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2 CVS > 19 Haemodynamic Shock > Flashcards

19 Haemodynamic Shock Flashcards

1
Q

Define haemodynamic shock.

A

Acute condition of inadequate blood flow (catastrophic fall in arterial blood pressure)

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2
Q

What are the 3 equations used to work out Mean Arterial Blood Pressure?

A

=

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3
Q

In general terms, what causes shock?

A

Fall in CO or TPR beyond capacity of heart to cope

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4
Q

What is cardiogenic shock?

A

Heart unable to pump enough blood to meet body’s needs

Pump failure- ventricle cannot empty properly

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5
Q

What are the potential causes of Cardiogenic shock?

A
  1. Myocardial infarction (LV damage) 2. Serious arrhythmias 3. Acute, worsening heart failure
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6
Q

What occurs within the heart and body as a result of cardiogenic shock?

Central Venous Pressure:

Arterial BP:

Urine:

A

Central Venous Pressure= normal/raised,

Arterial BP= drops

Oliguria (reduced urine production)-kidney’s= poorly perfused

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7
Q

What is a ‘Cardiac Arrest’?

A

Unresponsiveness associated with lack of pulse- heart stopped and ceased to pump effectively

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8
Q

What is ‘asystole’?

A

Complete loss of electrical and mechanical activity

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9
Q

What are the common causes of cardiac arrest?

A

Ventricular fibrillation

MI

Electrolyte imbalance

Arrythmias

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10
Q

How do we respond to a patient who has gone into cardiac arrest?

A
  1. BASIC LIFE SUPPORT: chest compression + external ventilation
  2. ADVANCED LIFE SUPPORT: defibrillation, electric current (depolarises cells- puts them in refractory period allowing coordinated electrical activity to restart)
    1. ADRENALINE: enhance myocardial function, increase peripheral resistance
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11
Q

What are the two main types of mechanical shock?

A

1) Cardiac tamponade

(accumulation of fluid in the pericardial space)

2) Pulmonary embolism

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12
Q

What is cardiac tamponade?

A

Blood/fluid build up in pericardial space- restricts heart filling- limits EDV

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13
Q

What happens to the central venous pressure and arterial blood pressure is cardiac tamponade occurs?

A

High CVP and Low arterial BP

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14
Q

How does a pulmonary embolus develop to ‘shock’?

A

Large pulmonary artery occluded

Pulmonary artery at high pressure

Right ventricle cannot empty

CVP is high

Reduced return of blood to left heart-limits filling

Left arterial pressure is low- arterial pressure is low

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15
Q

What symptoms might a person with a pulmonary embolus experience?

A
  1. Chest Pain 2. Dyspnoea (difficult breathing)
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16
Q

What % blood loss is required to cause ‘hypovolaemic shock’?

A

20-30%= some signs of shock 30-40%=serious shock response

17
Q

What may cause hypovolaemic shock?

A

1, Haemorrhage 2, Severe burns 3, Severe diarrhoea/vomiting

18
Q

If cardiac output and arterial pressure fall, what is the body’s compensatory response?

A

Pressure fall detected by BARORECEPTORS

Increased SYMPATHETIC stimulation

  1. TACHYCARDIA + increased FORCE of contraction
  2. Peripheral vasoconstriction + venoconstriction
19
Q

If a patient has hypovolaemic shock what symptoms will they have?

A

Tachycardia

Weak pulse

Pale skin

Cold+clammy extremities

Low CVP

20
Q

What is there a danger of if someone develops hypovolaemic shock?

A

DECOMPENSATION= peripheral vasoconstriction impairs tissue perfusion- tissue damage due to hypoxia- chemical mediators(VASODILATORS) released- TPR falls-blood pressure drops dramatically- vital organs no longer perfused.

21
Q

If the body loses about 20% of blood volume, how does the body restore original body volume? How long does it take?

A

1)Renin-angiotensin-aldosterone system 2)ADH - takes about 3 days

22
Q

What is distributive shock?

A

Low resistance shock- profound peripheral vasodilation- TPR drops (i.e. circulation volume increased, blood volume= constant)

23
Q

What are the 2 main causes of DISTRIBUTIVE SHOCK?

A

1) Toxic (septic) shock 2) Anaphylactic shock

24
Q

How could sepsis lead septic shock?

A

Endotoxins- released by circulating bacteria- profound circulatory inflammatory response- profound vasodilation- fall in TPR- impaired perfusion- +capillaries=leaky

25
Q

How would a patient with septic shock present?

A

Initially tachycardia +warm,red extremities. Later= vasoconstriction

26
Q

What is anaphylactic shock?

A

Severe allergic reaction- histamine released from mast cells- vasodilation

27
Q

Apart from effects on the CVS, what other effects can anaphylaxis have on the body?

A

DIFFICULTY BREATHING- bronchoconstriction and laryngeal oedema

28
Q

How will a patient with anaphylactic shock present?

A

Difficulty breathing, collapsed, rapid HR, red+warm extremities

29
Q

How do you treat anaphylactic shock?

A

Adrenaline- acts on alpha-1 receptors

2 CVS (16 decks)

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