Hemodynamics Part II: shock Flashcards

1
Q

define shock

A

transition between illness and death

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2
Q

shock aka

A

cardiovascular collapse

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3
Q

clinical manifestations of the inability of the circulatory system to adequately supply tissues with nutrients and remove toxic waste

A

shock

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4
Q

inadequate blood flwo secondary to decreased CO or mal-distributed output that results in irreversible tissue damage

A

shock

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5
Q

sequela of shock

A

hypotension –> impaired tissue perfusion –> cellular hypoxia

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6
Q

three major classifications of shock

A

cardiogenic
hypovolemic
septic

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7
Q

neurogenic shock

A

neurogenic dysfunction causes loss of vascular tone and peripheral pooling of blood (severing above T6)

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8
Q

anaphlactic shock

A

genrealized IgE mediated hypersensitivity response associated with vasodilation and increased vascular permeability

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9
Q

etiological classificiation

SSHHOCCKE

A
septic
spinal (neurogenic)
hypovolemic
hemorrhagic
obstructive
cardiogenic
cellular toxins
anaphylactic
endocrine/adrenal crisis
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10
Q

common final pathway of shock

A

cellular injury

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11
Q

five unifying features of shock

A

intracelllular calcium overload

intracellular hydrogen ion

cellular and interstitial edema

catabolic metabolism

inflammation

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12
Q

rosen’s empiric criteria for the diagnosis of shock (need 4 out of 6)

A
  1. ill appearance of decreased LOC
  2. HR > 100
  3. RR> 22 or PCO2 < 32
  4. Base deficit < -5 or lactate > 4
  5. urine ouput < 0.5 ml/kg/hr
  6. hypotension > 20 min duration
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13
Q

can you be in shock without being hypotensive?

A

yes

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14
Q

what is the base deficit?

A

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

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15
Q

three stages of shock

A

nonprogressive stage

progressive stage

irreversible stage

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16
Q

reflex compensation

mechanisms maintain tissue perfusion

A

nonprogressive stage of shock

17
Q

worsening circulatory/ metbolic imbalance

acidosis

A

progressive stage of shock

18
Q

at what shock stage to arterioles dilate –> poolin gin microcirculation

A

microcirculation

19
Q

define cardiogenic shock

A

decreased CO adn evidence of tissue hypoxia in presence of adequate intravascular volume

20
Q

criteria for cardiogenic shock (4)

A

hypotension < 90 for 30 min
30 mmHg below baseline
cardiac index < 2.2. L/mi/m2
PCWP pulmonary capillary wedge pressure >15 mmHg

or 4/6 rosens

21
Q

1500-2000 volume blood loss and patient is confused- what class of hemorrhagic shock ?

22
Q

what is the advantage of giving a colloid in hemorrhagic shock?

A

less fluid required

more volume in vascular space

potential to draw fluid in from tissues

23
Q

what clinical characteristics define SIRS systemic inflammatory response syndrome

A
  1. Temp > 38 or < 36
  2. HR > 90
  3. RR >20 or PaCO2 12 or 10% bands
24
Q

sepsis =

A

SIRS + documented infection

25
sever sepsis =
sepsis + multi-organ dysfunction
26
septic shock =
sepsis + hypotension refractory to volume resuscitation
27
neurogenic shock
loss of symphatetic autonomic function due to spinal cord injury
28
pathophysiology of neurogenic shock
hypotension (due to loss of sympathetic tone thus vasodilation and decreased SVR) and bradycardia (due to unopposed parasympathetic (vagal) tone to the heart)
29
lesion at or above T6
hypotension beacuse lower lesions leave enough of the body with intact sympathetics so that blood pressure doesnt drop
30
lesions at or above T4
bradycardia beacuse sympathetic innervation to heart is at T4
31
what type of hypersensitivity reactor is anaphylactic shock?
type 1 hypersensitivity rxn IgE mast cells