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Cardiovascular System > Lecture 11.1: Shock and Cardiac Arrest > Flashcards

Lecture 11.1: Shock and Cardiac Arrest Flashcards

1
Q

What is Shock?

A

Acute circulatory failure with inadequate or inappropriately distributed tissue perfusion

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2
Q

Mean Arterial BP Equation?

A

Mean Arterial BP = CO x TPR

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3
Q

Cardiac Output Equation?

A

CO = HR x SV

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4
Q

Fall in Cardiac Output in Shock (3)

A
  • Loss of volume (hypovolaemic)
  • Fall in contractility (cardiogenic)
  • Reduced cardiac filling (mechanical)
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5
Q

Fall in TPR in Shock (1)

A

Profound vasodilatation
(distributive)

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6
Q

Causes for Hypovolaemic Shock (4)

A
  • Blood loss (haemorrhage)
  • GI loss
  • Burns
  • Third space loss
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7
Q

What does the Severity of Hypovolaemic Shock depend on? (2)

A
  • The volume lost
  • The speed of loss
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8
Q

Pathophysiology of Hypovolaemic Shock: Decreased blood volume results in…? (5)

A
  • Fall in venous pressure
  • Reduced EDV [= reduced
    preload]
  • Reduced SV
  • Fall in CO
  • Fall in mean arterial BP
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9
Q

The reduction in mean arterial BP is detected by baroreceptors, this triggers compensatory mechanisms. Name these. (3)

A

1) Increased sympathetic nervous
system activity
2) Increased RAAS activity
3) Internal transfusion

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10
Q

Effect of increased Sympathetic NS Activity (4)

A
  • Vasodilation of cerebral/coronary vessels
    [Adr on β2]
  • Increase HR [NA on β1]
  • Increase contractility [NA on β1]
  • Venoconstriction [NA on ɑ1]
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11
Q

Effect of increased RAAS Activity (2)

A
  • Decrease in BP causes renin release
  • Renin –> angiotensin I –> angiotensin II
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12
Q

How does Angiotensin II release increase
MABP? (5)

A
  • Increasing sympathetic activity further by
    causing NA release (↑CO /TPR)
  • Arteries –> vasoconstricton (↑TPR)
  • Kidney –> Na+ reabsorption
  • Adrenal gland –> aldosterone release –>
    Na+ reabsorption
  • Brain –> ADH release
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13
Q

Effect of Internal Transfusion (2)

A
  • Reduced circulating reduces the
    hydrostatic pressure of capillaries
  • Resulting in a net movement of fluid into
    capillaries
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14
Q

What is Decompensated Shock?

A
  • The compensatory mechanisms help a
    shocked individual maintain a reasonable
    blood pressure and tissue perfusion
  • However as shock worsens, these
    mechanisms become insufficient and
    perfusion of vital organs is no longer
    maintained
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15
Q

Prolonged peripheral vasoconstriction results in..? (7)

A
  • Impaired tissue perfusion
  • Tissue hypoxia
  • Release of metabolic vasodilators
  • Fall in TPR
  • Further fall in mean arterial BP
  • Vital organs no longer being perfused
  • Multi-system failure
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16
Q

ABCDE Acronym

A

A: Airway
B: Breathing
C: Circulation
D: Disability (level of consciousness)
E: Environment

17
Q

What is Mechanical Shock caused by?

A

Caused by a fall in filling of the ventricles

18
Q

Why might there be a fall in filling of the ventricles?

A
  • This may be from restriction to filling e.g.
    cardiac tamponade
  • May be from obstruction to filling e.g.
    pulmonary embolism, tension
    pneumothorax
19
Q

What is Cardiac Tamponade?

A

It is a medical or traumatic emergency that happens when enough fluid accumulates in the pericardial sac compressing the heart and leading to a decrease in cardiac output and shock

20
Q

Signs and Symptoms of Shock (8)

A
  • SOB
  • Pleuritic Chest Pain
  • Haemoptysis
  • Raised JVP
  • Tachycardia
  • Hypotension
  • Pale
  • Sweaty
21
Q

Signs and Symptoms of Cardiac Tamponade (4)

A
  • Becks Triad: ↓ BP + ↑ JVP + Muffled
    heart sounds
  • Tachycardia
  • SOB
  • Features of compensation
22
Q

How is Cardiac Tamponade Treated?

A
  • Pericardiocentesis
23
Q

What is Cardiogenic Shock caused by?

A

Caused by a fall in contractility so the ventricles are unable to empty properly

24
Q

Why may ventricle contractility decrease? (3)

A
  • MI
  • Acute worsening of heart failure
  • Arrhythmia (loss of coordinated pump
    action)
25
Q

What is Distributive Shock?

A
  • Also known as vasodilatory shock
  • Profound peripheral vasodilation = Decreased TPR
  • Blood volume is the same but the
    capacity of the ‘container’ has increased
26
Q

Why may Distributive Shock occur? (2)

A
  • Septic (Toxic) Shock
  • Anaphylactic Shock
27
Q

What is Septic Shock?

A
  • Bacteria in blood release endotoxins that
    stimulate systemic inflammatory response
  • Vasodilation (fall in TPR)
  • Increased vascular permeability (thus fall
    in intravascular fluid volume -> fall in CO)
  • Thus fall in mean arterial BP
28
Q

Clinical Presentation of Septic Shock (4)

A
  • Tachycardia
  • Hypotension
  • Warm/Red Extremities
  • Fever
29
Q

Treatment of Septic Shock

A

SEPSIS-6

30
Q

What is Anaphylactic Shock caused by?

A
  • Hypersensitive response from the
    immune system to usually harmless
    substances
  • Reaction to allergens results in release of
    histamine from mast cells
31
Q

What is the Effect of Histamine on Blood Vessels

A
  • Histamine is a potential vasodilator
  • Thus fall in TPR and arterial BP
32
Q

Clinical Presentation of Anaphylactic Shock (5)

A
  • Tachycardia
  • Hypotension
  • Warm/Red Extremities
  • Airway Swelling: SOB, stridor
  • Rash
33
Q

Treatment of Anaphylactic Shock (3)

A
  • Adrenaline
  • Hydrocortisone
  • Chlorphenamine
34
Q

What happens to your various organs during Decompensated Shock? (brain, kidneys, skin)

A

1) Brain: altered mental status
2) Kidneys: oliguria (decreased urine output)
3) Skin: cool, blue (mottled) peripheries

35
Q

What is Cardiac Arrest?

A
  • Heart suddenly stops pumping effectively
  • Loss of cardiac output
  • Due to a loss of effective electrical or
    mechanical activity
36
Q

How does Cardiac Arrest present clinically? (3)

A
  • Loss of Consciousness
  • Loss of Pulse
  • Loss of Breathing
37
Q

The 4 H’s & 4 T’s of Cardiac Arrest

A
  • Hypoxia
  • Hypothermia
  • Hypovolaemia
  • Hyper/Hypokalaemia (metabolic)
  • Toxin
  • Tamponade
  • Tension Pneumothorax
  • Thrombosis (pulmonary or coronary)
38
Q

Chain of Survival for Cardiac Arrest (4)

A
  • Early recognition and call for help
  • Early CPR
  • Early Defibrillation
  • Post-resuscitation care

Cardiovascular System (19 decks)

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