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Surgery I > Hemorrhage > Flashcards

Hemorrhage Flashcards

1
Q

What is shock?

A

Oxygen delivery to body is compromised

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2
Q

What happens with shock?

A

Body will compensate as long as possible

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3
Q

What is seen in as a compensatory reaction to shock?

A

tachycardia + tachypnea + peripheral vasoconstriction

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4
Q

Reason in Shock: Tachycardia

A

Increase oxygen delivery

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5
Q

Reason in Shock: Tachypnea

A

Increase oxygenation

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6
Q

Reason in Shock: Peripheral vasoconstriction

A

Maintain perfusion to vital organs

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7
Q

What is a major consequence of perfusion and hypoxia?

A

Mental depression

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8
Q

What are the four types of shock?

A

Hypovolemia
Cardiogenic
Distributive
Hypoxic

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9
Q

What is hypovolemic shock?

A

Inadequate circulating volume

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10
Q

What can cause hypovolemic shock?

A

Hemorrhage
– and –
Loss of fluids

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11
Q

What occurs pathophysiologically with hypovolemic shock?

A

Reduced venous return = decreased preload
= less CO
= less oxygen to tissues

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12
Q

What are the classes of hemorrhagic shock?

A

I to IV

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13
Q

In what class of hemorrhagic shock do you see change in BP?

A

III

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14
Q

Blood loss amount: Class I

A

up to 15%

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15
Q

Blood loss amount: Class II

A

15 to 30%

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16
Q

Blood loss amount: Class III

A

30 to 40 %

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17
Q

Blood loss amount: Class IV

A

> 40%

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18
Q

What is cardiogenic shock?

A

Primary problem in the heart

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19
Q

What are the two types of cardiogenic shock?

A

Diastolic
– and –
Systolic

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20
Q

What is diastolic failure?

A

Heart has problems filling

21
Q

What is systolic failure?

A

Heart has problems pumping

22
Q

What is distributive shock?

A

problems regulating vascular tone

23
Q

What are the common causes of distributive shock?

A

Sepsis + SIRS

24
Q

What are the least common causes of distributive shock?

A

Anaphylactic reaction
Anesthesia
CNS damage

25
Q

What is the result of distributive shock?

A

Not enough BV to fill vascular space

Relative hypovolemia results

26
Q

What is hypoxic shock?

A

Adequate tissue perfusion but blood not carrying enough oxygen

27
Q

What are common causes of hypoxic shock?

A

Anemia
Hypoxemia
Toxins
Carbon monoxide poisonig

28
Q

What two structures in the body sense shock?

A

Baroreceptors
– and –
Low pressure stretch receptors

29
Q

Location: Baroreceptors?

A

Carotid sinus
– and –
Aortic arch

30
Q

Location: Low pressure stretch receptors

A

Atria
– and –
Pulmonary arteries

31
Q

What happens once the SNS system is activated?

A

Increase in HR = Increase CO
Constrict arterioles = blood to vital organs
Constrict large veins = effective vascular volume

32
Q

What does the SNS activation do chemically?

A

Activates the neuroendocrince response

Release angiotensin + vasopressin

33
Q

What are that three levels of hypovolemic shock?

A

compensatory
early compensatory
compensatory

34
Q

When do you start seeing hypovolemic induced tachycardia?

A

early compensatory

35
Q

What is a very reliable indicator that early compensatory response is occurring?

A

Tachycardia

36
Q

At what heart rate do you stop worrying about shock and more about a heart problem?

A

HR greater than 240

37
Q

Shock organ: Dog

A

Gut

38
Q

Shock organ: Cat

A

Lungs

39
Q

What is the normal lactate level in a dog or cat?

A
40
Q

What is considered hyperlactatemia?

A

6.0 mmol/L

41
Q

What two blood alterations are seen in hypovolemic shock?

A

Increased lactate
– and –
Metabolic acidosis

42
Q

What is the most common cause of hyperlactatemia?

A

Inadequate oxygen (type A)

43
Q

What organs metabolize lactate?

A

Liver + Kidneys

44
Q

What is the initial goal of treatment in shock?

A

Stabilize airway + breathing + circulation + neurologic derangements

45
Q

What are the three components of therapy?

A

optimize oxygen delivery
aggressive support of organ function
ID and treatment of underlying disease

46
Q

What are the components to treatment of shock?

A

Oxygen

Fluids

47
Q

What amount of oxygen is give in shock?

A

100 ml/kg/min = FiO2 of 40 to 60%

48
Q

What is a shock bolus?

A

dose of fluids/blood products given

normally give 1/4 to 1/3 and reassess patient

49
Q

When should NSAIDS be avoided in shock patients?

A

Hypoperfusion— will arm kidney

Surgery I (17 decks)

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