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General Pathology > Exam #2: Hemodynamics V > Flashcards

Exam #2: Hemodynamics V Flashcards

1
Q

What is the definition of shock?

A

Inadequate perfusion i.e. inability of the circulatory system to adequately supply tissues with nutrients and remove toxic waste

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2
Q

Outline the sequela of shock.

A

Reduced cardiac output or reduced effective circulating volume leads to:

1) Hypotension
2) Impaired tissue perfusion
3) Hypoxia

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3
Q

List the different classifications of shock. What is the mnemonic to remember the etiological classifications of shock?

A

SSHHOCCKE

S= septic 
S= spinal/neurogenic 
H= hypovolemic 
H= hemorrhagic 
O= Obstructive 
C= Cardiogenic 
C= Cellular toxins 
K= AnaphylaKtic 
E= Endocrine/ adrenal crisis
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4
Q

Draw the mechanisms of shock.

A

N/A

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5
Q

What is the common endpoint of shock?

A

Cellular injury

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6
Q

What are the five unifying features of shock?

A

1) Intracellular Ca++ overload
2) Intracellular H+ ion
3) Cellular & intersitial edema
4) Catabolic metabolism
5) Inflammation

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7
Q

What is the manifestation of irreversible shock?

A

Multisystem organ failure, esp. kidney, liver, brain

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8
Q

What are Rosen’s Emperic criteria for the diagnosis of shock?

A

1) Ill appearance or decreased LOC
2) HR greater than 100
3) RR greater than 22 & decreased PCO2 less than 32 (Normal 35-45) i.e. respiratory alkalosis
4) Lactic acid above 4 or base deficit anuria)
6) Hypotension greater than 20 min. duration

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9
Q

What is base deficit?

A

Amount of base required to neutralize the pH (normal is -2)

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10
Q

What are the three stages of shock?

A

1) Nonprogressive stage
2) Progressive stage
3) Irreversible stage

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11
Q

What is the nonprogressive stage of shock?

A

Blood pressure & cardiac output are maintained via:

1) Baroreceptor reflex
2) Catecholamine release
3) Activation of RAA
4) ADH release
5) General sympathetic stimulation

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12
Q

What is the progressive stage of shock?

A

1) Widespread tissue hypoxia in the microcirculation
2) Lactic acidosis
3) Confusion and decreased urinary output

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13
Q

What is the irreversible stage of shock?

A

1) Widespread cell injury

2) Subsequent decrease in urine output and severe fluid/electrolye disorders occur

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14
Q

What is the mortality of shock dependent on?

A

Physiologic health?
Etiology of shock
Duration of shock

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15
Q

What are the morphologic features of shock in the brain?

A

Ischemic encephalopathy

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16
Q

What are the morphologic features of shock in the heart?

A

Coagulation necrosis

Subendocardial

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17
Q

What are the morphologic features of shock in the kidneys?

A

Acute tubular necrosis

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18
Q

What are the morphologic features of shock in the lungs?

A

Diffuse alveolar damage

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19
Q

What are the morphologic features of shock in the adrenal gland?

A

Cortical cell lipid depletion

20
Q

What are the morphologic features of shock in the GI tract?

A

Mucosal hemorrhage & necrosis

21
Q

What are the morphologic features of shock in the liver?

A

Fatty change, central hemorrhagic necrosis

22
Q

What is the definition of cardiogenic shock?

A

Poor myocardial contractility

23
Q

Outline the sequala of cardiogenic shock.

A

N/A

24
Q

What are the diagnostic criteria for cardiogenic shock?

A

1) Hypotension
2) 30 mmHg below baseline
3) Cardiac index is lowered i.e. not enough CO to meet body need
4) Pulmonary Capillary Wedge Pressure >15mmHg*****
5) Rosen’s (4/6)

*****Swann cath.

25
Q

How is cardiogenic shock treated?

A

1) ABCs
2) Id cause
3) Fluid bolus
4) Ionotropic/ vasopressor support
5) Manage infarct

Don’t be shy on fluids if RV infarct

26
Q

What are the four different classes of hypovolemic shock classified?

A

I-IV

27
Q

What is Class I hypovolemic shock?

A

<100
BP & PP normal
LOC= anxious

28
Q

What is Class II hypovolemic shock?

A 
750- 1500 mL lost
HR 100-120 
PP decreased
BP normal
LOC= anxious
29
Q

What is Class III hypovolemic shock?

A 
1500 - 2,000 mL lost
HR 120- 140 
PP decreased
BP decreased
LOC= confused
30
Q

What is Class IV hypovolemic shock?

A 
>2,000 mL lost
HR > 140 
PP decreased
BP decreased
LOC= lethargic
31
Q

How is hypovolemic shock managed?

A

1) Crystalloid bolus
2) Blood transfusion
3) Identify and treat cause

32
Q

What are colloids? What are the advantages & disadvantages?

A

Colloid solutions refer to solutions that are hypertonic due to the addition of some solute to the fluid

Advantages:

  • Less fluid required
  • More volume in the vascular space
  • Shift fluid into vascular space from tissue

Disadvantages

  • Expensive
  • Allergic reactions can be mounted to solute
  • Coagulopathies
33
Q

Outline the pathophysiology of septic shock.

A

N/A

34
Q

Outline the effects of cytokine induction.

A

N/A

35
Q

What is the temproal progression of the cytokines?

A

LPS
TNF
IL-1

36
Q

What are the criteria for the diagnosis of SIRS?

A

Temp > 38C or < 36C
HR >90
RR >20 or PaCOP2 12 or 10% bands

37
Q

What is the definition of sepsis?

A

SIRS + documented infection

38
Q

What is severe sepsis?

A

Sepsis + MODS (multi-organ dysfunction)

39
Q

What is septic shock?

A

Sepsis + Hypotension refractory to volume resuscitation

40
Q

What is one of the most crucial factors in treating septic shock?

A

Early and appropriate initiation of antibiotics antibiotics

41
Q

What are some of the newer approaches to treating septic shock?

A

Vasoactive mediators
Coagulation Cascade
Inflammatory Mediators

42
Q

What is the difference between spinal shock and neurogenic shock?

A

Spinal= loss of cord function following injury, including motor, sensory, and sympathetic function

Neurogenic= loss of sympathetic tone due to spinal cord injury

43
Q

Neurogenic shock is usually seen in lesions at or above what level?

A

T6 & higher= vasodilation

T4 & higher= bradycardia

44
Q

Outline the pathophysiology of neurogenic shock.

A

Hypotension
- Loss of tone= vasodilation

Bradycardia
- Unopposed vagal tone on the heart

45
Q

Outline the pathophysiology of anaphylactic shock.

A

IgE mediated systemic vasodilation and increased vascular permeability–> shock

General Pathology (33 decks)

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