L15: Shock Flashcards
1
Q
Def of Shock
A
2
Q
Shock Reversibility
A
3
Q
Classification & Etiology of Shock
A
4
Q
Disributive Shock is characterized by severe peripheral (Vasodilatation/vasoconstriction)
A
severe peripheral vasodilatation (vasodilatory shock)
5
Q
what is the most common cause of destributive shock?
A
Septic Shock
6
Q
Characters of Septic Shock
A
6
Q
Def of Septic Shock
A
- A dysregulated host response to infection resulting in life-threatening organ dysfunction.
7
Q
Pathophysiology of Septic Shock
A
8
Q
Causes of Neurogenic Shock
A
- Spinal cord injury.
- Traumatic brain injury.
8
Q
Presentation of Neurogenic Shock
A
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”
10
Q
Cause of Anaphylactic shock
A
11
Q
Presentation of Anaphylactic shock
A
Cardinal features of anaphylaxis:
- Skin reactions.
- Hemodynamic collapse.
- Bronchospasm.
- Increase Airway resistance.
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”.
11
Q
**
Examples of Endocrine Shock
A
- Addisonian Crisis
- Myxedema
12
Q
Examples of Drug-Toxin Induced Shock
A
13
Q
Pathophysiology of Addisonian crisis
A
14
Q
Pathophysiology of Myxedema
A
15
Q
Cardiogenic shock and CO
A
Due to intracardiac causes of cardiac pump failure that result in Decreases cardiac output (CO).
16
Q
Cardiomyopathic causes of shock include:
A
17
Q
what is a Stunned myocardium?
A
Acutely ischemic myocardial segments with transiently impaired contractility “but completely reversible”
18
Q
Types of Arrhythmic Shock
A
Atrial “Tachyarrhythmias & Bradyarrhythmia”
Ventricular “Tachyarrhythmias & Bradyarrhythmia”
- Both induce hypotension, often contributing to states of shock.
19
Q
CO in Cardiogenic shock
A
Severely compromised
20
Q
Causes of Cardiogenic shock
A
Significant rhythm disturbances:
- Sustained ventricular tachycardia.
- Complete heart block.
21
CO in **Cardiac arrest**
Absent
22
Causes of **Cardiac arrest**
Because of the underlying rhythm:
- Pulseless ventricular tachycardia.
- Ventricular fibrillation.
22
Def of **Hemorrhagic shock**
Decreased Intravascular volume from blood loss can result in shock.
23
what causes **Mechanical Cardiogenic Shock**?
23
CO & **Hypoveolemic shock**
Due to Decreased intravascular volume (l.e. Decreased preload) ---> Decreased co.
24
Causes of **Hemorrhagic shock**
25
Def of **Non-hemorrhagic causes**
Decreased Intravascular volume from fluid loss other than blood can cause shock.
26
Causes of **Non-hemorrhagic causes**
27
Obstructive Shock
- Due to extracardiac causes of cardiac pump failure.
- Often associated with poor right ventricle output.
- Either Pulmonary vascular **(Most Common)** or Mechanical
28
Causes of **Pulmonary Vascular Obstructive Shock**
- Hemodynamically significant pulmonary embolism (PE).
- Severe pulmonary hypertension (PH).
29
Mechansim of **Pulmonary Vascular Obstructive Shock**
30
Causes of **Mechanical Shock**
- Tension pneumothorax.
- Pericardial tamponade)
- Constrictive pericarditis
- Restrictive cardiomyopathy (Stiff, rigid muscle wall).
31
Mechanism of **Mechanical Shock**
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.
32
Comparison between Different types of shocks
33
which type of shock is CCC by Bradychardia?
Neurogenic
34
what type of shock is CCC by tachpnea?
- Septic
- Cardiogenic
35
what type of Shock is CCC by fever?
Septic
35
what type of shock is CCC by Crackles?
Cardiogenic
36
what type of shoch is CCC by increased SVR?
- Cardiogenic
- Hypovolemic
37
Mechanism of Shock
38
- Intracellular edema.
- Leakage of intracellular contents into the extracellular space.
- Inadequate regulation of intracellular pH.
**These biochemical processes, when unchecked:**
39
40
41
42
43
Stages of Shock
44
Mechanism of Pre-shock stage
**Compensatory responses to decrease tissue perfusion**
As an example...
- In early hypovolemic pre-shock a compensatory..
1. Tachycardia.
2. Peripheral vasoconstriction.
45
what is **Pre-shock** Known as?
