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CRAAB 5 > Adams- Shock > Flashcards

Adams- Shock Flashcards

1
Q

What is shock?

A

Hypoperfusion of vital organs (brain, heart, kidney, lungs, gut)

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2
Q

What proportion of patients diagnosed with shock will die?

A

1/2

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3
Q

Is shock associated with low BP?

A

NO

BP can be normal if systemic vascular resistance is elevated and you still have end organ damage (hypoperfusion to organs)

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4
Q

What causes shock?

A

Oxygen consumption > delivered oxygen

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5
Q

What decreases oxygen?

A
  1. Displacement of 02
  2. Decreased carrying capacity (Hb)
  3. Decreased pulmonary function
  4. Decreased blood flow
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6
Q

What decreases oxygen consumption of O2?

A
  1. Work of breathing
  2. Fever
  3. Infection
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7
Q

What decreases the oxygen that is delivered?

A
  1. Hypoxia
  2. Anemia
  3. Hypovolemia
  4. Decreased CO
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8
Q

What happens on a biochemical level if there is not enough oxygen?

A

Anaerobic metabolism

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9
Q

What is a marker of the severity of oxygen supply/demand balance?

A

Lactic acidosis

*Follow lactic acid to track course of illness/treatment effectiveness

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10
Q

What are autonomic responses to anaerobic metabolism?

A
  1. Arteriolar vasoconstrcition
  2. Increase HR and contractility (HR falls over time)
  3. Venous constriction
  4. Release of Epi, DA, NE, Cortisol
  5. Release of ADH to conserve water and Na
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11
Q

How do you cells respond to O2 imbalance?

A 
Atp depletion>
ion pump dysfunction>
influx of Na and loss of Na>
cellular edema>
lysosomal enzyme release>
cell death
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12
Q

What are common findings in someone with shock?

A
  1. Hyperkalemia
  2. Hyponatremia
  3. Metabolic acidosis
  4. Hyperglycemia
  5. Lactic acidosis

**all d/t loss of cell integrity

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13
Q

What is the continuum of shock?

A

Concern>
SIRS (systemic inflammatory response syndrome>
MODS (multi organ dysfunction syndrome)>
death

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14
Q

What is SIRS?

A

A septic like disorder in the ABSENCE of infection

Sepsis or SIRS can progress to MODS

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15
Q

How do you diagnose SIRS?

A

At least two of the following sxs:

  1. Temp 38
  2. Pulse > 90 tachycardia
  3. Respirations >20
  4. PaCO2 < 4000 or > 12000 or 10% bands
  5. WBC 12000

*Infection w/out a bug

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16
Q

What happens if there’s a huge fall in CO or SVR?

A

Cardiac shock and inadequate tissue perfusion

17
Q

What are the 4 clinical phases of SIRS?

A
  1. Increased V requirements, mild respiratory alkalosis + (oliguria, hyperglycemia, increased insulin requirements)
  2. Tachypneic, hypocapnic, hypoxemic. Moderate liver dysfunction and possible hematologic abnormalities.
  3. Develops shock with azotemia and acid-base disturbances. Significant coagulation abnormalities.
  4. Vasopressor dependent and oliguric or anuric. Ischemic colitis and lactic acidosis follow.
18
Q

A pt shows up with hypotension, cool, clammy skin, and altered mental status, what’s wrong with them?

A

Shock!

These are the classical findings.

Urine output <20 cc/hr

19
Q

What causes cool, clammy skin?

A

High output shock with decreased SVR

**Distributive/dissociative can have uniquely WARMm skin

20
Q

What are the two most important things to monitor with shock?

A

Level of alertness

Urine output

21
Q

What is the shock index?

A

Heart rate divided by systolic pressure

22
Q

What is a normal shock index?

A

s. 5-.7; an index >1 has increased mortality

* Index is inversely related to effective left ventricular stroke work

23
Q

What is capillary wedge pressure? What is the problem with Swan Ganz?

A

The holy grail of physiology! The Swan Ganz catheter tells you what’s happening in the LV.

People who had SG died more often.

*Best tool to see what’s happening in the LV if you have healthy lungs

24
Q

What are the 4 major types of shock?

A
  1. Cardiogenic (heart fails- usually MI/valvular disease))
  2. Distributive/Dissociative (increased area for blood to disperse to-more volume to fill then you have CO to fill it with)
  3. Extracardiac (outflow obstruction- PE)
  4. Hypovolemic (lack of fluid)
25
Q

What are the primary characteristics that affect oxygen delivery?

A
  1. Extracardiac, PE, tamponade
  2. Hypovolemia, Blood loss, dehydration
  3. Decreased CO, MI, valve damage
26
Q

What are the primary issues affecting consumption of oxygen?

A

Distributive

Sepsis, anaphylaxis

27
Q

What is Cardiogenic shock? What causes it?

A

Heart fails

Decreased cardiac output d/t:

  1. Acute MI > 40% myocardial damage
  2. Arrhythmia (too fast/slow)
  3. Out-flow obstruction (AS, hypertrophic cardiomyopathy)
  4. Mitral regurgitation, VSD
28
Q

What kills high school kids?

A

Hypertrophic cardiomyopathy

29
Q

What is distributive/dissociative shock?

A
  1. Initially CO is increased then it falls

2. Decreased SVR or maldistribution

30
Q

What causes Distributive/Dissociative shock?

A
  1. Septic shock (gram Neg-endotoxins, gram pos- exotoxins)
  2. Spinal cord injury
  3. anaphylaxis
  4. Cyanide
  5. Carbon monoxide
31
Q

What is extracardiac shock? What causes it?

A

Outflow obstruction

  1. PE
  2. Pericardial tamponade
  3. Constructive pericarditis
  4. Pulmonary hypertension (RV fails can’t push blood)
32
Q

What is hyopovolemic shock and what causes it?

A

Lack of fluid

Causes of decreased cardiac output d/t decreased preload:

  1. Diarrhea, vomiting, diuretics, sweating
  2. Hemorrhage
  3. Burns
  4. 3rd Spacing: ascites
33
Q

What is the primary principle for treatment of shock?

A

VOLUME REPLACEMENT

Normal Saline (20-30 ml/kg blood)

34
Q

What is used to treat shock?

A
  1. Vasopressor agents (NE, EP, DA, Dobutamine- pure beta so it’s not good if you’re hypotensive only stimulates the heart)- no difference in safety of the first two
  2. Possibly: antibiotics, surgery, thrombolytics, anticoagulants
35
Q

A pt comes in with shock. What do you do?

A

Give them fluids!

ALWAYS

36
Q

Does hypothermia work well as a treatment?

A

probably not….

37
Q

What treatment options decrease oxygen demand?

A

Antibiotics
Intubation
antipyretics

38
Q

What treatment options increase oxygen delivery?

A

Vasopressors
Blood transfusions
Fluids
Oxygen

CRAAB 5 (9 decks)

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