Hemodynamics 2

Question 1

What is shock?

Answer 1

Shock is a state of total body hypoperfusion, a state of cardiovascular collapse.

Question 2

What are the three causes of shock?

Answer 2

1. Decreased circulating blood volume
2. Decreased cardiac output
3. Sepsis

Question 3

What are the three types of shock?

Answer 3

1. Hypovolemic shock
2. Cardiogenic Shock
3. Septic Shock

Question 4

What is sepsis?

Answer 4

SIRS due to suspected or proven shock

Question 5

What is severe sepsis?

Answer 5

Sepsis with acute organ dysfunction

Question 6

What is septic shock?

Answer 6

Sepsis-induced hypotension with bp less than 90 mm Hg.

Question 7

What is SIRS?

Answer 7

Having 2 of 4 of:
Fever
Elevated RR
Elevated HR
Leukocytosis

Question 8

What type of shock is cardiac tamponade? What is cardiac tamponade?

Answer 8

Cardiogenic Shock

Filling of the pericardium with fluid or blood, preventing the filling of the heart to pump sufficient blood

Question 9

What are the clinical features of shock?

Answer 9

Agitation, decreasing mental status, progressing from confusion to lethargy to delirium and coma.

Question 10

What are the physical signs of hypovolemic or cardiogenic shock?

Answer 10

Having a weak rapid pulse and cool, clammy, sometimes cyanotic shock

Question 11

What are physical signs of septic shock?

Answer 11

Warm flushed skin

Question 12

In general, how do you treat the three forms of shock?

Answer 12

Hemorraghic shock - blood transfusion
Cardiogenic shock - assisting the heart
Septic shock - antibiotics

Question 13

What causes septic shock?

Answer 13

Vasodilation due to increasing flow out of the vascular system, leaving too little to be pumped through the body

Question 14

What is a common problem in patients with long bone fractures?

Answer 14

Shock that is partly hemorraghic and partly more like septic shock due to increased production of TNF, IL-1, AND IL-6

Question 15

What can lead to hypovolemic shock?

Answer 15

Dehydration, severe diarrhea, extensive burns

Question 16

What percentage of blood volume loss is typically necessary to induce hemorraghic shock?

Answer 16

A loss of about 25-30%

Question 17

What are counter-regulatory mechanisms to sepsis and shock?

Answer 17

Lipoxins generated from Arachidonic Acid inhibited neutrophil adhesion to endothelial cells and chemotaxis. In the complement system, C1INH, Factor H and DAF serve to counter-regulate the pro-inflamm effects of complement activation

Question 18

What is toxic shock syndrome?

Answer 18

Due to nonspecific immunologic over-rxn to a secreted bacterial product

Question 19

What are the stages of shock?

Answer 19

1. non-progressive
2. progressive
3. irreversible, with resultant death

Question 20

What are the gross and microscopic manifestations of shock?

Answer 20

Cerebral necrosis (red neurons), hypereosinophilia, Pyknosis

Question 21

What occurs to the bowels in shock?

Answer 21

Mucosa becomes leaky and sticky. Stool sticks to the lining, blood leaks into mucosa. Cecum is particularly vulnerable

Question 22

What is characteristic of shock liver?

Answer 22

Alternating red and brown tissue resembling cut surface of nutmeg. Steatotic areas