Hemodynamics Part II: shock

Question 1

define shock

Answer 1

transition between illness and death

Question 2

shock aka

Answer 2

cardiovascular collapse

Question 3

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

Answer 3

shock

Question 4

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

Answer 4

shock

Question 5

sequela of shock

Answer 5

hypotension –> impaired tissue perfusion –> cellular hypoxia

Question 6

three major classifications of shock

Answer 6

cardiogenic
hypovolemic
septic

Question 7

neurogenic shock

Answer 7

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

Question 8

anaphlactic shock

Answer 8

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

Question 9

etiological classificiation

SSHHOCCKE

Answer 9

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

Question 10

common final pathway of shock

Answer 10

cellular injury

Question 11

five unifying features of shock

Answer 11

intracelllular calcium overload

intracellular hydrogen ion

cellular and interstitial edema

catabolic metabolism

inflammation

Question 12

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

Answer 12

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

Question 13

can you be in shock without being hypotensive?

Answer 13

yes

Question 14

what is the base deficit?

Answer 14

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

Question 15

three stages of shock

Answer 15

nonprogressive stage

progressive stage

irreversible stage

Question 16

reflex compensation

mechanisms maintain tissue perfusion

Answer 16

nonprogressive stage of shock

Question 17

worsening circulatory/ metbolic imbalance

acidosis

Answer 17

progressive stage of shock

Question 18

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

Answer 18

microcirculation

Question 19

define cardiogenic shock

Answer 19

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

Question 20

criteria for cardiogenic shock (4)

Answer 20

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

Question 21

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

Answer 21

class III

Question 22

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

Answer 22

less fluid required

more volume in vascular space

potential to draw fluid in from tissues

Question 23

what clinical characteristics define SIRS systemic inflammatory response syndrome

Answer 23

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

Question 24

sepsis =

Answer 24

SIRS + documented infection

Question 25

sever sepsis =

Answer 25

sepsis + multi-organ dysfunction

Question 26

septic shock =

Answer 26

sepsis + hypotension refractory to volume resuscitation

Question 27

neurogenic shock

Answer 27

loss of symphatetic autonomic function due to spinal cord injury

Question 28

pathophysiology of neurogenic shock

Answer 28

hypotension (due to loss of sympathetic tone thus vasodilation and decreased SVR) and bradycardia (due to unopposed parasympathetic (vagal) tone to the heart)

Question 29

lesion at or above T6

Answer 29

hypotension beacuse lower lesions leave enough of the body with intact sympathetics so that blood pressure doesnt drop

Question 30

lesions at or above T4

Answer 30

bradycardia beacuse sympathetic innervation to heart is at T4

Question 31

what type of hypersensitivity reactor is anaphylactic shock?

Answer 31

type 1 hypersensitivity rxn

IgE mast cells