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Physiology I Block 4 > Circulatory Shock & Treatment > Flashcards

Circulatory Shock & Treatment Flashcards

1
Q

what is the definition of circulatory shock

A

Generalized inadequate blood flow through the body to the extent that the tissues are damaged

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2
Q

heart failure vs. heart shock

A

failure: tissues aren’t supplied what they are needed, it can progress to shock and tissues are damaged

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3
Q

heart failure can lead to

A

shock

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4
Q

circulatory shock can be caused by

A

decreased in cardiac output

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5
Q

what cardiac abornoalities that decrease ability of heart to pump lead to cardiogenic shock

A

Myocardial infarction
Severe valvular dysfunction
Heart Failure

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6
Q

what factors taht decrease venous return can lead to schock

A

Decreased blood volume
Decreased vascular tone
Obstruction to blood flow

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7
Q

what situation can lead to circulatory shock without a decrease in cardiac output

A

hyperthyroidism

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8
Q

thyroid hormone does what

A

increases metabolic activity of tissues in body

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9
Q

how can hyperthyroidism cause shock

A

there is increased metabolism in all the tissues so they can’t get enough blood even with increased CO

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10
Q

what would happen in pt with hyperthyroidism, why do vessels dilate?

A

metabolism - local control

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11
Q

increased in metabolism with hyperthyroidism releases vasodilators and causes

A

vessels to dialte

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12
Q

what happens to peripheral resistance in individual with hyperthyroidism

A

falls tremendously (all the vessels are dilating)

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13
Q

what happens to venous return with individuals with hyperthrydoism

A

increases

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14
Q

what is CO in individuals with hyperthyroidism

A

very high

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15
Q

what are baroreceptors trying to do in pt with hyperthyroidism

A

lots of sympathetic stimulation but they can’t decrease vessels b/c of local stimulation

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16
Q

what is HR in individual with hyperthyroidism

A

high and high contractility

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17
Q

AV fistula stands for

A

arteriol venous fistula

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18
Q

what is AV fistula

A

blood vessel that connects arteries to veins

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19
Q

what does AV fistula do to total peripheral resistance?

A

put one vessel of low resistance there so total peripheral resistance will decrease

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20
Q

what does arterial pressure do with AV fistula

A

decrease

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21
Q

what are the two ways to have circulatory shock without decrease in CO

A 
hyperthyroidism
AV fistula (abnormal tissue perfusion patterns)
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22
Q

what is the end result of circulatory shock

A

tissue deterioration

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23
Q

once shock gets to a critical point, shock leads to

A

more shock

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24
Q

what kindo f loop once shock gets to critical point

A

positive feedback loop

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25
Q

positive feedback loop of shock leads to

A

death

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26
Q

what are the three stages of shock

A

Non-progressive Stage
progressive
irreversible

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27
Q

what is the non-progressive stage of shock

A

(Compensated stage)

Normal circulatory compensatory mechanisms will eventually cause full recovery without help of therapy.

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28
Q

what is the progressive stage of shock

A

in which, without therapy, shock becomes progressively worse.

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29
Q

what is the irreversible stage of shock

A

Shock has progressed to a stage where no known therapy will avert eventual death.

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30
Q

without therapy, progressive shock will

A

become worse

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31
Q

progressive shock can degrade into

A

irreversible shock

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32
Q

no matter what you do, if person has irreversible shock

A

you can’t save them

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33
Q

if you remove 10% of blood volume, blood pressure and CO do what

A

remain normal

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34
Q

why do BP and CO remain normal if you remove 10% of blood

A

baroreceptors kick in and make the the veins squeeze, more blood back to heart

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35
Q

how much blood does it take to lose to have a change in cardiac output

A

20%

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36
Q

why does cardiac output change before arterial pressure does (in regards to blood loss)

A

arterial pressure is controlled independently of anything else

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37
Q

body is set up to keep arterial pressure high - why? (even at the expense of other things)

A

need high arterial pressure always to get blood to brain

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38
Q

past 20% blood loss, what happens to Arterial pressure and CO

A

both fall

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39
Q

at what point do both arterial pressure and CO fall

A

after 20% blood bloss

40
Q

what is plateau phase at about 35% blood loss due to?

A

CNS Ischemic response

41
Q

if blood pressure falls realy low we get

A

massive sympathetic stimulation

42
Q

if there is 35% blodo loss and you are in ischemic response, what is happening with blood vessels

A

they are almost all constricted

43
Q

if you lose 40-45% of blood what happens

A

body can’t do anything about that, BP is 0

44
Q

is there a number for the amoutn that there is critical shock

A

no there is not number, but there is a point where non-progressive shock goes into progressive shock

45
Q

go through pg 7 and understand why each reflex contributes to non-progressive shock

A

pg 7

46
Q

why is renin-angiotensin system activated in compensated shock

A

pressure is low so kidney sense and rekease renin

47
Q

vasopressin is also known as

A

anti-diuretic hormone

48
Q

vasopressin is a

A

vasoconstrictor

49
Q

what does vasopressin do

A

puts water pores in collecting ducts of kidney so kidneys reabsorb all the water that might leave through urine

