10. Haemodynamic Shock

Question 1

What are the 3 main types of shock that result in reduced CO?

Answer 1

• cardiogenic
• mechanical
• hypovolaemic

Question 2

What are 3 potential causes of cardiogenic shock?

Answer 2

• MI/heart Ischaemia
• arrhythmias
• acute worsening of heart failure

Question 3

In cardiogenic shock what will happen to the CVP?

Answer 3

May increase or be normal

Question 4

What is happening to the patient if there is pulseless electrical activity?

Answer 4

Cardiac arrest

Question 5

What is long QT syndrome?

They are more at risk of getting..?

Answer 5

Rare, congenital/acquired syndrome where there is a delayed repolarisation of the heart

Ventricular fibrillation
&
Torsades de pointes (abnormal heart rhythm)

Question 6

What is cardiac tamponade?

Answer 6

Blood/fluid building up in the pericardial space

Question 7

What are two causes of mechanical shock?

Answer 7

Cardiac tamponade

Massive Pulmonary embolism

Question 8

How does cardiac tamponade cause mechanical shock?

Answer 8

Restricts filling of the heart in diastole.

Question 9

In cardiac tamponade which side of the heart is effected?

Answer 9

Both

Question 10

What happens to the CVP in mechanical shock ?

What happens to the arterial pressure ?

Answer 10

Increases

Low

Question 11

If a PE was to cause mechanical shock where would it lodge ?

Answer 11

Large pulmonary artery

Question 12

In Mechanical shock caused by PE what happens to the pressure in the right and left side of the heart?

Answer 12

Left = low 
Right = high

Question 13

If someone has a PE what sx would they get?

Answer 13

Dyspnoea

Chest pain

Question 14

What can cause hypovolaemic shock?

Answer 14

Haemorrhage
Severe burns
Severe diarrhoea or vomiting

Question 15

What percentage of blood loss will show signs of shock ?

Answer 15

20-30%

Question 16

What percentage of blood loss is severe shock?

Answer 16

30-40%

Question 17

What is the compensatory response for shock ?

Answer 17

- increased sympathetic stimulation via baroreceptors 
= 
- peripheral vasoconstriction
-venoconstriction 
- tachycardia 
- increased force of contraction

Question 18

What is internal transfusion ?

Answer 18

Seen in hypovolaemic shock.

Reduced hydrostatic pressure in the capillaries causes fluid to move out of the tissue space and into the capillaries.

Question 19

How might a patient with hypovolaemic shock present?

Answer 19

Tachycardia
Weak pulse
Pale skin
Cold, clammy extremities

Question 20

What are longer term responses to restore blood volume?

Answer 20

• RAA system

- ADH

Question 21

If there is 20% blood volume loss how long will it take to restore?

Answer 21

3 days if salt and water are adequate

Question 22

What is the type of shock caused by reduced TPR

Answer 22

Distributive shock

Question 23

What are two examples of distributive shock ?

Answer 23

Toxic/septic shock

Anaphylactic shock

Question 24

What happens to the vessels in distributive shock ?

What happens to the arterial pressure?

Answer 24

Vasodilation

Decrease

Question 25

What is inside an epipen?

Answer 25

Adrenaline

Question 26

How does adrenaline help in an anaphylactic shock ?

Answer 26

Alpha 1 agonist

= vasoconstriction to increase TPR and thus blood pressure.

Question 27

How might a patient in anaphylactic shock present?

Answer 27

Tachycardia
Warm, red extremities.
Difficulty breathing
Collapsed

Question 28

In sepsis what happens to the arteries initially and what happens to them in later stages of sepsis?

Answer 28

Initially vasodilation

Later vasoconstriction