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Pathophysiology > 20 Shock > Flashcards

20 Shock Flashcards

1
Q

Shock

pathogenesis

A
  • imbalance bw O2 supply + O2 requirement at the cellular level
  • shock represents a diverse group of life-threatening conditions
  • common factor among all types of shock HYPOPERFUSION + impaired cellular O2 utilization
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2
Q

inadequate cellular oxygenation may result from…

A

1 decreased CO
2 maldistribution of BF
3 reduced blood oxygen content

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3
Q

Shock

types

A

1 Cardiogenic
2 Obstructive
3 Hypovolemic
4 Distributive

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4
Q

Cardiogenic Shock

A

inadequate CO despite sufficient vascular volume

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5
Q

Obstructive Shock

A

circulatory blockage (like a large pulmonary embolus or cardiac tamponade)

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6
Q

Hypovolemic Shock

A

loss of blood volume as a result of hemorrhage or excessive loss of extracellular fluids

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7
Q

Distributive Shock

A

greatly expanded vascular space bc of inappropriate vasodilation

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8
Q

lack of oxygen causes…

A

reperfusion injury

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9
Q

Types of Distributive Shock

A
  • characterized by excessive vasodilation + peripheral pooling of blood
  • –CO inadequate due to reduced preload

1 Anaphylactic Shock
2 Neurogenic Shock
3 Septic Shock

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10
Q

Anaphylactic SHock

A
  • Type I Hypersensitivity

- mast cells release HISTAMINE resulting in severe hypotension

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11
Q

Histamine

A

vasodilatory mediators

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12
Q

Neurogenic Shock

A

loss of sympathetic activation of arteriolar smooth muscles

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13
Q

Septic Shock

A

severe systemic inflammatory response to infection

-NO + kinin

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14
Q

Shock

complications

A
  • shock states results in reduced/inadequate cellular oxygen consumption
  • -may affect all organs + systems of body
  • complications are INFLAMMATORY
  • inflammation triggered by hypoxic injury to cells, by antigen or endotoxin
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15
Q

Acute Respiratory Distress Syndrome [ARDS]

A
  • commonly assoc w Septic Shock
  • dvlpt of refractory hypoxia, decr pulmonary compliance, + radiographic evidence of pulmonary edema
  • neutrophils release proteolytic enzymes, produce oxygen-free radicals, + secrete inflammatory chem that makes pulmonary capillaries leaky
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16
Q

primary cause of death in ARDS

A

multiple organ failure

-NOT severe hypoxemia

17
Q

exudate

A

a mass of cells and fluid that has seeped out of blood vessels or an organ, especially in inflammation

18
Q

Neutrophils role in ARDS

A

1 release proteolytic enzymes,
2 produce oxygen-free radicals,
3 secrete inflammatory chem that makes pulmonary capillaries leaky

19
Q

Neutrophils effects in ARDS

A

1 exudate leaks into interstitial spaced + alveoli of lung
—interfered w pulmonary gas xchange
2 inflammation may also damage type II pneumocytes which normally produce surfactants

20
Q

Disseminated Intravascular Coagulation [DIC]

A
  • usually in septic shock
  • immune activation of clotting cascade
  • microcirculation obstruction leads to ischemic tissue damage
  • widespread clot formation (consumes platelets + clotting factors)
21
Q

DIC clinical manifestations

A

low platelet + fibrinogen levels

high D-dimer

22
Q

Acute Renal Failure

A

-kidneys undergo long periods of hypoperfusion
-vasoconstriction causes decr flomerular BF
»reduced hydrostatic P + filtration rt
-Acute Tubular Necrosis
-may need dialysis

23
Q

Acute Tubular Necrosis [ATN]

A

assoc w decreased urinary excretion of waste products (creatinine + urea)
-assoc w acute renal failure

24
Q

Multiple Organ Dysfunction Syndrome [MODS]

A

-when 2 or more systems are affected
-initiated by overactive + destructive immune mechanisms
-cytokines affect endothelium, recruit neutrophils, + activate inflammation in vascular beds
»» leads to tissue destruction + organ dysfunction

25
Q

most common cause of secondary MODS

A

sepsis + septic shock

26
Q

Stenosis

A

failure of the valve to open completely in result of extra pressure work for the heart

27
Q

Regugitation

A

insufficiency

  • inability of a valve to completely close
  • results in extra volume work for the heart
28
Q

Mitral Valve Stenosis

A

chronic pulmonary HTN

  • RIGHT VENTRICLE HTN
  • right sided HTN
29
Q

Shock - Clinical Manifestations

Heart, Circulatory, + Lungs

A

INCR: heart rt, resp rt,

DECR: pulse pressure, hypotension (SBP<90), capillary refill, constrict of slanchnic vessel

30
Q

Shock - Clinical Manifestations

hormonal + kidney

A

RELEASE: ADH (brain),
Aldosterone + Cortisol (kidney)

decr urine output, incr specific gravity

31
Q

Shock - Clinical Manifestations

s/s

A

cool clammy bluish/gray color

thirst, restlessness, dilated pupils

Pathophysiology (32 decks)

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