NSG 4100 — Exam 4 (Final) Quick Notes
Comprehensive & Critical Care Concepts: Condensed Content Review
Shock — Quick ID Table
Hypovolemic
● Blood/fluid loss → ↓HR-up, ↓BP, cool clammy skin
● Treat: control source of loss + IV fluids/blood products
Cardiogenic
● Pump failure (often post-MI) → ↓CO, ↑SVR, crackles, cold extremities
● Treat: inotropes (dobutamine), consider IABP; watch distal pulses w/ IABP
Distributive (Septic, Anaphylactic, Neurogenic)
● Septic: early warm/flushed skin → later cold/mottled; lactate ↑ = hypoperfusion
● Anaphylactic: hives, wheeze, hypotension → epinephrine IM first; add fluids/pressors if
still hypotensive
● Neurogenic (high SCI): ↓BP + ↓HR (bradycardia, NOT tachycardia) + warm dry skin
below injury
Obstructive
● Physical blockage to cardiac filling/output
● Tension pneumo: absent breath sounds + JVD + hypotension → needle decompression
emergency
● Cardiac tamponade: Beck's triad = muffled heart sounds + JVD + hypotension
General Shock Pearls
● MAP goal >65 mmHg for organ perfusion
● UOP <30 mL/hr (or <20-0.5mL/kg/hr) = inadequate renal perfusion
● Falling lactate = improving perfusion; rising lactate = worsening
● Vasopressors ideally via CENTRAL line (peripheral extravasation → tissue necrosis)
● First-line fluid: isotonic crystalloid (NS or LR)
MODS & Critical Care
MODS
● ≥2 organ systems failing, often from prolonged shock/sepsis
● Best prevention = early aggressive treatment of the underlying cause
Ventilator Care
Comprehensive & Critical Care Concepts: Condensed Content Review
Shock — Quick ID Table
Hypovolemic
● Blood/fluid loss → ↓HR-up, ↓BP, cool clammy skin
● Treat: control source of loss + IV fluids/blood products
Cardiogenic
● Pump failure (often post-MI) → ↓CO, ↑SVR, crackles, cold extremities
● Treat: inotropes (dobutamine), consider IABP; watch distal pulses w/ IABP
Distributive (Septic, Anaphylactic, Neurogenic)
● Septic: early warm/flushed skin → later cold/mottled; lactate ↑ = hypoperfusion
● Anaphylactic: hives, wheeze, hypotension → epinephrine IM first; add fluids/pressors if
still hypotensive
● Neurogenic (high SCI): ↓BP + ↓HR (bradycardia, NOT tachycardia) + warm dry skin
below injury
Obstructive
● Physical blockage to cardiac filling/output
● Tension pneumo: absent breath sounds + JVD + hypotension → needle decompression
emergency
● Cardiac tamponade: Beck's triad = muffled heart sounds + JVD + hypotension
General Shock Pearls
● MAP goal >65 mmHg for organ perfusion
● UOP <30 mL/hr (or <20-0.5mL/kg/hr) = inadequate renal perfusion
● Falling lactate = improving perfusion; rising lactate = worsening
● Vasopressors ideally via CENTRAL line (peripheral extravasation → tissue necrosis)
● First-line fluid: isotonic crystalloid (NS or LR)
MODS & Critical Care
MODS
● ≥2 organ systems failing, often from prolonged shock/sepsis
● Best prevention = early aggressive treatment of the underlying cause
Ventilator Care