50
Q

what kind of urine does hemorrhaging person have

A

concentrated

51
Q

in shock in capillaries is ther net absorption or secretion

A

absorption back into capillaries

52
Q

of the four capillary pressure what changes the most in shock

A

capillary pressure

53
Q

if blood goes through capillary, rather than filtration and lymphatics removing it in shock, there is

A

re absorption from itnerstitium back into capillaries to try to increase blood volume

54
Q

cardiac degeneration is what

A

heart itself begins to deteriorate

55
Q

progressive shock does what to heart

A

cardiovascular deterioration

56
Q

when heart starts to deteriorate in progressive shock what does that do

A

makes the shock worse - more positive feedback

57
Q

sludged blood, what is it

A

happens with progressive shock
tissue levels of oxygen decrease
lactic acid and other things are released, CO2 not removed, pH acidic, the acidic pH causes sludged blood

58
Q

acidic pH in blood causes

A

blood cells to agglutinate with each other

59
Q

increased capillary permeability in late stage of schock:

A

movement of fluids from blood into tissues

60
Q

what is released by ischemic tissue

A

endotoxin

61
Q

endotoxin is released from what

A

dead gram negative bacteria in intestines

62
Q

endotoxin does what to heart

A

inhibitory - depresses cardiac function

63
Q

non-progressive vs. progressive shock depends on if

A

negative feedback mechanisms can overcome the positive feedback mechanisms

64
Q

what are forms of hypovolemic shock

A

intestinal obstruction
severe burns
dehydration

65
Q

hypovolemic shock is caued by

A

plasma loss

66
Q

if you lose vasomotor tone (constant firing of vasoconstrictor area) what will happen

A

sympathetic nerves stop firing and blood vessels and veins will dilate

67
Q

in neurogenic shock what do you see

A

increase vascular capacity

68
Q

why does vascular capacity increase in neurogenic shock

A

because no more vasomotor tone

69
Q

what happens to mean systemic circulatory pressure in neurogenic shock

A

decreased

70
Q

what are causes of neurogenic shock

A

Deep general anesthesia - depression of vasomotor center
Spinal anesthesia - blocks sympathetic outflow.
Brain damage - brain concussion or contusion of basal regions of brain  profound neurogenic shock.

71
Q

in neurogenic shock you have decreased in CO etc without

A

losing any fluid

72
Q

anesthesize spinal cord how can this cause neurogenic shock

A

can block sympathetic outflow

73
Q

how can brain tdamage cause neurogenic shock

A

brain concussion or contusion of basal regions of brain  profound neurogenic shock.

74
Q

how can deep general anesthesia cause neurogenic shock

A

depression of vasomotor center

75
Q

if pt is in deep general anesthesia what do you do for them if BP drops dramatically (neurogenic shock)

A

don’t give fluids, they have got enough fluids

want to constrict the arteries and veins - alpha antagonist like NE

76
Q

does person in neurogenic shock have enough fluids

A

yes -the problem is the vessels are too dilated to get enough blood back to the heart. all the blood vessels are dilated

77
Q

anaphylactic shock - what is this

A

due to allergic reaction and CO and arterial pressure fall dramatically

78
Q

what is released into blood in anaphylactic shock

A

histamine
basophils
mast cells release

79
Q

what happens to arteries in anaphylactic shock

A

dilation

80
Q

arteriol dilation does what to arterial pressure in anaphylactic shock

A

decrease

81
Q

what happens to vascular capacity in anaphylactic shock

A

increased capacity - decreased (I think it might actually be increased) compliance

82
Q

what happens to capillary permeability in anaphylactic shock

A

increased permeability

83
Q

what happens to venous return in anaphylactic shock

A

decreased

84
Q

what is septic shock

A

Bacterial infection widely disseminated to many areas of the body
Many varieties of septic shock because of the many types of bacterial infections

85
Q

most cases of septic shock are caused by

A

Gram-positive bacteria, followed by endotoxin-producing Gram-negative bacteria

86
Q

what is Disseminated intravascular coagulation

A

micro blood clots everywhere in body - and the clots use up all the clotting factors so you can have hemorrhaging

87
Q

what does DIC stand for

A

Disseminated Intravascular Coagulation

88
Q

DIC can happen in

A

septic shock

89
Q

endotoxic shock often occurs when

A

large segment of gut becomes strangulated & loses blood supply

90
Q

when blood supply is reintroduced in endotoxic shock what happens

A

the endotoxins go everywhere, especially the eart

91
Q

when endotoxin is released to body in endotoxic shock what happens to heart

A

similar to anaphylaxis - sever e shock, inhibits myocardial contractility

92
Q

how can you treat shock (2 main treatments)

A

replacement therapy

sympathomimetics

93
Q

describe replacement therapy for treatment of shock

A

plasma is best b/c it keeps fluid in capillaries - blood and plasma transfusion

94
Q

what are sympathomimetics

A

sympathic like

95
Q

what can be used as sympathomimetics

A

Ne
EPI
Dopamine

96
Q

why is dopamine good for sympathomimetics

A

it has alpha, beta, properties depending on dose

and dopamine receptors in kidney to increase renalblood flow

97
Q

sympathomimentcs are not useful in what kind of shock

A

hemorrhagic

Physiology I Block 4 (13 decks)

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