chapter 6 Shock

Question 1

a. shock is the clinical picture observed when tissue _____delivery or utilization is compromised.

Answer 1

a. shock is the clinical picture observed when tissue oxygen delivery or utilization is compromised.

Question 2

d. ___________shock is used to describe conditions that impair forward flow of blood from the heart.
i. Can result from anything that interferes with the ability of the heart to fill (diastolic failure) or pump blood (systolic failure)

Answer 2

d. cardiogenic shock is used to describe conditions that impair forward flow of blood from the heart.
i. Can result from anything that interferes with the ability of the heart to fill (diastolic failure) or pump blood (systolic failure)

Question 3

e. ______shock occurs when circulating volume is inadequate
i. this leads to impaired oxygen delivery to a reduction in venous return to the heart (preload) and, as a consequence, reduced cardiac output. Hypovolemic shock can because by hemorrhagic losses (internal or external bleeding) or by the loss of other bodily fluids (third space, gastrointestinal/urinary losses, burns).

Answer 3

e. Hypovolemic shock occurs when circulating volume is inadequate
i. this leads to impaired oxygen delivery to a reduction in venous return to the heart (preload) and, as a consequence, reduced cardiac output. Hypovolemic shock can because by hemorrhagic losses (internal or external bleeding) or by the loss of other bodily fluids (third space, gastrointestinal/urinary losses, burns).

Question 4

f. _____shock is caused by inappropriate vasodilation, resulting in inadequate effective circulating volume.
i. The most common causes of distributive shock are sepsis in the systemic inflammatory response syndrome (SIRS) however, distributive shock can be caused by anaphylactic reactions, drugs, or severe damage to the central nervous system associated with sudden loss of autonomic nervous stimulation on the vessels (neurogenic shock).

Answer 4

f. Distributive shock is caused by inappropriate vasodilation, resulting in inadequate effective circulating volume.
i. The most common causes of distributive shock are sepsis in the systemic inflammatory response syndrome (SIRS) however, distributive shock can be caused by anaphylactic reactions, drugs, or severe damage to the central nervous system associated with sudden loss of autonomic nervous stimulation on the vessels (neurogenic shock).

Question 5

h. ____ shock results from inadequate arterial oxygen content or impaired mitochondrial function (impaired oxygen uptake).
i. The most common causes of hypoxic shock are anemia (reduced hemoglobin concentration) and hypoxemia, associate with respiratory failure. Methemoglobinemia (acetaminophen toxicity in cats) or carbon monoxide poisoning.

Answer 5

h. Hypoxic shock results from inadequate arterial oxygen content or impaired mitochondrial function (impaired oxygen uptake).
i. The most common causes of hypoxic shock are anemia (reduced hemoglobin concentration) and hypoxemia, associate with respiratory failure. Methemoglobinemia (acetaminophen toxicity in cats) or carbon monoxide poisoning.

Question 6

CO =

Answer 6

a. CO = SV X HR

Question 7

what is preload…

Answer 7

c. Pre-load is the load imposed on a resting muscle to stretch

Question 8

what is afterload…

Answer 8

d. Afterload is the force that opposes muscle contraction, and in cardiac muscle, it is equivalent to the ventricular wall tension developed during systole. It can also be described as pressure in the left ventricle required to eject blood into the systemic circulation.
i. Increasing blood pressure with vasopressin or agents will increase perfusion pressures but can have the untoward effect of increasing the work of the heart

Question 9

c. Blood loss more than ___% of circulating blood volume, if left untreated, induces irreversible shock. Blood loss between __and __% of circulating blood volume is able to trigger shock.

Answer 9

c. Blood loss more than 40% of circulating blood volume, if left untreated, induces irreversible shock. Blood loss between 30 and 40% of circulating blood volume is able to trigger shock.

Question 10

c. diffusion of resistance: oxygen is poorly soluble in ______solutions; therefore tissue edema will increase diffusion of distance and limit oxygen availability to the tissues.

Answer 10

c. diffusion of resistance: oxygen is poorly soluble in aqueous solutions; therefore tissue edema will increase diffusion of distance and limit oxygen availability to the tissues.

Question 11

a. the reduction in circulating volume is sensed by baroreceptors located in large thoracic arteries (_____ _____ and ____ ____) and lower pressure stretch receptors in the atria and pulmonary arteries. Stimulation of these receptors initiates the immediate (within seconds) activation of strong sympathetic reflexes that cause the following
i. constriction of most of the arterials, leading to an increase in systemic vascular resistance and reduction of blood flow towards vital organs
ii. constriction of large venules and veins, resulting in an increase in venous return and a reduction in the effective vascular volume
iii. marked increase in heart rate, with a consequent increase in cardiac output. Activation of the renin angiotensin aldosterone system occurs with subsequent vasoconstriction sodium and water retention
iv. Vasopressin, a hormone synthesized in the hypothalamus increases water retention and is a powerful vasoconstrictor.
v. Decreased total protein and not can be observed in patients with hemorrhagic shock. The cute fall in hydrostatic pressures shifts body from the interstitium into the intravascular space. me may augment decreased level

