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Drug Action I > Block 2 - Shock Physiology > Flashcards

Block 2 - Shock Physiology Flashcards

1
Q

What is shock?

A

Clinical syndrome characterized by acute circulatory failure with inadequate or inappropriately distributed tissue perfusion → imbalance between oxygen supply and demand

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2
Q

Hypoperfusion can trigger ___ and ____ cascades

A

Inflammatory and clotting

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3
Q

What are the types of shock?

A
  1. Obstructive
  2. Cardiogenic
  3. Distributive
  4. Hypovolemic
  5. Septic (anaphylactic)
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4
Q

What are the common characteristics of shock?

A

Acute circulatory failure that causes hypotension and inadequate tissue perfusion.

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5
Q

What circulatory alterations that lead to shock?

A
  1. HF
  2. Low BV
  3. Redistribution of ECF to extravascular sites
  4. Obstruction of blood flow
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6
Q

What are the factors affect CO?

A
  1. Factors that decrease blood volume
  2. Affect cardiac filling
  3. Affect contractility
  4. Affect HR
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7
Q

Systemic vascular resistance is caused by ___

A
  1. Extensive increase in systemic vascular dilation
  2. Fluid redistribution
  3. Inflammatory reactions
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8
Q

How many ICU patients are effected by shock?

A

1/3

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9
Q

How do you diagnose shock?

A
  1. Clinical
  2. Hemodynamic
  3. Biochemical
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10
Q

What is the clinical diagnoses for shock?

A

<90/70
Tachycardia
Tissue hypoperfusion
Renal output
Altered mental state

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11
Q

What are the hemodynamic diagnoses for shock?

A

Hyperlactemia
Hypercoagulability

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12
Q

Shock is ultimately a ___ of fluid in circulatory system

A

Deficit

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13
Q

How does the body compensate for shock?

A
  1. Increase HR and SNS
  2. Vascoconstriction
  3. Hypotension
  4. Circulating volume continues to drop
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14
Q

What is hemodynamic?

A

Forces the heart has to respond to maintain blood flow through the cardiovascular system and supply oxygen to all tissues.

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15
Q

What are the four facotrs that influence circulation?

A
  1. BV
  2. Systemic vascular tone
  3. HR
  4. Force of contraction
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16
Q

What it MODs and what does it cause?

A

Multiple organ dysfunction syndromes: Hypoxia and decreased oxygen delivery → anaerobic metabolism

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17
Q

What it MODs and what does it cause?

A
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18
Q

Map how metabolic mods cause shock?

A
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19
Q

What is hypovolemic shock?

A

Rapid blood or other ECF fluid loss.

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20
Q

What is cardiogenic shock?

A

Hypoxic damage to organs that results when the heart is unable to circulate an adequate amount of blood.

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21
Q

What is distributive shock?

A

Impaired distribution of blood flow due to extensive vasodilation and loss of vascular tone.

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22
Q

What is obstructive shock?

A

Life-threatening condition caused by obstruction of blood flow to body’s organs.

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23
Q

What is anaphylactic shock?

A
  1. Acute, life-threatening, IgE-mediated allergic reaction.
  2. re-exposure in those persons sensitive to an allergen
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24
Q

What are the stages of shock?

A
  1. Early, reversible, or compensated shock.
  2. Intermediate or progressive shock.
  3. Refractory or irreversible shock.
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25
Q

What occurs in stage 1 of shock?

A
  1. Baroreceptors respond to low blood pressure → increased sympathetic stimulation → increased heart rate and constriction of blood vessels.
  2. Poor kidney perfusion → activation of RAAS → reabsorb sodium and water.

Strong chance of recovery with proper treatment

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26
Q

What occurs in stage 2 of shock?

A

Decrease in perfusion → leads to cellular hypoxia → confusion and disorientation

Reversible wtith prompt treatment

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27
Q

What occurs in stage 3 of shock?

A
  1. Decline in heart funciton
  2. Kidney shutdown
  3. Organ injury

Death due to multiple organ dysfunction

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28
Q

How does hypovolemic shock cause hemodynamic instability?

A

H: Decrease in tissue perfusion and O2 delivery

29
Q

To be classified as hypovolemic shock, a patient must loss ___ of body fluids?

A

15%

30
Q

What causes the rapid loss of fluid and whole blood?

A
  1. Trauma
  2. Internal bleeding
  3. Edema
  4. Dehydration
  5. Postpartum hemmorage
31
Q

What does fluid loss lead to in hypovolemic shock?

A
  1. Hemodynamic instability
  2. Decreases in tissue perfusion and oxygen delivery
  3. Cellular hypoxia
  4. Organ damage
  5. Death
32
Q

What are the management goals for hypovolemic shock?

A
  1. Stop bleeding
  2. Restore circulation
33
Q

What are the compensatory mech of hypovolemic shock?

A
  1. Hematologic
  2. Cardiovascular
  3. Renal
  4. Neuroendocrine
34
Q

What occurs in the hematologic compensatory mechanism? How long does it take and why is it good?

A

Clotting of blood to end further blood loss (24 hr) to improve CO and perfusion pressure

35
Q

What is importance of decline BP?

A

Increased sympathetic outflow → release of NE and epinephrine → increased SVR and HR

Decreased vagal (parasympathetic) outflow

36
Q

What occurs in the renal compensatory mechanism?

A

Kidney responds to a decrease in perfusion pressure by releasing renin activating RAAS

37
Q

What occurs in the cardiovascular compensatory mechanism? What symptoms does it cause?

A
  1. Shunts blood to vital organs requiring more oxygen.
  2. Decreases blood flow to less vital organs.

Cold, clammy skin and delayed capillary refill

38
Q

What are the clinical manifestation of hypovolemic shock?

