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Y3R4 - BMS 🏥 > L15: Shock > Flashcards

L15: Shock Flashcards

1
Q

Def of Shock

A
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2
Q

Shock Reversibility

A
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3
Q

Classification & Etiology of Shock

A
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4
Q

Disributive Shock is characterized by severe peripheral (Vasodilatation/vasoconstriction)

A

severe peripheral vasodilatation (vasodilatory shock)

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5
Q

what is the most common cause of destributive shock?

A

Septic Shock

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6
Q

Characters of Septic Shock

A
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6
Q

Def of Septic Shock

A
  • A dysregulated host response to infection resulting in life-threatening organ dysfunction.
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7
Q

Pathophysiology of Septic Shock

A
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8
Q

Causes of Neurogenic Shock

A
  • Spinal cord injury.
  • Traumatic brain injury.
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8
Q

Presentation of Neurogenic Shock

A
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9
Q

In some cases, ……. is common in patients with severe traumatic brain injury & spinal cord injury:

  • Due to …….
A
  • overt shock
  • combined neurogenic shock & hypovolemic shock “from blood loss”
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10
Q

Cause of Anaphylactic shock

A
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11
Q

Presentation of Anaphylactic shock

A

Cardinal features of anaphylaxis:
- Skin reactions.
- Hemodynamic collapse.
- Bronchospasm.
- Increase Airway resistance.

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11
Q

Def of Drug-Toxin Induced Shock

A

Drug or toxin reactions that can be associated with:

  • Shock
  • or SIRS-like syndromes “Systemic Inflammatory Response Syndrome”.
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11
Q

**

Examples of Endocrine Shock

A
  • Addisonian Crisis
  • Myxedema
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12
Q

Examples of Drug-Toxin Induced Shock

A
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13
Q

Pathophysiology of Addisonian crisis

A
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14
Q

Pathophysiology of Myxedema

A
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15
Q

Cardiogenic shock and CO

A

Due to intracardiac causes of cardiac pump failure that result in Decreases cardiac output (CO).

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16
Q

Cardiomyopathic causes of shock include:

A
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17
Q

what is a Stunned myocardium?

A

Acutely ischemic myocardial segments with transiently impaired contractility “but completely reversible”

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18
Q

Types of Arrhythmic Shock

A

Atrial “Tachyarrhythmias & Bradyarrhythmia”
Ventricular “Tachyarrhythmias & Bradyarrhythmia”

  • Both induce hypotension, often contributing to states of shock.
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19
Q

CO in Cardiogenic shock

A

Severely compromised

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20
Q

Causes of Cardiogenic shock

A

Significant rhythm disturbances:
- Sustained ventricular tachycardia.
- Complete heart block.

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21
Q

CO in Cardiac arrest

A

Absent

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22
Q

Causes of Cardiac arrest

A

Because of the underlying rhythm:
- Pulseless ventricular tachycardia.
- Ventricular fibrillation.

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22
Q

Def of Hemorrhagic shock

A

Decreased Intravascular volume from blood loss can result in shock.

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23
Q

what causes Mechanical Cardiogenic Shock?

A
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23
Q

CO & Hypoveolemic shock

A

Due to Decreased intravascular volume (l.e. Decreased preload) —> Decreased co.

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24
Q

Causes of Hemorrhagic shock

A
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25
Q

Def of Non-hemorrhagic causes

A

Decreased Intravascular volume from fluid loss other than blood can cause shock.

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26
Q

Causes of Non-hemorrhagic causes

A
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27
Q

Obstructive Shock

A
  • Due to extracardiac causes of cardiac pump failure.
  • Often associated with poor right ventricle output.
  • Either Pulmonary vascular (Most Common) or Mechanical
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28
Q

Causes of Pulmonary Vascular Obstructive Shock

A
  • Hemodynamically significant pulmonary embolism (PE).
  • Severe pulmonary hypertension (PH).
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29
Q

Mechansim of Pulmonary Vascular Obstructive Shock

A
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30
Q

Causes of Mechanical Shock

A
  • Tension pneumothorax.
  • Pericardial tamponade)
  • Constrictive pericarditis
  • Restrictive cardiomyopathy (Stiff, rigid muscle wall).
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31
Q

Mechanism of Mechanical Shock

A

Patients in this category present clinically as hypovolemic shock:

  • Because their primary physiologic disturbance is decreased preload, rather than pump failure i.e. due to
  1. Venous return to the right atrium
  2. inadequate right ventricle filling.
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32
Q

Comparison between Different types of shocks

A
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33
Q

which type of shock is CCC by Bradychardia?

A

Neurogenic

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34
Q

what type of shock is CCC by tachpnea?

A
  • Septic
  • Cardiogenic
35
Q

what type of Shock is CCC by fever?

A

Septic

35
Q

what type of shock is CCC by Crackles?

A

Cardiogenic

36
Q

what type of shoch is CCC by increased SVR?

A
  • Cardiogenic
  • Hypovolemic
37
Q

Mechanism of Shock

A
38
Q
  • Intracellular edema.
  • Leakage of intracellular contents into the extracellular space.
  • Inadequate regulation of intracellular pH.

These biochemical processes, when unchecked:

A
39
Q
A
40
Q
A
41
Q
A
42
Q
A
43
Q

Stages of Shock

A
44
Q

Mechanism of Pre-shock stage

A

Compensatory responses to decrease tissue perfusion

As an example…
- In early hypovolemic pre-shock a compensatory..
1. Tachycardia.
2. Peripheral vasoconstriction.

45
Q

what is Pre-shock Known as?

