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Pathology > Hemodynamics V > Flashcards

Hemodynamics V Flashcards

1
Q

What are the causes of shock?

A 
Hemorrhage
Trauma
Burns
MI
PE
Sepsis
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2
Q

What is the definition of shock?

A

Clinical manifestation of the inability of the circulatory system to adequately supply tissues with nutrients and remove toxic wastes

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3
Q

What are the sequela of shock?

A

Hypotension
Impaired tissue perfusion
Cellular hypoxia

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4
Q

What are the four types of cardiogenic shock?

A

Infarction
Arrhythmia
Tamponade
PE

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5
Q

What are the five type of shock?

A 
Cardiogenic
Neurogenic
Anaphylactic
Septic
Hypovolemic
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6
Q

What is neurogenic shock?

A

Neurogenic dysfunction causes loss of vascular tone and peripheral pooling of blood

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7
Q

What is anaphylactic shock mediated by?

A

IgE mediated hypersensitivity response

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8
Q

What are the etiological classifications of shock?

A 
Septic
Spinal
Hypovolemic
Hemorrhage
Obstructive
Cardiogenic
Cellular toxins
Anaphylactic
Endocrine/adrenal crisis

(SSHHOCCKE)

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9
Q

What are the causes of vasodilation seen in shock?

A

Anaphylaxis
Neurogenic impulses
Sepsis

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10
Q

What happens to muscles during shock? What is the major systemic effect?

A

Produce lactic acid, producing metabolic acidosis

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11
Q

What happens to the kidneys in shock?

A

Decreased blood flow = oliguria

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12
Q

What happens to the lungs in severe shock?

A

ARDS

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13
Q

What are the two major cytokines in shock?

A

TNFalpha

IL-1

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14
Q

What is the final common pathway in shock?

A

Cellular injury

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15
Q

What are the five unifying features of shock?

A 
Intracellular Ca overload
Intracellular H ion
Cellular interstitial edema
Catabolic metabolism
Inflammation
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16
Q

What are the 6 Rosen’s Empiric criteria of shock? How many are needed to diagnose shock?

A 
Toxic appearance
Tachycardia
Tachypnea
Acidemia
Anuria
Hypotension

4/6

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17
Q

How long does someone have to be hypotensive for, to be actually considered hypotensive?

A

> 20 minutes

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18
Q

What are the three stages of shock?

A

Non Progressive stage
Progressive stage
Irreversible stage

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19
Q

What happens in the non-progressive stage of shock?

A

Maintain pressure and CO

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20
Q

How does the body attempt to maintain bp and CO in the nonprogressive stage? (3)

A

Tachycardia
Peripheral vasoconstriction
Renal conservation of fluid

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21
Q

What are the five main things that happen in the “progressive stage” of shock?

A 
Widespread hypoxia
Lactic acidosis
Arteriolar dilation
Confusion
Anuria
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22
Q

What causes the widespread cellular injury seen in the irreversible stage of cell injury?

A

Lysosomal enzyme leakage
Decrease myocardial contraction
Renal failure

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23
Q

What happens in the brain during shock?

A

Ischemic encephalopathy

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24
Q

What happens in the heart during shock?

A

Coagulative necrosis

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25
Q

What happens in the kidneys during shock?

A

Acute tubular necrosis

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26
Q

What happens in the lungs during shock?

A

Diffuse alveolar damage

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27
Q

What happens in the adrenal glands during shock?

A

Cortical cell lipid depletion

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28
Q

What happens in the GI tract during shock?

A

Hemorrhages and necrosis

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29
Q

What happens in the liver during shock?

A

Fatty change, hemorrhagic necrosis

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30
Q

What happens to the blood vessel sympathetic tone in cardiogenic shock? What two bad outcomes does this lead to?

A

Increases (vasoconstriction), leading to edema, and renal ischemia

31
Q

What causes the sympathetic tone in cardiogenic shock?

A

Decreased myocardial contractility

32
Q

What happens pathologically in cardiogenic shock?

A

40% loss of myocardium

33
Q

What is the cardiac index, and what happens during cardiogenic shock?

A

CO/surface area

Falls below 2.2

34
Q

What happens to the arteries and vein volume in cardiogenic shock?