Answer 11

a. the reduction in circulating volume is sensed by baroreceptors located in large thoracic arteries (carotid sinus and aortic arch) and lower pressure stretch receptors in the atria and pulmonary arteries. Stimulation of these receptors initiates the immediate (within seconds) activation of strong sympathetic reflexes that cause the following
i. constriction of most of the arterials, leading to an increase in systemic vascular resistance and reduction of blood flow towards vital organs
ii. constriction of large venules and veins, resulting in an increase in venous return and a reduction in the effective vascular volume
iii. marked increase in heart rate, with a consequent increase in cardiac output. Activation of the renin angiotensin aldosterone system occurs with subsequent vasoconstriction sodium and water retention
iv. Vasopressin, a hormone synthesized in the hypothalamus increases water retention and is a powerful vasoconstrictor.
v. Decreased total protein and not can be observed in patients with hemorrhagic shock. The cute fall in hydrostatic pressures shifts body from the interstitium into the intravascular space. me may augment decreased level

Question 12

i. In dogs, shock organ is the ___ _____. In cats shock organ is the _____

Answer 12

i. In dogs, shock organ is the gastrointestinal tract. In cats shock organ is the lungs

Question 13

v. renal perfusion (70-1 30 mmHg)
vi. myocardial circulation-(60-1 40 mmHg)
vii. cerebral circulation-(50-1 80 mmHg)
viii. the minimum blood pressure needed to maintain perfusion of major body systems is typically defined as MAP >_____mmHg

Answer 13

v. renal perfusion (70-1 30 mmHg)
vi. myocardial circulation-(60-1 40 mmHg)
vii. cerebral circulation-(50-1 80 mmHg)
viii. the minimum blood pressure needed to maintain perfusion of major body systems is typically defined as MAP >60 mmHg

Question 14

1. The blood pressure cuff width should be ___% of the limb circumference.

Answer 14

1. The cuff width should be 40% of the limb circumference.

Question 15

The Doppler method measures only ______pressure

Answer 15

The Doppler method measures only systolic pressure

Question 16

a. in one clinical study in anesthetized cats, Doppler measurements proved to be more closely correlated with _____arterial pressure than was _____pressure

Answer 16

a. in one clinical study in anesthetized cats, Doppler measurements proved to be more closely correlated with mean arterial pressure than was systolic pressure

Question 17

5. Inadequate oxygen delivery is the most common cause of increased blood lactate type ___ lactic acidosis. Type _____lactic acidosis may occur when mitochondrial function is impaired (drugs, toxins, sepsis). This type of hyperlactatemia is associated with diseases such as sepsis, diabetes mellitus, and neoplasia.

Answer 17

5. Inadequate oxygen delivery is the most common cause of increased blood lactate type a lactic acidosis. Type B lactic acidosis may occur when mitochondrial function is impaired (drugs, toxins, sepsis). This type of hyperlactatemia is associated with diseases such as sepsis, diabetes mellitus, and neoplasia.

Question 18

b. oximetry utilizes the different light absorption between oxygenated and deoxygenated _______different with and requires light transmission from the probe through pulsatile vascular bed.

Answer 18

b. oximetry utilizes the different light absorption between oxygenated and deoxygenated hemoglobin different with and requires light transmission from the probe through pulsatile vascular bed.

Question 19

1. GDV patient’s having a catheter placed in the hind limbs is less optimal because of compression of the ____ ____ ___ by the dilated stomach, which prevents adequate venous return from the caudal portion of the body.

Answer 19

1. GDV patient’s having a catheter placed in the hind limbs is less optimal because of compression of the caudal vena cava by the dilated stomach, which prevents adequate venous return from the caudal portion of the body.

Question 20

1. common sites for ________ catheterization include the trochanteric fossa, the proximal humerus, and the tibial crest.

Answer 20

1. common sites for intraosseous catheterization include the trochanteric fossa, the proximal humerus, and the tibial crest.

Question 21

vi. fluids: saline does not contain a buffer and has an acidifying effect. Most patients in shock will be _______and would benefit from a buffered isotonic crystalloid

Answer 21

i. fluids: saline does not contain a buffer and has an acidifying effect. Most patients in shock will be academic and would benefit from a buffered isotonic crystalloid

Question 22

ii. ______defined as the clinical syndrome caused by infection (bacterial, viral, fungal, or protozoal) and the hosts systemic inflammatory response to it

Answer 22

ii. Sepsis defined as the clinical syndrome caused by infection (bacterial, viral, fungal, or protozoal) and the hosts systemic inflammatory response to it

Question 23

4. ____impairs the function of the cardiovascular system, affecting the myocardium, vessels, and coagulation, and thus contributing to acute circulatory failure. Other organs also will be affected eventually, and this will contribute to the development of multiple organ dysfunction syndrome (MODS).

Answer 23

4. sepsis impairs the function of the cardiovascular system, affecting the myocardium, vessels, and coagulation, and thus contributing to acute circulatory failure. Other organs also will be affected eventually, and this will contribute to the development of multiple organ dysfunction syndrome (MODS).

Question 24

iii. Activated protein _____ is decreased and septic humans and canine patients, which may be associated with mortality; however, in a human activated protein C has not proven to be an effective therapeutic agent except in certain populations.

Answer 24

iii. Activated protein C is decreased and septic humans and canine patients, which may be associated with mortality; however, in a human activated protein C has not proven to be an effective therapeutic agent except in certain populations.

Question 25

i. In cats with Pyothorax, identified risk factors include the ____/___ environment and ____-___household.

Answer 25

i. In cats with Pyothorax, identified risk factors include the indoor/outdoor environment and multi-cat household.

Question 26

ii. In cats with peritonitis, ____or ____is the most commonly recognized cause.

Answer 26

ii. In cats with peritonitis, neoplasia or trauma is the most commonly recognized cause.