Compensated shock or cryptic shock
46
Symptoms pf **Pre-shock** Stage
- Asymptomatic "in healthy adult"
- Preserve a normal blood pressure: Despite a 10% decrease in total effective arterial blood volume.
47
what is **Shock**stage known as?
Progressive phase
48
Mechanism of Shock stage
**The compensatory mechanisms become overwhelmed**
- Signs & symptoms of organ dysfunction appear.
49
Symptoms of **Shock** stage
**Signs & symptoms including:**
© Symptomatic tachycardia.
© Dyspnea.
© Restlessness.
© Diaphoresis.
© Metabolic acidosis.
© Hypotension.
© Oliguria.
® Cool & clammy skin.
50
what is End-organ dysfunction stage known as?
Stage of decompensation
51
mechasnism of **End-organ dysfunction** satge
52
Symptoms of **End-organ dysfunction** stage
Progressive shock leads to...
- Irreversible organ damage.
-Multiorgan failure (MOF).
- Death. **(Common in this phase)**
53
When to suspect shock?
CP of Shock
54
Hypotension & Shock
55
Approach to shock
56
Hemodynamic support in shock
- Intravenous fluids
- Vasopressors
57
Lab evaluation of shock
**"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
what is the First-line agents in the treatment of patients with undifferentiated hypotension & shock?
IVFs
59
Dose of **Intravenous Fluids (IVFs)**
We prefer to administer IVFs in well-defined boluses (E.g. 500 to 1000 mL).
60
End point of **Intravenous Fluids (IVFs)**
61
Hemodynamic Support In hypotensive patients with pulmonary edema
62
Fluid type in hemodynamic support in shock
63
Vassopressors used in hemodynamic support
64
Types of vasopressors used in hemodynamic support
65
Adrenergic agonists
**(Vasopressors)**
66
Inotropic agenys used in TTT of Shock
67
Dobutamine is often administered together with norepinephrine, why?
- To offset the fall in peripheral vascular resistance that occurs when low doses of dobutamine are used.
68
End point of using vasopressors in shock
69
Dx of **Shock**
70
managment of **Anaphylactic Shock**
**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
Drugs in TTT of **Anaphylactic Shock**
- Epinephrine
- Other agents
72
Route of Epinephrine in **Anaphylactic Shock**
intramuscular "injected into the mid-outer thigh"
73
Dose of Epinephrine in **Anaphylactic Shock**
- The typical adult dose is 0.3 mg of 1:1000 epinephrine
- Repeated every 5 to 15 minutes as needed.
74
Effect of Epinephrine in **Anaphylactic Shock**
- VC.
- Increased Heart properties.
- Bronchodilation.
75
Other pharmacologic agents frequently administered following epinephrine
76
Lab diagnosis of anaphylaxis
**Increased Serum ß tryptase level. "Confirmatory"**
- So blood for total tryptase or histamine should be drawn prior to or shortly after treatment.
77
Presentation of **Septic Shock**
- Fever.
- Hypotension
- A suspected septic source.
78
what do patients with **Septic Shock** benefit from?
**Early administration of intravenous antibiotics**
- The choice of antibiotic determined by the suspected source.
**Early Intravenous fluid resuscitation.**
79
Antibiotics used in **Septic Shock**
80
...
81
CP of **Cardiogenic Shock From MI**
82
Lab results in **Cardiogenic Shock From MI**
Elevated Troponin or creatine phosphokinase levels.
83
Rad results in **Cardiogenic Shock From MI**
Pulmonary edema on chest radiography.
84
Intervention in **Cardiogenic Shock From MI**
85
CP of **Hemodynamically Significant Pulmonary Embolism**
- Hypotension.
Associated with:
* Acute dyspnea.
* Hypoxemia.
**Are strongly suspected of having a pulmonary embolism (PE)**
86
Lab Results in **Hemodynamically Significant Pulmonary Embolism**
Increased D-dimer, troponin, & natriuretic peptide levels.
87
Rad Results in **Hemodynamically Significant Pulmonary Embolism**
88
Interventions in **Hemodynamically Significant Pulmonary Embolism**
These patients Benefit from the administration of systemic thrombolytic therapy "Provided no contraindications are present".
89
Lab results of **Adrenal Crisis**
Blood for (Serum cortisol - Corticotropin (ACTH) - Aldosterone - Renin - Serum chemistries) should be drawn to confirm the diagnosis.
90
CP of **Adrenal Crisis**
- Hypotension.
Associated with:
* Volume depletion.
* History of glucocorticoid deficiency or withdrawal.
**Patients suspected of having an adrenal crisis**
91
Intervention in **Adrenal Crisis**
