E1. Shock Flashcards
Define shock
Decreased cellular energy production
List the types of shock.
Hypovolemic, cardiogenic, distributive, hypoxemic, metabolic,
A life-threatening decrease in circulating blood volume is \_\_\_\_\_\_\_\_ A. Hypovolemic shock B. Distributive shock C. Cardiogenic shock D. Hyperemic shock E. metabolic shock
A. Hypovolemic shock
\_\_\_\_\_\_ results mainly from failure of adequate forward blood flow (diastolic, systolic, obstructive) A. Hypovolemic shock B. Distributive shock C. Cardiogenic shock D. Hyperemic shock E. metabolic shock
B. Distributive shock
\_\_\_\_\_\_\_ is a condition in which systemic vascular resistance (SVR) is abnormal causing maldistribution of blood flow ( vasodilatory shock, septic shock, systemic inflammatory response syndrome (SIRS), anaphylaxis, heat stroke, neurogenic shock) A. Hypovolemic shock B. Distributive shock C. Cardiogenic shock D. Hyperemic shock E. metabolic shock
C. Cardiogenic shock
\_\_\_\_ is caused by decreased blood and oxygen content (anemia,methemoglobinemia, carbon monoxide poisoning, hypoventilation, pulmonary parenchymal disease). A. Hypovolemic shock B. Distributive shock C. Cardiogenic shock D. Hyperemic shock E. metabolic shock
D. Hyperemic shock
______ is caused by deranged cellular metabolism that leads to decreased cellular energy production(
cyanide and bromethalin poisoning, severe hypoglycemia, relative adrenal insufficiency, severe pH changes, cytopathic hypoxia)
A. Hypovolemic shock
B. Distributive shock
C. Cardiogenic shock
D. Hyperemic shock
E. metabolic shock
E. metabolic shock
A dog has been hit by a car and is bleeding badly, what type of shock Will the dog go into? A. Hypovolemic shock B. Distributive shock C. Cardiogenic shock D. Hyperemic shock E. metabolic shock
A. Hypovolemic shock
What might be seen in early shock (compensated shock)? (5)
- Tachycardia
- Normal or mild decreased mentation
- Normal, pale, or hyperemic mucous membranes
- Tachypnea, strong pulse quality
- Normotension
- Early signs of shock may not be clinically obvious because of compensatory mechanisms
What might be seen in intermediate shock (early decompensated shock)? (12)
- Profound vasoconstriction
- Increase in salt and water retention (renin-angiotensin- aldosterone and ADH stimulation)
- Organ dysfunction
- Pale mucous membranes
- Prolonged capillary refill time (CRT)
- Tachycardia
- Poor pulse quality
- Hypotension
- Decreased mentation
- Weakness
- Cool extremities
- Decreased rectal temperature
What might you see in late shock (late decompensated shock or irreversible shock)? (6)
- Stupor or coma
- Pale mucous membranes
- Prolonged or absent CRT
- Bradycardia
- Hypothermia
- Poor or absent pulse quality
What are the vasopressors used to correct hypotension? Give classification then drugs. (3 classes, 3 drugs)
Nonselective alpha agonists (norepinephrine and epinephrine)
Selective alpha one agonists (Phenylephrine)
Vasopressin
What is not needed in any type of shock, but may be needed if the shock patient has an adrenal insufficiency?
Glucocorticoids
Get the 3 types of monitoring shock.
Physical examination
Laboratory
Advanced macrohemodynamic monitoring
List what’s involved in your physical examination of shock. (6)
– Heart rate (HR) – Mucous membrane color – Capillary Refill Time (CRT) – Respiratory rate (RR) – Temperature – Mentation
List what’s involved in your laboratory monitoring of shock. (8)
– Blood pressure (BP) – Hematocrit – Electrolytes – Blood gases – Urine output – Central venous pressure – Body weight – Blood pH
Give a breakdown of adults body weight in water percent. Give the breakdown of the neonates body weight in water.
Adult 60% (40% is intracellular (ICF) (20% is extracellular fluid (ECF) (15% is in the interstitial space and 5% is in the intravascular space))) is water.
80% of the neonates body is water.
What are the isotonic crystalline solutions used to treat shock? (5)
– 0.9% NaCl solution (isotnoic saline, NS) – Ringer’s solution (RS) – Lactated Ringer’s solution (LRS) – Sodium gluconate and acetate solutions » Normosol-R » Paslma-lyte-A
What can you add to crystalloids? (5)
– 50% dextrose – Potassium – Sodium bicarbonate – Calcium – Vitamins
List your natural and synthetic colloids? (3 of each)
• Natural colloids – Whole blood – Plasma – Albumin (human/dogs) • Synthetic colloids – Dextrans – Hydroxyethyl starch (hetastarch) – Hemoglobin glutamer-200 (Oxyglobin)
What are the negative side effects of fluid therapy? (10)
– Fluid overload and life-threatening pulmonary edema
– Dilutional coagulopathy
– Hypoproteinemia
– Caution with LRS in liver disease patients
– Rapid administration of hypertonic or hypotonic solutions may cause destruction of RBCs
– Rapid administration of maintenance crystalloids may cause hyperkalemia
– Subcutaneous administration of dextrose may cause irritation and necrosis
– Human albumin may cause hypersensitivity reactions
– Caution with colloids in renal disease patients
– Hypertonic solutions should not be used dehydration
Where the 4 ways you can get fluid therapy?
Intravenous
subcutaneous
intraperitoneal
oral rehydration
Why would you use intravenous fluid therapy?
– Ideal route
– Essential in treatment of shock
– Necessary to place polyethene catheters
Why would you use subcutaneous fluid therapy?
– Widely used
– Convenient
– Volumes given are limited and uptake is poor
– Inadequate for treatment of shock but may useful for maintenance after IV
