B4-008 CBCL Hemodynamic Shock Flashcards
TBW calculation as a percent of body weight
TBW = 60% of BW
calculation of TBW as a percent of lean body mass
LBM = BW - Fat weight
TBW= 72% of LBM
most accurate method of calculating TBW
using lean body mass
fat cells contain less water
water movement between ECF and ICF is driven by
osmotically active solutes
water movement within the ECF depends on
hydrostatic and oncotic pressure
starling forces
water follows
solute
water will move from [..] to […] osmotic pressure compartments
low to high
gives you information about the number of molecules dissolved in the solution, but may not allow you to predict how cells will respond
osmolarity
defines the effect a solution has on the steady state volume of a cell
tonicity
causes cell volume to increase
hypotonic
does not change initial cell volume
isotonic
causes cell volume to decrease
hypertonic
body fluid disturbance arise from changes in
2 things
- osmolarity (tonicity)
- volume (expansion/contraction)
hypotonic, isotonic, hypertonic indicate change in
2 things
- osmolarity
- ICF volume
hypotonic, isotonic, hypertonic indicate change in
2 things
- osmolarity
- ICF volume
expansion, contraction
indicate a change in
ECF volume
increase in ECF/plasma volume (expansion) will increase venous return, preload, SV and CO. As a result […] will increase
MAP
a decrease in ECF/plasma volume (contraction) will reduce venous return, preload, SV and CO. As a result, this will decrease […]
MAP
excessive H2O intake is an example of
tonicity/volume
hypotonic expansion
how does hypotonic expansion effect:
ECF osmolality:
ECF volume:
ICF osmolality:
ICF volume:
ECF osmolality: decrease
ECF volume: increase
ICF osmolality: decrease
ICF volume: increase
how does hypotonic contraction effect:
ECF osmolality:
ECF volume:
ICF osmolality:
ICF volume:
ECF osmolality: decrease
ECF volume: decrease
ICF osmolality: decrease
ICF volume: increase
[loss of NaCl]
how does isotonic expansion effect:
ECF osmolality:
ECF volume:
ICF osmolality:
ICF volume:
ECF osmolality: no change
ECF volume: increase
ICF osmolality: no change
ICF volume: no change
how does isotonic contraction effect:
ECF osmolality:
ECF volume:
ICF osmolality:
ICF volume:
ECF osmolality: no change
ECF volume: decrease
ICF osmolality: no change
ICF volume: no change
how does hypertonic expansion effect:
ECF osmolality:
ECF volume:
ICF osmolality:
ICF volume:
ECF osmolality: increase
ECF volume: increase
ICF osmolality: increase
ICF volume: decrease
[gain of NaCl]
how does hypertonic contraction effect:
ECF osmolality:
ECF volume:
ICF osmolality:
ICF volume:
ECF osmolality: increase
ECF volume: decrease
ICF osmolality: increase
ICF volume: decrease
[loss of water]
salt loss is an example of
tonicity/volume
hypotonic contraction
[loss of NaCl]
IV infusion of .9% saline is an example of
tonicity/volume
isotonic expansion
hemorrhage is an example of
tonicity/volume
isotonic contraction
IV infusion of hypertonic saline is an example of
tonicity/volume
hypertonic expansion
dehydration/severe sweating is an example of
tonicity/volume
hypertonic contraction
[water loss]
hemorrhage, burns and excessive fluid loss cause what kind of shock?
hypovolemic
septic, anaphylactic, and neurogenic cause what kind of shock?
distributive
cardiac tamponade, heart failure, MI cause what kind of shock?
cardiogenic
all types of shock cause decreased MAP and
inadequate tissue perfusion
- inadequate CO
- cold/clammy skin
- low central venous pressure
hypovolemic shock
- systemic vasodilation (decreased TPR)
- normal blood volume
- skin feels warm
distributive shock
caused by low blood volume
hypovolemic shock
caused by arteriolar problem
decreased TPR
distributive shock
- inadequate CO by diseased/impaired heart
- venous pressure increased
- skin cold/clammy
cardiogenic shock
caused by a pump problem
cardiogenic shock
decreased venous return lowers EDV, SV and CO ultimately lowering MAP
hypvolemic shock
accompanied by weak pulse
hypovolemic shock
- decrease EDV, SV, CO –> MAP
- decreased pulse pressure
hypovolemic shock
- excessive NO production leads to arteriolar vasodilation
- decreased TPR, MAP
septic (distributive) shock
systemic arteriolar dilation results in higher rate of runoff
distributive shock
cause of low MAP in all types of distributive shock
decreased TPR
mast cell degranulation triggers the release of histamine causing arteriolar vasodilation and increased vascular permeability
anaphylactic (distributive) shock
degranulation of mast cells in response to allergen
anaphylactic (distributive) shock
epi pens activate what receptors?
