Cardiogenic – lemone 274 (learn the chart with manifestations)

Cardiogenic – lemone 274 (learn the chart with manifestations)

Heart's pumping ability is compromised to the point that it cannot maintain cardiac output & adequate tissue perfusion, cyanosis more prevalent,↑CVP, edema, fluid overload. * MI is primary cause

anterior wall of heart affected

cardiogenic shock leads to:

1. decreased cardiac contractility which leads to ↓l

2. decreased stroke volume & cardiac output which leads to ↓l

3. pulmonary congestion which leads to ↓l

4. decreased coronary artery perfusion which leads to ↓l

5. decreased cardiac contractility (creates cycle)

*treatment:

1. give O₂,

2. control chest pain (morphine a. dilates blood vessels, b. ↓preload, c.↓afterload, d.↓anxiety)

morphine is a vasoactive drug

Distributive

1. vasodilation &↓peripheral resistance (ability of vessels to contract & relax)

2. relative hypovolemia – body not really have low volume, but body thinks so due to vasodilation.

3. when you faint, this is distributive shock

4. precipitating event (infection etc)

5. vasodilation

6. activation of inflammatory response (↑capillary permeability – fluid seeps into tissue. if not treated, then pt really does lose fluid)

7. maldistribution of blood volume which leads to ↓

8. decreased venous return which leads to↓

9. decreased cardiac output which leads to ↓

10. decreased tissue perfusion

Septic – caused by widespread infection, most common type of distributive shock

1. leading cause of death in ICU

2. gram neg. bacteria. ie. E. coli; also some gram +

3. look for susceptible people: transplant pt, chemotherapy, elderly, very young, chronic illnesses, malnourished, invasive procedures

4. skin warm due to vasodilation ↑temp; later skin will be cold

5. blood clotting in capillaries will use up clotting factor, pt will get "DIC" - prone to bleeding

6. use APC – human activated protein will↓mortality in septic shock, anti-inflammatory, stimulates fibrinolysis, balances hemostasis between coagulation & anti-coagulation

7. nutrition needed also