8- Circulatory Shock Flashcards
BP =
SVR x CO
CO =
HR x SV
SV =
EDV - ESV
what is the common direct effect of all types of shock?
a reduction in mean arterial pressure MAP
decrease symp nerve activity - what type?
neurogenic shock
vasodilattor release - what type?
anaphylactic or septic shock
fluid loss- what type?
hypovolemic shock
myocardial failure - what type?
cardiogenic shock
what are the four compensatory responses to shock and their outcomes?
- increase HR
- increase contractility
- increase venous tone
- increase arteriolar tone
HOW? decrease para and increase symp activity
results? increase in MAP , BUT also a decrease in organ blood flow
what are the 4 types of shock?
hypovolemic
cardiogenic
distributive
obstructive
blood loss or volume loss
hypovolemic shock
dysrhythmia or cariomyopathy or mechanical failure
cardiogenic shock aka anything that reduces CO
anaphylaactic or septic or neurogenic or drug-induced vasodilation
distributive shock
aka blood doesn’t get back to the heart
tension pneumothorax ro pericardial disease or pulmonary embolism
obstructive shock
aka inability to actually fill the heart
observe decreased EDV - what type shock?
hypovolemic
this lowers CO so… increase SVR to maintain BP
observe: skin cool and pale, reflex thirst activated, sweating
hypovolemic shock or cardiogenic shock (symptoms of symp activity)
define crush syndrome:
reperfusion induced injury with increased ions and other products entering and impairing renal function
surgical shock and burn shock are examples of..
hypovolemic shock
observe: increased ESV and decreased SV
cardiogenic shock
tachycardias or bradycardias …
cardiogenic shock (too fast or slow to eject contents properly)
3 treatments for cardiogenic shock =
- vasopressors (NE, Dopa, dobutamine)
- revascularization
- balloon pump to improve coronary perfusion and drug delivery
how do anaphylasis induce shock?
bronchospasm reduces ventilation and blood pressure is low (systemic vasodilation)
observe: high temp, high HR, high RR, high WBC
septic shock
observe low SVR
distributive shock
“warm shock”
neurogenic or other types of distributive shock
what drug overdoses might cause shock?
beta blocker or calcium channel blocker
shock with unilateral decreased breath sounds
tension pneumothorax
shock with low BP, and elevated right heart pressure
pericardial tamponade
shock with chest pain, syncope tachypnea, hypotension with right ventricular overload
pulmonary embolism
a reductionin MAP leads to a further reduction in MAP
decompensated shock
“cold shock”
hypovolemic shock
vasovagal syncope
reflex response to deep pain associated with traumatic injuries inhibits normal sympatatet and accompaining increase in vagal activity
how does glycogneolysis play a role in shock?
increased release of glucose from the liver by epi/NE leads to an increses in extracellular osmolarity which will shift fluid into the extracellular space
why is BP not an adequate measure of shock
because the compensatory mechanism involve overwhelming arteriolar vasoconstriction, perfusion of tissues other than the heart and brain may be inadequate despite early normal arterial pressure
