1. Shock! Eric Alison Lexi Kevin

2. Article http://byui.idm.oclc.org/login?url=http://se arch.ebscohost.com/login.aspx?direct=tru e&db=cmedm&AN=24509521&site=ehost- live

3. Distributive shock EXPANDED INTRAVASCULAR SPACE Anaphylactic shock tx- Epi-pen, Benadryl, Steroids (SoluMedrol) neurogenic tx- Immobilization, IV fluids, steroids, surgery Septic tx- Antibiotics, IV fluids

4. Hypovolemic Shock Decreased Blood volume -leads to decreased blood pressure. MAP of 65-75 is generally the accepted minimum needed to perfuse vital organs. -Internal or External blood loss (hemorrhage) -Severe loss of extracellular fluids (vomiting, diarrhea, and excessive diuresis) tx- IV fluids, blood transfusion, stop the cause of fluid/blood loss

5. Obstructive Shock CIRCULATORY BLOCKAGE WHICH DISRUPTS CARDIAC OUTPUT *Pulmonary Embolism tx- anticoagulation therapy * Cardiac tamponade tx- pericardiocentesis * Tension Pneumothorax tx- Chest tube

6. Cardiogenic Shock Cardiogenic shock is a systolic blood pressure less than 90 mmHg for at least 30 minutes secondary to myocardial dysfunction MI with loss of > 40% of left ventricle myocardium Right ventricle MI End-stage cardiomyopathy Papillary muscle dysfunction Cardiac rupture Congenital heart defects tx- Stop the cause, surgery, cardiac catheterization, medications, heart transplant

7. Treatment Call 911 US/CAN, UK 999, Europe 112, Australia 000, Brazil 192, Argentina 107, Chile 131 -Check pt. airway, breathing, and circulation (start CPR) -Elevate legs 12 inches and keep warm -Administer O2 and IV fluids

8. Current Practice Biomedical Press published results from a study Feb 6, 2014 involving twenty-five patients. “The patients suffered from shock secondary to myocardial infarction and were successfully treated with percutaneous coronary intervention. Before the inclusion, 16/25 patients presented a cardiac arrest in the presence of medical staff. Norepinephrine was titrated to increase MAP from 65 mmHg to 85 mmHg during 1 h..In conclusion, a short-term increase in MAP with norepinephrine in resuscitated cardiogenic shock complicated by post reperfusion disease is associated with better cardiac performance and improved microcirculatory variables.” (Perez)