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957 Block 4 > 2. Oxygen Delivery & Shock > Flashcards

2. Oxygen Delivery & Shock Flashcards

1
Q

What is CaO₂?

A

Concentration of arterial oxygen (mL/dL)

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2
Q

What is Hgb?

A

hemoglobin concentration (mg/dL)

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3
Q

What is SaO₂?

A

arterial oxygen saturation (%)

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4
Q

What is PaO₂?

A

arterial oxygen pressure (mmHg)

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5
Q

What is normal CaO₂?

A

17–20 mL/dL

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6
Q

What is the primary contributor to arterial oxygen content?

A

Hgb and SaO₂ (oxygen bound to hemoglobin)

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7
Q

What are the 5(+1) factors that contribute to oxygen delivery?

A
  1. Hgb
  2. SaO₂
  3. CO
  4. VO₂
  5. Hgb oxygen affinity
  6. microcirculatory regulation
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8
Q

Why are the 5(+1) factors that impact oxygen delivery and not just 5?

A

We cannot change microcirculatory regulation

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9
Q

What is DO₂?

A

delivery of oxygen to tissues (mL/min/m²)

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10
Q

What is CO?

A

cardiac output (L/min/m²)

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11
Q

What is normal DO₂?

A

550–650 mL/min/m²

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12
Q

What are the 2 components that contribute to CO?

A

HR and SV

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13
Q

What is CvO₂?

A

concentration of venous oxygen (mL/dL)

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14
Q

What is SvO₂?

A

venous oxygen saturation (%)

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15
Q

What is PvO₂?

A

venous oxygen pressure (mmHg)

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16
Q

What is a normal CvO₂?

A

15 mL/dL

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17
Q

What is the primary contributor to venous oxygen content?

A

Hgb and SvO₂ (oxygen bound to hemoglobin)

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18
Q

What is VO₂?

A

oxygen consumption by tissues (mL/min/m²)

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19
Q

What is normal CaO₂ – CvO₂?

A

4–6 mL/dL

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20
Q

What is normal VO₂?

A

115–165 mL/min/m²

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21
Q

Since humans cannot store oxygen, the amount of oxygen consumed is the difference between _______ and __________.

A

CaO₂ and CvO₂

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22
Q

An SvO₂ < ____% is incompatible with life.

A

50%

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23
Q

What factors may cause Hgb to have an increased affinity for oxygen?

A
  • decreased temperature
  • decreased 2-3 DPG
  • alkalosis
24
Q

What factors may cause Hgb to have a reduced affinity for oxygen?

A
  • increased temperature
  • increased 2-3 DGP
  • acidosis
25
Q

At a cellular level, oxygen diffusion is determined by what?

A

pressure gradients

26
Q

How can utilization of oxygen can be estimated?

A

SvO₂

27
Q

Describe stage 1 of shock.

A
  • BP normal
  • HR/RR elevated
  • mild respiratory alkalosis
  • anxiety/agitation
28
Q

Describe stage 2 of shock.

A
  • BP low
  • obvious hypoperfusion (oliguria, AMS)
  • metabolic acidosis due to lactate
29
Q

Describe stage 3 of shock?

A
  • BP very low
  • severe lactic acidosis
  • cardiac dysfunction - arrhythmia, tachycardia, ischemia
  • intubation required
  • high mortality
30
Q

If a patient survives stage 3 shock, what is likely to occur?

A

multi-organ failure

31
Q

What is the goal of early management of shock?

A

restore oxygenation

32
Q

What 3 steps are taken to restore oxygenation in shock?

A
  • fluid resuscitation
  • vasopressors/inotropes
  • blood products
33
Q

What are the steps to discovering the etiology of shock?

A
  • H&P

- lab data

34
Q

ANS compensation of shock is mediated how?

A

carotid and aortic arch baroreceptors

35
Q

ANS compensates for shock by releasing ______ in response to _______.

A
  • catecholamines (EPI, NE)

- BP reduction

36
Q

What are the 3 major effects of ANS compensation?

A
  1. Arteriolar vasoconstriction (↑ SVR)
  2. Reduction in venous capacitance (↑ venous return)
  3. Increase in heart rate/contractility
37
Q

What are the hormonal responses to shock?

A

Increased serum cortisol leads to

  • water retention
  • sodium retention
  • insulin resistance and hyperglycemia
38
Q

Each organ system can autoregulate blood flow. (T/F)

A

True

39
Q

What are the major categories of shock?

A
  • hypovolemic
  • cardiogenic
  • distributive
  • neurogenic
  • obstructive
40
Q

What is always the problem with shock, no matter the category

A

poor tissue oxygenation

41
Q

What is the main disturbance with hypovolemic shock?

A

reduction in intravascular volume

42
Q

What is the prototype of hypovolemic shock?

A

hemorrhagic shock

43
Q

What is the main treatment for hypovolemic shock?

A

volume restoration

44
Q

What is the main disturbance with cardiogenic shock?

A

reduction in pump function

45
Q

What is the prototype of cardiogenic shock?

A

post-MI

46
Q

What is the main treatment of cardiogenic shock?

A
  • careful volume restoration
  • correction of underlying problem
  • inotropic support
47
Q

What is the main disturbance of distributive shock?

A

Loss of microcirculatory autoregulation (compounded by increased metabolic demand)

48
Q

What is the prototype of distributive shock?

A

sepsis

49
Q

What is the main treatment of distributive shock?

A
  • volume restoration

- vasopressor support

50
Q

What is the main disturbance of neurogenic shock?

A

loss of sympathetic tone

51
Q

What is the prototype of neurogenic shock?

A

spinal cord trauma

52
Q

What is the main treatment of neurogenic shock?

A

vasopressor/inotropic support

53
Q

What is the main disturbance of obstructive shock?

A
  • impaired venous return

- decreased CO

54
Q

What is the prototype of obstructive shock?

A
  • tension pneumothorax
  • pericardial tamponade
  • massive pulmonary embolism
55
Q

What is the treatment of obstructive shock?

A

correction of underlying physiology

957 Block 4 (3 decks)

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