10- Shock Flashcards
What does the PNS do to the circulatory system and “with what”
- Slow rate
- Vagus nerve
What does the SNS do to the circulatory system and “with what”
- Increase rate
- Cardiac plexus
What is stroke volume
Amount of blood ejected from the heart in a single beat
What is preload
Amount of ventricle stretch as blood enters
What is ventricular filling
Amount of blood that enters a ventricle before contraction
What is the frank-starling mechanism
Rubber band effect
What is after load
The force the heart must contract to send blood out
What is the formula for cardiac output
Stroke volume x Heart rate
What is the fick principle
Perfect O2 take in and off load to tissues
Describe shock in 1 word
Hypoperfusion
What is hypoperfusion and 5 possible problems that cause it
-Inadequate tissue perfusion
1 Pump problem 2 Volume problem 3 Container problem 4 Obstruction problem 5 Respiratory problem
What are the 3 stages of shock
1 Compensated
2 Decompensated
3 Irreversible
What are the 5 signs of compensated shock
- Pulse rate increase
- Pulse strength decrease
- Skin may become cool and clammy
- Progressive anxiety, restlessness, combativeness
- Thirst, weakness, eventual air hunger
What are the 4 signs of decompensated shock
- Pulses become unpalpable
- Blood pressure drops precipitously
- Patient become unconscious
- Respiration’s slow or cease
What is irreversible shock
Irreversible damage, cells die, tissues dysfunction and the patient dies
What happens to the BP in compensated vs decompensated shock
Comp - Maintains
Decomp - Drops
What is the formula for BP
BP = Cardiac output x peripheral vascular resistance PVR
What does PVR determine
After load
What is pulse pressure
Difference between the systolic and diastolic
Ex. Which does each BP possibly indicate
70/40
70/60
70/30
70/40 - Normal BP, need fluid
70/60 - Pump problem (weak heart)
70/30 - Container problem (vasodilated, fluid problem)
What are the 5 compensatory mechanisms in order
- Baroreceptors
- Renin-angiotensin-aldosterone
- Chemoreceptors
- ADH (anti diuretic hormone)
- Fluid return
Where are Baroreceptors located and their effect on SNS (3) and PNS (2)
Location - Atria, vena cava, aortic arch (Most), carotid sinus
SNS effect
- Stimulates arenalglands
- Secrete Epi and norepi
- Aalpha and beta effects
PNS
- Stops signal to vagus nerve
- Increase HR and vasoconstriction
What are the 5 steps of the renin-angiotensin-aldosterone compensatory mechanism
- BP drops
- Renin is released from the kidneys
- Renin + blood (plasma) = Angiotensin 1
4, ACE (angiotensin converting enzyme) converts angiotensin 1 to angiotensin 2
-Angiotensin 2 vasoconstricts
- Aldosterone is released by adrenal cortex
- Stimulates kidneys to reabsorb sodium to decrease ursine output and maintain fluids
What is the role of chemoreceptors and what is the bodies response to acidosis
Monitor pH and in turn signal to breath more or less
In acidosis the rate and depth of respiration’s increase to blow off CO2
What is the role of ADH and what part of the body secretes it
Also what else is secreted by that part of the body and its role
Released by anterior pituitary gland to decrease the production of urine
The anterior pituitary also releases vasopressin a vasoconstrictor
What is the role of fluid return and what is the action called
It’s the constriction of the spleen to release 200 - 300 mL of stored blood into circulation
This is the splenic squeeze
Arteries, capillaries and veins contain what percentage of blood volume
Arteries - 13%
Capillaries - 7%
Veins - 64%
At the capillary level how does blood get from an artery to a vein
- Artery
- Precapillary sphincter
- Capillary
- Postcapillary sphincter
- Vein
OR from artery directly to vein through AV shunt
Capillary sphincters during normalcy
Pre - Open
Post - Open
AV shuts - Closed
Capillary sphincters during compensated shock
Pre - Closed (no new blood in capillaries)
Post - Open
AV shunt- Blood goes through
Since no new blood comes in surrounding tissues release their fluid for the body
Capillary sphincters during late compensated shock
Pre - closed
Post - closed
Surrounding tissues stop fluid release so they can survive
Capillary sphincters during early decompensated shock
Pre - open
Post - closed
Tissues that gave fluid now need more, Lactic acid builds up
Capillary sphincters during irreversible shock
Pre - open
Post - open
Since the body NEEDS all the fluid it can get everything opens and the lactic acid that built up in the capillaries is released with new blood
What are the 4 types of shock
- Hypovolemic
- Distributive
- Cardiogenic
- Obstructive
What is hypovolemic shock, the causes, s/s and treatment
- Loss of blood volume
- Causes - Trauma, burns, dehydration
- S/S - Classic shock (cool, pale, clammy)
- Treatment - Stop fluid loss, give fluid to stabilize vitals
What is distributive shock and the 3 types
Prevents appropriate distribution of nutrients and the removal of waste, vasodilation occurs and overrides vasoconstriction
3 types
- Anaphylactic
- Septic
- Neurogenic
What is anaphylactic shock, causes, s/s and treatment
- Container and respiratory problem due to an overrelease of histamine
- Causes - Allergic reaction
- S/S - Hives (wheal on skin), SOB, Rapid drop in BP
- Treatment - Epi, Benadryl
Again, vasodilation over rides vasoconstriction
What is septic shock, causes, s/s and treatment
Massive infection throughout the body resulting in a container and fluid problem, vessels are damaged
- Causes - Infection
- S/S - Hot, dry, flushed skin, petechia (purple) rash
- Treatment - Fluids and antibiotics
What is neurogenic shock, causes, s/s and treatment
Container problem due to vasodilation from a cervical injury preventing messages to be send from body to brain resulting in wide spread vasodilation
- Causes - Head/neck injury
- S/S - Skin normal, rapid drop in BP, loss of body temp control
- Treatment - Fluid and steroids
What is cardiogenic shock, causes, s/s and treatment
Pump failure
- Causes - MI, tension pneumo, cardiac tamponade, PE
- S/S - Classic shock, only with CP
- Treatment - Dobutamine, dopamine
HELP THE PUMP!!!
What is MODS and the definition
Multiple Organ Dysfunction Syndrome
Altered organ function in acutely ill patients such that homeostasis cannot be maintained without intervention and usually involves 2 or more organ systems
What constitutes as mods
Two or more organ systems from and injury or infection (sepsis)
What is primary MODS
From the primary disorder which triggers the response
What is secondary MODS
Concurrent failure of two or more organs or organ systems that were initially unharmed by the acute disorder
What occurs during MODS
Immune, inflammatory and coagulation response is a decrease in blood flow to organs and organ systems
The body attempts to compensate by accelerating tissue metabolism
Results in imbalance in oxygen supply and demand
What is the tissue result of hypoxia from MODS (6)
- Hypoperfusion
- Exhaustion of ATP
- Metabolic failure
- Lysosome breakdown
- Anaerobic metabolism and acidosis
- Impaired cellular function
