Hemodynamics 2 Flashcards
What is shock?
Shock is a state of total body hypoperfusion, a state of cardiovascular collapse.
What are the three causes of shock?
- Decreased circulating blood volume
- Decreased cardiac output
- Sepsis
What are the three types of shock?
- Hypovolemic shock
- Cardiogenic Shock
- Septic Shock
What is sepsis?
SIRS due to suspected or proven shock
What is severe sepsis?
Sepsis with acute organ dysfunction
What is septic shock?
Sepsis-induced hypotension with bp less than 90 mm Hg.
What is SIRS?
Having 2 of 4 of: Fever Elevated RR Elevated HR Leukocytosis
What type of shock is cardiac tamponade? What is cardiac tamponade?
Cardiogenic Shock
Filling of the pericardium with fluid or blood, preventing the filling of the heart to pump sufficient blood
What are the clinical features of shock?
Agitation, decreasing mental status, progressing from confusion to lethargy to delirium and coma.
What are the physical signs of hypovolemic or cardiogenic shock?
Having a weak rapid pulse and cool, clammy, sometimes cyanotic shock
What are physical signs of septic shock?
Warm flushed skin
In general, how do you treat the three forms of shock?
Hemorraghic shock - blood transfusion
Cardiogenic shock - assisting the heart
Septic shock - antibiotics
What causes septic shock?
Vasodilation due to increasing flow out of the vascular system, leaving too little to be pumped through the body
What is a common problem in patients with long bone fractures?
Shock that is partly hemorraghic and partly more like septic shock due to increased production of TNF, IL-1, AND IL-6
What can lead to hypovolemic shock?
Dehydration, severe diarrhea, extensive burns
What percentage of blood volume loss is typically necessary to induce hemorraghic shock?
A loss of about 25-30%
What are counter-regulatory mechanisms to sepsis and shock?
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
What is toxic shock syndrome?
Due to nonspecific immunologic over-rxn to a secreted bacterial product
What are the stages of shock?
- non-progressive
- progressive
- irreversible, with resultant death
What are the gross and microscopic manifestations of shock?
Cerebral necrosis (red neurons), hypereosinophilia, Pyknosis
What occurs to the bowels in shock?
Mucosa becomes leaky and sticky. Stool sticks to the lining, blood leaks into mucosa. Cecum is particularly vulnerable
What is characteristic of shock liver?
Alternating red and brown tissue resembling cut surface of nutmeg. Steatotic areas
