Chapter 155 Additional mechanisms of shock

Question 1

Is distributive shock the result of increased or decreased systemic vascular resistance?

Answer 1

Both. It can occur secondary to overdose of vasopressors or from pheochromocytoma

Question 2

Whats the difference between cold and warm distributive shock?

Answer 2

Warm shock (hyperdynamic) has increased cardiac contractility. Cold has decreased cardiac contractility.

Question 3

Whats the difference between anaphylaxis and anaphylactoid reaction?

Answer 3

Anaphylaxic is IgE medicated and require previous exposure to allergen. Anaphylactoid is NOT IgE mediated and doe NOT require previous exposure to allergen.

Question 4

In what ways can sepsis cause shock

Answer 4

1. Release of inflammatory cytokines -> Vasodilation
2. Glycocalyx damage and leakage of fluid -> Hypovolemia
3. Cytokines cause mitocondria dysfunction -> Decreased ATP production

Question 5

Name four reasons for obstructive shock:

Answer 5

• GDV
• Cardiac tamponade
• PTE
• Pleural space disease

Question 6

How much of O2 is bound to hemoglobin vs freely dissolved in plasma?

Answer 6

98% bound to hemoglobin vs 2% dissolved in plasma

Question 7

What are the main categories of hypoxia

Answer 7

• Decreased inspired oxygen/Hypoventilation
• Alveolar diffusion impairment
• Ventilation-perfusion mismatching
• Anatomical shunting of venous blood into the arterial system
• Lack of hemoglobin, lack of hemoglobins ability to carry O2 (carboxyhemoglobin - smoke inhalation, methemoglobin - acetaminophen)

Question 8

What is metabolic shock?

Answer 8

Not enough energy substrate produce ATP or mitochondrial dysfunction

Question 9

Reasons for metabolic shock?

Answer 9

Hypoglycemia, bromethalin toxicity, sepsis