A

Arteries volume decreased

Veins increased

35
Q

What happens to the arteries and vein volume in hypovolemic shock?

A

both decreased

36
Q

What happens to the arteries and vein volume in obstructive shock?

A

Severe decreased in arteries and increase in veins

37
Q

What are the management steps of cardiogenic shock? (3)

A

Stabilize ABCs
Identify etiology
IVFs

38
Q

What percent of volume loss is characteristic of each class (I-IV) of hemorrhagic shock?

A

I = 40 %

39
Q

At what class of hemorrhagic shock is BP decreased?

A

Class III

40
Q

At what class of hemorrhagic shock is PP decreased?

A

Class II

41
Q

Why are colloids given in shock?

A

Less fluid required

Draw fluids from tissues

42
Q

What are the disadvantages of colloids?

A

Allergic rxn

Coagulopathies

43
Q

Which type of bacteria has LPS?

A

Gram negative

44
Q

What are the three major cytokines that are released in response to gram negative bacteria?

A

IL-1
TNFa
IFNgamma

45
Q

What are the three effects of cytokine production in shock?

A

Coag
Leukotrienes
Complement activation

46
Q

What are the three major effects of inflammatory cytokines in low quantities?

A

C5a, C3a increased
Endothelial cell activation
Leukocyte activation

47
Q

What are the three systemic effects of inflammatory cytokines in moderate quantities?

A

Leukocytosis
Acute phase proteins
Fever

48
Q

What are the three systemic effects of inflammatory cytokines in high quantities?

A

DIC
ARDS
Low CO

49
Q

What are bands?

A

Immature white cells that have gotten out into the circulation

50
Q

SIRS + documented infx =?

A

Sepsis

51
Q

Sepsis + MODS = ?

A

Severe sepsis

52
Q

Sepsis + hypotension refractory to volume resuscitation = ?

A

Septic shock

53
Q

What are the three chemicals that are used to treat the coagulation cascade in the shock?

A

Protein C
Protein S
Antithrombin III

54
Q

What are the two vasoactive mediators given in septic shock?

A

Vasopressin

NO

55
Q

What are the inflammatory mediators given in septic shock?

A

Tissue factor pathway inhibitor

IVIG

56
Q

What is spinal shock?

A

Initial loss of spinal cord function following spinal cord injury

57
Q

Above what spinal level is neurogenic shock seen?

A

T6

58
Q

What causes the bradycardia in neurogenic shock?

A

Unopposed parasympathetic stimulation

59
Q

What causes the hypotension seen in neurogenic shock?

A

Loss of sympathetic tone

60
Q

What type of T cells are activated in anaphylactic shock? What does this cause?

A

Th2 cells–promotes B cell class switching to IgE

61
Q

What is the main goal of treating shock?

A

Prevent organ failure

62
Q

What happens to intracellular Ca levels in shock?

A

Increases

63
Q

What happens to intracellular hydrogen ion in shock?

A

Increases

64
Q

What happens to cellular and interstitial fluid in shock?

A

Increases (edema)

65
Q

What happens to cellular metabolism during shock?

A

Shift to catabolic metabolism

66
Q

What is a base deficit?

A

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

67
Q

True or false: hypotension is absolutely necessary to diagnose shock

A

False–early stages are without hypotension

68
Q

What type of hypersensitivity is anaphylactic shock?

A

Type I

69
Q

What is the HR for Class I-IV of hemorrhagic shock?

A

I = 140

70
Q

When does the Pulse pressure decrease in hemorrhagic shock: Class I, II, III, or IV

A

After I/ at II

71
Q

When does the BP drop in hemorrhagic shock: (class I, II, III, or IV)?

A

After class II/at class III

72
Q

When does the LOC change from anxious to confused to lethargic in hemorrhagic shock? (Class I, II, III, IV)

A

Class III = confused

Class IV = lethargic

73
Q

ACtivation of TNFalpha and IL-1 leads to what three inflammatory responses?

A
  1. Coag activation
  2. Prostaglandin/leukotriene release
  3. Complement activation
74
Q

What is the MOA of Ranitidine?

A

Blocks release of histamine from mast cells

Pathology (32 decks)

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