A
  1. <90 SBG
  2. Orthostatic hypotension (SBP decrease of 20 mmHg, or DBP decrease of 10 mmHg, or
    Increase in HR of 15 beats/min)
39
Q

How is hypovolemic shock diagnose?

A

1.CBC
2. Serum electrolyte
3. Blood glucose
4. PTT
5. Hematocrit
6. Serum lactate and arterial pH

40
Q

What are symptoms of hypovolemic shock?

A
  1. Rapid breating
  2. SOB
  3. Tachycardia
  4. Weak pulse
  5. Pale skin and cold appendages
  6. Low urination
41
Q

What are the treatments for hypovolemic shock?

A
  1. Maxamize O2 delivery
  2. Prevent further fluid loss
  3. Replace lost fluids
42
Q

What are the hemodynamic changes of cardiogenic shock?

A
  1. Persistnet hypotension
  2. Reduction of CI
  3. Adequate or elevated filling pressures
43
Q

What are cormorbidities of cardiogenic shock?

A
  1. LVHF
  2. Bardiac trauma
  3. Myocarditis
44
Q

What is the cause of cariogenic shock?

A

Acute MI → Progressive decrease in coronary perfusion, myocardial contractility and SV, Increase in ESV→ Increased O2 demand → Hypoxia

45
Q

Hpoperfusion increases ____ and ____ leading to _____ from ____

A
  1. Anaerobic metabolism
  2. Production of lactic acid

Acidosis and hypoxia from lysosomal breakdown, mitochondrial swelling and inflammatory cascade

46
Q

____,_____,and_____ are the compensatory mechanisms involved in cariogenic shock that increase _____, _____,_____, and _____

A
  1. SNS
  2. RAAS
  3. ADH

Fluid retention, HR, Contractility. cardiac O2 and nutrient demand

47
Q

How do you worsen the heart in cariogenic shock?

A
  1. Shock
  2. Impaired tissue metabolism
48
Q

What are the clinical manifestation of cariogenic shock?

A
  1. Cyanosis
  2. Rapid pulse
  3. Low pressure, tachycardia
  4. Distant heart sounds
  5. Peripheral edema
  6. Jugular distention
  7. Crackles in lungs
49
Q

What are the types of distributive shock?

A
  1. Septic
  2. Anaphylactic
  3. Neurogenic
50
Q

What is anaphylaxis?

A

Acute, life-threatening, IgE-mediated allergic reaction that occurs on re-exposure in individuals who are sensitive to an allergen or antigen.

51
Q

What is anaphylactic shock?

A

antibody IgE produced by plasma cells binds to membrane receptors on mast cells and basophils.

52
Q

What are some triggers for anaphylactics?

A
  1. Drugs, foods, and proteins
  2. Animal or insect venoms
  3. Latex
  4. Heavy metal poisoning
  5. Exercise and exposure to cold temperature
53
Q

What are the clinical manifestation of anaphylactic shock?

A
  1. Stridor
  2. Tachycardia
  3. Dyspnea
  4. Edema
  5. Brondoconstriction
  6. Hypotension
54
Q

What is the treatment for anaphylactic shock?

A
  1. E
  2. Patent airway
  3. Beta agonists
  4. IV fluid expanders
  5. Vasopressors
55
Q

What is septic shock?

A

Life-threatening organ dysfunction caused by dysregulated host response to infection.

56
Q

Septic shock accounts for ____ of deaths in hospital patients?

A

40%

57
Q

What is SOFA?

A

Sequential organ failure assessment: Assessment measure that evaluates the different systems believed to be involved in the pathogenic process of sepsis or influenced by resultant organ failure

58
Q

What is the qSOFA diagnostic criteria?

A
  1. ICU
  2. ≥22/min
  3. Altered mentally
  4. SBP: ≤100
59
Q

What is the treatment for septic shock?

A
  1. Perfusion restored with IV fluids and vasopressors
  2. O2 support
  3. Broad spectrum antibiotics
  4. Infection source control
60
Q

What is neurogenic shock caused by?

A
  1. Blockage of sympathetic nervous system outflow to intrathoracic sympathetic chain.
  2. Any factor/condition that increases parasympathetic stimulation.
61
Q

What are risk factors for neurogenic shock?

A
  1. Spinal cord injury above T6
  2. Absence of hypovolemia
62
Q

What is spinal shock?

A

Loss of reflex function below spinal cord injury level; resolves gradually over 4 weeks

63
Q

What is hypovolemic shock?

A

Associated with tachycardia

64
Q

What are the clinical manifestations of neurogenic shock?

A
  1. Blockage of sympathetic outflow → bradycardia and vascular dilation
  2. Blood pools in peripheral vessels → decreased venous return and CO, hypoperfusion of organs
65
Q

What is the treatment for neurogenic shock?

A
  1. Fluid replenishment
  2. Vasopressors
  3. Stabilization of spine and neck
  4. Airway patency
  5. O2
  6. CS
  7. Atropine
66
Q

What are causes of obstructive shock?

A
  1. Pulmonary embolism
  2. Cardia tamponade
  3. Tension pneumothorax
67
Q

What are the clinical manifestations of obstructive shock?

A
  1. Disturbances of consciousness
  2. Oliguria
  3. Hypotension
  4. Tachycardia
  5. Decreased cardiac function and circulatory failure
68
Q

What is the treatment of obstructive shock?

A
  1. Pneumothorax (decrease chest tension or pressure on heart)
  2. Needle thoracotomy and pericardiocentesis (pericardial effusion and cardiac tamponade)
  3. Pulmonary emboli (surgical removal of block)

Drug Action I (32 decks)

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