EXAM #2: SHOCK Flashcards
What is shock?
Inability to maintain perfusion
What are the four components of tissue perfusion?
1) Cardiac function
2) Arterial pressure
3) Vascular function
4) Cellular function i.e. oxygen delivery
What are the three major categories of circulatory shock?
1) Cardiogenic
2) Hypovolemic
3) Distributive
What is cardiogenic shock?
Markedly reduced contractility/CO e.g. from acute MI
*Does not have to be STEMI
What is hypovolemic shock?
Shock that results from a loss of blood volume e.g.
- Hemorrhage
- Severe burn
What is distributive shock?
Generally, an abnormal shunting of blood e.g. sepsis
*Note that the CO may be HIGH in an attempt to compensate (trying to fill a tank that is too big)
How does sepsis cause distributive shock?
Sepsis causes widespread vasodilation
What is the general feature of shock?
Very low systolic arterial blood pressure (less than 60 mmHg)
What is the classic etiology of cardiogenic shock?
Loss of large amount/function of myocardial contractile tissue
*AMI, dilated cardiomyopathy, valvular defect, arrhythmia
Most is the most important indicator of prognosis in cardiogenic shock?
LV function
Note that this is true for ANY heart disease
What are the consequences of shock?
1) Multiorgan dysfunction
2) Acidemia
3) Myocardial dysfunction
4) ARDS
5) ATN (Acute Tubular Necrosis)
6) GI
- Hepatic injury/ “shock-liver
- Intestinal ischemia/injury
7) CNS
What is the effect of acidemia on cardiac function?
Acidemia decrease myocardial function
What are the most important features of shock management?
1) ICU care
2) Oxygen supplementation
3) ABGs to manage acid-base status
What kind of fluid should be used for volume expansion in shock?
Isotonic (NS or LR)