alpha 1 and beta2
causes decreased sympathetic activity and generalized arteriolar dilation resulting in low TPR
neurogenic (distributive) shock
deep anesthesia, pain reflex from deep trauma, and vasovagal syncope are causes of what kind of shock?
neurogenic
distributive
- fluid accumulation in the pericardial sac causes impaired filling of the heart
- decreases SV, CO and MAP
cardiogenic shock
jugular venous distension will be observed in what kind of shock?
cardiogenic
increased sympathetic firing will have what effects on beta 1 and alpha 1 receptors?
beta 1: increase HR and SV
alpha 1: arteriolar constriction and venoconstriction
decreased parasympathetic firing in shock will cause
increased HR
impaired oxygen delivery to tissues leads to
anaerobic metabolism
lactic acid = acidosis
decreased MAP will decrease baroreceptor stretch leading to a reduction in the release of
atrial natriuretic peptide
angiotensin II and ADH would be expected to […] in response to decreased MAP
rise
decreased MAP leads to increased sympathetic firing, […] the metabolites of NE in plasma
increasing
cold skin and jugular vein distension indicates what kind of shock?
cardiogenic
[…] serum lactate would indicated adequate volume replacement
decreased
indicates adequate tissue oxygenation
- hypotensive with signs of HF
- JVD
- cold, clammy extremities
what kind of shock?
cardiogenic
in what type of shock is CO greater than normal?
distributive
- low MAP
- skin feels warm
- high heart rate
distributive shock
increased rate of runoff of blood from systemic arteries to veins
distributive shock
extensive burns cause loss of plasma, but not RBC. what kind of shock is this?
non hemmorrhagic
hypovolemic
- central venous pressure low
- EKG normal
hypovolemic shock
- venous return decreased
- EDV decreased
hypovolemic shock
in response to low BP, the baroreflex will
increase HR
when whole blood is lost, that is
tonicity/volume
isotonic contraction
hypovolemic shock causes […] stroke volume
decreased
decreased venous return and cardiac output
hypovolemic shock
increased sympathetic firing to ventricular myocytes will cause
increased cytosolic calcium
increased sympathetic firing to systemic arterioles will cause
increase TPR
during hypovolemic shock, capillary pressure is
low
filtration of fluid out of capillary is decreased
giving 2.0% saline would cause
tonicity/volume
hypertonic expansion
severe dehydration causes
tonicity/volume
hypertonic contraction
normal compensatory response for shock
2
- increase HR
- increase arteriolar constriction
what causes the decrease in hematocrit in hemorrhagic shock?
- decreased capillary pressure reduces filtration
- net reabsorption of fluid into plasma
decreases crit and ECF volume
- the volume of the ECF is increased, increasing the plasma volume as well as the interstitial fluid volume
- ICF volume will decrease
tonicity/volume
hypertonic expansion
calculate ICF volume
2/3 x TBW
calculate ECF volume
1/3 x TBW
calculation for TBW using lean body mass
(weight - body fat) x .72
when calculating ECF after an infusion remember to add
liters infused to the ECF value
an infusion of 0.45% NaCl would cause
tonicity/volume
hypotonic expansion
an infusion of isotonic saline to a person with dilutional hyponatremia will […] ICF volume and […] intracellular osmolality
decrease volume
increase osmolality
infusion with 5% dextrose is the equivalent of
administering water
infusion of […] will increase both extracellular and intracellular fluid volumes
5% dextrose
similar to administering water (hypotonic expansion)
ingesting a large amount of water will have what effect on
ICF volume
ICF osmolality
ECF volume
ECF osmolality
ICF volume: increase
ICF osmolality: decrease
ECF volume : increase
ECF osmolality: decrease
hypotonic expansion
effect of EpiPen on alpha 1 and beta 2 receptors?
alpha 1: vasoconstriction
beta 2: relaxation of airway smooth muscle
administering 5% dextrose plus 0.9% NaCl would result in
volume/tonicity
isotonic expansion
administering 5% dextrose would result in
volume/tonicity
hypotonic expansion
elevated plasma osmolality suggests what kind of shock?
hypovolumic
dehydration
in hypovolumic shock due to dehydration, the person should be given […] to increase total body water
5% dextrose solution
increased rate of runoff off blood from sytemic arteries to veins
distributive shock
- low MAP
- warms skin
- high heart rate
what kind of shock?
distributive
- low MAP
- cold skin
- no JVD
- weak pulse
what kind of shock?
hypovolemic
- cardiac output is increased due to baroreflex
- warm skin
what type of shock?
distributive
cool, clammy skin indicates the cause of the low MAP is
2
either hypovolemic or cardiogenic
cardiac tamponade impairs ventricular filling, causing
effect on preload and SV
decreased preload and SV
decreased MAP increases SYM firing to the heart causing
increased inotropy
increased HR
decreased MAP decreases PARA firing to the heart via the baroreflex causing
increased HR
mast cell degranulation causes dilation of systemic arterioles and decreased TPR
anaphylactic (distributive) shock