Shock Classification and Hemodynamics
From The CRNA Club Podcast · 28:23
Show by Sachi Lord
Grab the FREE Types of Shock Comparison Cheat Sheet: https://thecrnaclub.com/free/types-of-shock-comparison-cheat-sheet Try The CRNA Club FREE for 7 days: https://thecrnaclub.com/free-trial The four types of shock are hypovolemic, cardiogenic, distributive and obstructive. MAP roughly equals cardiac output times SVR, and a different piece of that equation breaks in each type. Hypovolemic loses preload, cardiogenic loses pump strength, distributive loses vascular tone, and obstructive blocks filling or forward flow. Cardiac output, filling pressures and SVR show which piece broke. IN THIS EPISODE: How shock starts with oxygen delivery and what happens inside the cell Baroreceptors, alpha-1, beta-1, RAAS and vasopressin as the body's response Hypovolemic shock numbers and the bedside picture Cardiogenic shock, the wedge pressure, right ventricular infarct and treatment Septic, anaphylactic and neurogenic shock as the three distributive types Massive PE, tamponade and tension pneumothorax as obstructive shock Telling the types apart from cardiac output, filling pressures, SVR, wedge and PA diastolic Where to keep learning shock pathophysiology and pharmacology COMMON QUESTIONS: Do all types of shock cause hypotension? Not always. In hypovolemic shock the vessels clamp down, so blood pressure often holds until about 30 percent of blood volume is lost. Heart rate, pulse pressure, lactate and urine output usually change first, so a normal blood pressure does not rule shock out. Is sepsis a type of shock? Septic shock is a type of distributive shock, but sepsis alone is not septic shock. Septic shock means sepsis where a vasopressor is still needed to keep the MAP at 65 or higher after adequate fluids, with a lactate above 2. Nitric oxide relaxes the vessels, so the SVR falls. What type of shock does cardiac tamponade cause? Cardiac tamponade causes obstructive shock. Fluid or blood fills the pericardial sac, pressure rises and chambers barely fill. Cardiac output falls, and CVP, PA diastolic and wedge pressures rise toward one number. Beck's triad is low blood pressure, distended neck veins and muffled heart sounds. Drainage fixes it. Follow The CRNA Club: Instagram: @thecrnaclub Website: thecrnaclub.com
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