A

Compensated shock or cryptic shock

46
Q

Symptoms pf Pre-shock Stage

A
  • Asymptomatic “in healthy adult”
  • Preserve a normal blood pressure: Despite a 10% decrease in total effective arterial blood volume.
47
Q

what is Shockstage known as?

A

Progressive phase

48
Q

Mechanism of Shock stage

A

The compensatory mechanisms become overwhelmed

  • Signs & symptoms of organ dysfunction appear.
49
Q

Symptoms of Shock stage

A

Signs & symptoms including:

© Symptomatic tachycardia.
© Dyspnea.
© Restlessness.
© Diaphoresis.
© Metabolic acidosis.
© Hypotension.
© Oliguria.
® Cool & clammy skin.

50
Q

what is End-organ dysfunction stage known as?

A

Stage of decompensation

51
Q

mechasnism of End-organ dysfunction satge

A
52
Q

Symptoms of End-organ dysfunction stage

A

Progressive shock leads to…

  • Irreversible organ damage.
    -Multiorgan failure (MOF).
  • Death. (Common in this phase)
53
Q

When to suspect shock?

CP of Shock

A
54
Q

Hypotension & Shock

A
55
Q

Approach to shock

A
56
Q

Hemodynamic support in shock

A
  • Intravenous fluids
  • Vasopressors
57
Q

Lab evaluation of shock

A

“Part of initial diagnostic evaluation”

© Serum lactate.
© Renal & liver function tests.
© Cardiac enzymes & natriuretic peptides.
© Complete blood count & differential.
© Coagulation studies & D-dimer level.
© Blood gas analysis.

58
Q

what is the First-line agents in the treatment of patients with undifferentiated hypotension & shock?

A

IVFs

59
Q

Dose of Intravenous Fluids (IVFs)

A

We prefer to administer IVFs in well-defined boluses (E.g. 500 to 1000 mL).

60
Q

End point of Intravenous Fluids (IVFs)

A
61
Q

Hemodynamic Support In hypotensive patients with pulmonary edema

A
62
Q

Fluid type in hemodynamic support in shock

A
63
Q

Vassopressors used in hemodynamic support

A
64
Q

Types of vasopressors used in hemodynamic support

A
65
Q

Adrenergic agonists
(Vasopressors)

A
66
Q

Inotropic agenys used in TTT of Shock

A
67
Q

Dobutamine is often administered together with norepinephrine, why?

A
  • To offset the fall in peripheral vascular resistance that occurs when low doses of dobutamine are used.
68
Q

End point of using vasopressors in shock

A
69
Q

Dx of Shock

A
70
Q

managment of Anaphylactic Shock

A

In addition to signs & symptoms in of anaphylaxis:

  • Patients on mechanical ventilation may also have a sudden it in peak inspiratory pressures
    “due to bronchospasm & 11 airway resistance”.

Drugs:
- Epinephrine
- Other agents

71
Q

Drugs in TTT of Anaphylactic Shock

A
  • Epinephrine
  • Other agents
72
Q

Route of Epinephrine in Anaphylactic Shock

A

intramuscular “injected into the mid-outer thigh”

73
Q

Dose of Epinephrine in Anaphylactic Shock

A
  • The typical adult dose is 0.3 mg of 1:1000 epinephrine
  • Repeated every 5 to 15 minutes as needed.
74
Q

Effect of Epinephrine in Anaphylactic Shock

A
  • VC.
  • Increased Heart properties.
  • Bronchodilation.
75
Q

Other pharmacologic agents frequently administered following epinephrine

A
76
Q

Lab diagnosis of anaphylaxis

A

Increased Serum ß tryptase level. “Confirmatory”

  • So blood for total tryptase or histamine should be drawn prior to or shortly after treatment.
77
Q

Presentation of Septic Shock

A
  • Fever.
  • Hypotension
  • A suspected septic source.
78
Q

what do patients with Septic Shock benefit from?

A

Early administration of intravenous antibiotics
- The choice of antibiotic determined by the suspected source.

Early Intravenous fluid resuscitation.

79
Q

Antibiotics used in Septic Shock

A
80
Q
A

…

81
Q

CP of Cardiogenic Shock From MI

A
82
Q

Lab results in Cardiogenic Shock From MI

A

Elevated Troponin or creatine phosphokinase levels.

83
Q

Rad results in Cardiogenic Shock From MI

A

Pulmonary edema on chest radiography.

84
Q

Intervention in Cardiogenic Shock From MI

A
85
Q

CP of Hemodynamically Significant Pulmonary Embolism

A
  • Hypotension.

Associated with:
* Acute dyspnea.
* Hypoxemia.

Are strongly suspected of having a pulmonary embolism (PE)

86
Q

Lab Results in Hemodynamically Significant Pulmonary Embolism

A

Increased D-dimer, troponin, & natriuretic peptide levels.

87
Q

Rad Results in Hemodynamically Significant Pulmonary Embolism

A
88
Q

Interventions in Hemodynamically Significant Pulmonary Embolism

A

These patients Benefit from the administration of systemic thrombolytic therapy “Provided no contraindications are present”.

89
Q

Lab results of Adrenal Crisis

A

Blood for (Serum cortisol - Corticotropin (ACTH) - Aldosterone - Renin - Serum chemistries) should be drawn to confirm the diagnosis.

90
Q

CP of Adrenal Crisis

A
  • Hypotension.

Associated with:
* Volume depletion.
* History of glucocorticoid deficiency or withdrawal.

Patients suspected of having an adrenal crisis

91
Q

Intervention in Adrenal Crisis

A

Y3R4 - BMS 🏥 (18 decks)

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