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Renal > Assessment of shock > Flashcards

Assessment of shock Flashcards

1
Q

Define stroke volume

A

volume of blood ejected from left ventricle

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2
Q

Define systemic vascular resistance

A

resistance to BF offered by systemic vasculature (determined by diameter)

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3
Q

Differentiate shock from dehydration

A
  • Intravascular - shock

- Interstitial - dehydration

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4
Q

CS - dehydratio

A
  • tacky MM
  • skin tent
  • dry tear film / sunken eyes
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5
Q

CS - shock

A

6 perfusion parameters:

  • HR
  • pulse quality
  • MM colour
  • CRT
  • extremity / body temperature
  • mentation
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6
Q

Normal HR range - cats

A

160-200bpm

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7
Q

Why do you see tachycardia in shock?

A

compensation

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8
Q

What happens to HR when shock lasts a long time?

A

bradycardia - this is decompensated shock

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9
Q

Other ddx - tachycardia

A
  • shock
  • hypoxaemia
  • anaemia
  • pain
  • tachyarrythmia
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10
Q

Other ddx - bradycardia

A
  • bradyarrhythmia
  • increased ICP
  • shock
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11
Q

Define pulse quality

A

difference b/w systolic and diastolic BP

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12
Q

Where to measure pulse quality?

A

femoral and metatarsal pulse

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13
Q

How does pulse quality change in shock?

A

increased or decreased - depends on the type of shock

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14
Q

T/F: sometimes pulse quality is not the same as blood pressur

A

True

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15
Q

MM colour - shocked patients

A

pale or injected

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16
Q

Ddx - pale MM

A

shock, anaemia, hypoxaemia

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17
Q

Ddx - injected MM

A

shock, gingivitis

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18
Q

Where to take CRT on gingivitis patients?

A

Mucosa of lip as gingivitis can affect CRT

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19
Q

How can temperature indicate shock?

A
  • decreased extremity: mild to moderate shock

- decreased body temperature: common in cats, severe shock in dogs

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20
Q

Mentation with shock

A
  • obtunded
  • stuporous (non-responsive except painful sitmuli)
  • comatosed (non-responsive even with painful stimuli)
21
Q

Why is shock life-threatening?

A

cardiac arrest

22
Q

What are the 4 types of shock?

A
  • hypovolaemaic
  • vasodilatory
  • obstructive
  • cardiogenic
23
Q

Colour of patients with the different types of shock

A
  • vasodilatory: injected

- hypovolaemic, obstructive and cardiogenic: pale

24
Q

Why might you have decreased preload?

A

hypovolaemic or obstructive shock

25
Q

Why might you have reduced cardiac contractility?

A

cardiogenic shock

26
Q

Why might you have reduced HR and rhythm?

A

cardiogenic shock

27
Q

How are the 6 signs of shock categorised?

A

mild, moderate, decompensated

28
Q

How do we differentiate b/w the 3 types of vasoconstrictive shock

A

hx
PE
other diagnostic tools

29
Q

What are the 3 types of vasoconstrictive shock?

A

hypovolaemic
obstructive
cardiogenic

30
Q

CS- hypovolaemic shock

A
  • dehydration
  • V/D
  • haemorrhage
  • 3rd space loss
  • PU
31
Q

Tx - hypovolaemic shock

A
  • IVFT

- tx underlying cause (e.g. haemorrhage)

32
Q

Examples of causes of obstructive shock

A
  • GDV
  • pericardial effusion
  • pneumothorax
33
Q

PE - obstructive shock

A
  • distended abdomen
  • decreased heart sounds
  • decreased lung sounds
34
Q

Dx tools - obstructive shock

A
  • radiographs

- ultrasound of chest

35
Q

Tx - obstructive shock

A
  • relieve obstruction

+/- IVFT

36
Q

PE - cardiogenic shock

A
  • asucultate heart and lugns

- jugular distension

37
Q

Tools - cardiogenic shock

A
  • ECG

- echocardiogram: La:Ao (enlarged >1.5) contractility, pericardial effusion

38
Q

Tx - cardiogenic shock

A
  • NOT FLUIDS!!!
  • anti-arrhythmics
  • positive inotropes
39
Q

Name 3 ventricular arrythmias

A
  • VPCs
  • accelerated idioventricular rhythm
  • ventricular tachycardia
40
Q

When can ventricular arrhythmias occur in shock?

A

any of the 4 types of shock: challenging as may require fluids depending on the cause

41
Q

Examples of vasodilatory shock

A
  • systemic inflammatory response syndrome (SIRS)
  • sepsis
  • anaphylaxis
  • anaesthesia
42
Q

Tx -vasodilatory shock

A
  • IVF

- vasopressors to improve systemic vascular resistance

43
Q

Name 2 other markers of shock

A
  • lactate

- BP

44
Q

How is lactate a marker of shock?

45
Q

Outline BP in shock

A
  • mild-moderate may be normal
  • normal systolic 90-160mmHg
  • normal mean BP 60-120mmHg
46
Q

Is it possible to have more than one type of shock?

47
Q

What affects stroke volume?

A

preload, afterload and contractilit

48
Q

Outline the 6 signs of vasoconstrictive shock related to the category (mild, moderate, decompensated)

A
  • HR: mild - increased, moderated - more increased, decompensated - decreased (n.b. cats may have increased or decreased rate at any stage)
  • PULSE QUALITY: mild - increased/decreased, moderate - quite decreased, decompensated - severely decreased
  • MM COLOUR: mild - pale pink, moderate - pale, decompensated - very pale
  • CRT: mild - 1.5-2, moderate 2-3, severe >3
  • EXTREMITY/BODY TEMPERATURE: mild - decreased, moderate - quite decreased (cats decreased BT), decompensated - decreased BT
  • MENTATION: mild - mild obtundation, moderate - moderate obtundation, decompensated - stuporous
49
Q

Outline the 6 signs of vasoDILATORY shock in relation to the categories (mild, moderate, decompensated)

A
  • HR: mild - increased, moderate - quite increased, decompensated - decreased (cats can have increased or decreased at any stage)
  • PULSE QUALITY: mild - increased, moderate - increased (cats decreased) decompensated - increased/decreased (cats decreased)
  • MM COLOUR: mild - injected, moderate - injected, cats pale, decompensated - injected, cats pale
  • CRT: mild 2s
  • EXTREMITY/BODY TEMPERATURE: mild - increased, moderate - increased, decompensated - increased/decreased
  • MENTATION: mild - mild obtundation, moderate - moderate obtundation, decompensasted - stuporous

Renal (30 decks)

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