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ANSTZ > A.3-7 > Flashcards

A.3-7 Flashcards

1
Q

shock definition?

A

Acute hymodynamic disorder, independant of cause, leading to insufficient O2 supply and tissue hypoxia

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2
Q

which part of our circulation is the main thing in shock?

A

microcirculation due to shunting and skipping this part causing hypoxia

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3
Q

phases of shock?

A

compensated: initially, reversible

decompensated: critical pH7.2. irreversible

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4
Q

pahtophysiology of compensated phase?

A

-centralized circulation
-catecholamines outflow

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5
Q

what do we need to examine during the compensated phase of shock?

A

organ perfusion:
- brain: consciousness, orientation
- skin: CRT, extremity temp
- bowel: paralyisis, sounds
- kidney: diuresis/hr (nromal:0.5-1.5ml/kg/h)

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6
Q

pahtophysiology of decompensated phase?

A

-cetralized circulation become affected
-catecholamines are ineffective

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7
Q

what are the hypodynamic shocks?
what do they all have in common)

A

cardiogenic (increased preload)
hypovolemic
obstructive
all: cold and clammy
decreased CO, preload
Increased SVR (afterload)

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8
Q

what are the hyperdynamic shocks?
what do they have in common?

A

The three distributiv shocks (septic, anaphylactic, neurogenic)
All: flushed, warm

increased CO, later decreases due to CMP
decreased SVR (afterload), PCWP (preload)

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9
Q

what is Neurogenic shock?

A

loss of normal SYMP innervation after damage to CNS by a spinal cord injury

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10
Q

what happens in Neurogenic shock?

A

loss of the ability of normal vasoconstriction

blood shunts from a–>v in shortest way instead of capillary

tissue is still hypoperfused !!

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11
Q

symptoms of shock?

A

skin: alpha1 rec. –> vasoconstriction –> pale clammy

brain: cerebral hypoperfusion –> confusion

kidney: alpha1 rec. –> vasoconstriction –> oliguria

heart: beta1 rec. –> tachycardia

lungs: increase in O2 supply requirement + acidosis compensation –> tachypnoe

low BP: depletion of compensation

bowel: splanchnic vasoconstriction –> absence of bowel sounds

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12
Q

how do you diagnose shock?

A

physical examination
hemodynamic monitoring
invasive BP monitoring
invasive MAP monitoring
CVP monitoring
CO monitoring
ABG
ECG
RUSH protocol

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13
Q

non-invasive hemodynamic monitoring in shock?

A

non-invasive BP
ECG
pulse oximetry
echo
esophageal doppler
ultrasonic CO monitoring

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14
Q

invasive hemodynamic monitoring in shock?

A

invasive BP monitoring
CVP measurement
PiCCO
Swan-Ganz catheter

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15
Q

indications of invasive BP monitoring?

A

unstable hemodynamics
vasoactive therapy required
perioperative monitoring of high risk surgery

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16
Q

advantages of invasive BP monitoring?

A

continuous and accurate

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17
Q

shock therapy main goals?

A

restoration of homeostasis before compensation

elimination of local acidotic mediators from hypoperfused regions

maintenance of O2 level and tissue perfusion

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18
Q

shock therapy initial management?

A

O2 supplimentation: face mask

obtaining 2 large IV catheters: 14G and 16G
or central line

admission to ICU

19
Q

Etiology of cardiogenic shock?

A
  • decrease in pump function
  • valvular disorder
  • intracardiac shunt
  • arrythmia
20
Q

how do you treat cardiogenic shock?

A

supportive
drugs
circulatory support

21
Q

supportive therapy in cardiogenic shock?

A

oxygenation
IV access
fluid resuscitation

22
Q

Drug used in Cardiogenic shock?

A

Dobutamine
Levosimendan
milirinone

23
Q

mechanical circulatory support in cardiogenic shock?

A

VAD: ventricular assist device

ECMO: Veno-Venous, Arterio-Venous

24
Q

Anaphylactic shock definition?

A

Generalized immunological condition of sudden onset, which develops after the exposure to a foreign subtsance

25
Q

symptoms of typical anaphylactic shock?
(the triad)

A

angioedema
bronchoconstriction
hypotension

26
Q

other important clinical features of anaphylactic shock?

A

skin and mucosa:
-erythma
-urticaria
-pruritus

resp.:
-chest tightness
-dyspnoe
-stridor, wheezing
-hypoxia, cyanosis

G.I.:
-nausea and vomiting
-diarrhea and pain

cardiovascular:
-hypotension
-tachycardia
-weak peripheral pulses

27
Q

signs of End-organ failure in anaphylactic shock?

A

brain: syncope
kidney: oliguria, anuria
skin: motteling, low temp, CRT >2s

28
Q

therapy of anaphylactic shock?

A

allergen removal
drugs
resp. support
fluids

29
Q

Drugs of choice in anaphylactic shock?

A

1st line: Epinephrine/Adrenalin
(0.5 mg IM or 0.1 IV)

Antihistamines: H1-rec. antag

steroids (resp)
beta2 agonists (resp)
muscarinic antag. (resp)

30
Q

resp support in anaphylactic shock?

A
  • high flow O2
  • early intubation in stridor after epineph.
31
Q

Hemmorrhagic shock signs and symps?

A
  • cold peripheries
  • decrease: CO, SVR, BP
  • tachycardia
  • altered mental status

ABG:
-low Hgb
-high lactate
-metabolic acidosis

32
Q

Hemorrhagic shock diagnostics?

A

ABCDE
and physical examination
ABG
coagulation studies, bleeding time and elastography

33
Q

Hemorrhagic shock therapy?

A
  • stop bleeding
  • aggressive fluid resusci. (isotonic ringer 2L)

-blood transfusion:
packed RBC
FFP: if coagulopathy

-PLT transfusion

34
Q

what to give if refractory to NE of in severe pulmonary hypertension?

A

Argipressin

35
Q

Hemodynamic parameters you look at in shock?

A

CVP
CO
PCWP
SVR
HR
SVO2

36
Q

Why is temperature important in bleeding?

A

Temperature affects coagulation
Hypothermia decreases coagulation!!!!

37
Q

what the deal with distributive shock?

A

there is a loss of vasoconstriction and blood is going “everywhere” and not to the tissue really needing it

38
Q

Obstructive shock definition?

A

obstruction of blood flow into or out of the heart due to impaired diastolic filling or excessive afterload

39
Q

Obstructive shock etiology?

A
  • pulmonary embolism
  • temponade
  • tension PTX
40
Q

symptoms of obstuctive shock?

A

cold peripheries
hypotension
tachycardia
tachypnoe
oliguria
subcutanous emphysema
chest/abd. pain

41
Q

obstructive shock diagnosis?

A

ABCDE
ABG
RUSH
Pulmonary angiography/scintigraphy

42
Q

obstructive shock treatment?
PE

A
  • Anticoagulation: Heparin
  • thrombolysis: Alteplase
  • Trend.el.burg procedure: surgical thrombectomy
43
Q

obstructive shock treatment?
Temponade

A

Pericardiocentesis
surgery: seldinger technique

44
Q

obstructive shock treatment?
TPTX

A

needle thoracostomy

ANSTZ (7 decks)

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