer(s).

(0/0)

Stop any............or............ If pressors (dopamine, epinephrine, neosynephrine, etc), if shock is present despite aggressive fluid resuscitation and pressors are available

Fill in the blanks

(0/0)

search for source & start empiric antibiotics based on likely type of infection. Give IV fluids

Select the correct answer(s).

(0/0)

Explanation

IV fluids, check electrolytes, fix underlying condition (e.g. diabetic ketoacidosis), send for type & crossmatch for urgent transfusion if hemorrhage

Select the correct answer(s).

(0/0)

Explanation

IV fluids may be harmful, IV lasix and or dopamine may help, fix the underlying problem (e.g. valve replacement).

Select the correct answer(s).

(0/0)

Explanation

IV fluids, urgent ECG, CXR to confirm, thrombolysis for PE, chest tube for tension pneumothorax, percardiocentesis for tamponade.

Select the correct answer(s).

(0/0)

Explanation

IV fluids, subcutaneous epinephrine 0.3ml 1:1000 solution if severe, antihistamines, & corticosteroids may help.

Select the correct answer(s).

(0/0)

Explanation

give hydrocortisone 100mg TDS x 5/7

Select the correct answer(s).

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Explanation

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