Myocardial depressant factor from ischemic pancreas Hypovolemic Shock - Inadequate volume - Low MAP Divided in 2 causes direct loss (external) and indirect loss (internal) External loss: Trauma, vomiting, diabetes Ins, diuresis, diarrhea surgery Internal Loss: Hemorrhage, burns, Ascites, peritonitis, dehydration Hypovolemic shock Treatment - Maintain patent airway (A) - Administer High-flow o2 (B) - Anticipate intubation (A) - 2 large bore IVs for fluid resuscitation (C ) - Control external bleeding (C ) - Vasopressors after hypovolemia has been corrected - Insert Foley - treat arrhythmias
Fluid Replacement - 20 ml/kg Bolus - 30 ml/ kg for Septic Shock Crystalloids: - Normal Saline - Lactated Ringer’s - 3:1 rule 1 ml of blood loss 3x amount of a crystalloids volume Colloids - Hespan - Albumin - Dextran Start with antecubital in left arm because it’s close to the circulation (14 or 16 guage) **Hypothermia and Hypervolemia can occur!! Cardiogenic shock - Special kind when the heart muscle itself is not working properly - Clinical presentation varies depends on which area of the heart isn’t working properly - Know that cardiac output is insufficient Distributive shock - Enough volume is not in the right place caused by sympathetic tone blood pools in venous beds and increased capillary permeability
Anaphylactic shock - Allergic reaction within 2 minutes after the irritant occurs 2 nd exposure to the allergen. - Signs flushed, difficulty breathing, stridor, hives, itching, voice change - Treatment- epinephrine IV - Oxygen or epinephrine? Epinephrine first!!!! Neurogenic Shock - Hemodynamic phenomenon occurs after spinal cord injury at T5 or above results in vasodilation - Most important clinical manifestos - Hypotension - bradycardia - Poikilothermia – take on temp of the room Septic Shock -The presence of sepsis with hypotension despite fluid resuscitation along with the presence of tissue perfusion abnormalities.
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- Spring '17
- mrs. Vargovich