Lecture 37 - Shock

Question 1

Shock is characterized by a decrease in ___ delivery to the tissues. As this continues, the tissues essentially “switch” their metabolism to _______ and thus produce lactic acid. How does an acidic environment affect O2’s ability to dissociate from Hb?

Answer 1

Oxygen

Glycolysis

In an acidic environment, O2 dissociates more readily. Should make sense, since the tissues need more O2.

Question 2

How might the appearance of neck veins differ in CHF, PE, or Tamponade VS Hypovolemia?

Answer 2

Distended in CHF, PE, or Tamponade, but flattened in Hypovolemia.

Question 3

Urinary output may _____ (increase or decrease?) in shock patients bc the kidneys are not being perfused adequately.

Answer 3

Decrease

Question 4

In hypovolemic shock, the body will respond by ______ (increasing or decreasing?) vasomotor tone. Similarly, blood flow is redistributed to perfuse vital organs.

Answer 4

Increasing

Question 5

Cardiogenic shock result from a primary _____ failure (increased preload), as opposed to reduced preload seen in Hypovolemic shock. Keep in mind this basically makes it so blood flow through the heart backs up –> leads to pulmonary _____. These patients have typically suffered _____ or are in end-stage heart failure. The body tries to compensate in the same way as during Hypovolemic shock, but increasing myocardial ______ has limited effect.

Answer 5

Pump failure

Pulmonary edema

MI

Contractility

Question 6

Osbtructive shock typically occurs from _____ (intrinsic or extrinsic?) blockage. Think about patients at risk for clots/emboli.

Answer 6

Intrinsic

Question 7

Distributive shock can arise from a neurological disorder that leads to loss of peripheral ______ tone. Think of patients who may have injured what?

Answer 7

Vasomotor tone

Spinal Cord

Question 8

Distributive shock can also arise from ______. In this case, inflammatory mediators cause vasodilation and vascular leakage –> reduces the absolute and effective circulating blood volume –> ______ (increases or decreases?) preload AND afterload.

Answer 8

Sepsis

Decreases

Question 9

Norepinephrine is an ___1 and ____1 adrenergic agonist, and it is the pressor of choice for ____ and _______ shock.

Answer 9

Alpha1 and Beta1

Septic

Hypovolemic

Question 10

Epinephrine is an ___1, ____1, and ____2 adrenergic agonist, and it is the pressor of choice for ______ shock.

Answer 10

Alpha1, Beta1, and Beta2

Anaphylactic

Question 11

Phenylephrine is an ___1 adrenergic agonist, and it is the pressor of choice when ______ is contraindicated.

Answer 11

Alpha1 (remember that this means it ONLY acts on the peripheral vasculature.)

Norepi (i.e. in ventricular tachyarrhythmia)

Question 12

Dopamine is thought to have an advantage of selective vasodilation of _____ and ______ vasculature, but it has more side effects than Norepi in treatment of septic shock.

Answer 12

Renal and Splanchnic

Question 13

_______ is an inotrope with some vasodilation qualities that can be used in Cardiogenic shock.

Answer 13

Milrinone