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CLASP - Sudden Death > Physiology of Shock > Flashcards

Physiology of Shock Flashcards

1
Q

What are the 5 main types of shock.

A 
Hypovolaemic
Cytotoxic
Cardiogenic
Obstructive
Distributive
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2
Q

What is the basis behind Hypovolaemic Shock?

A

There isn’t enough circulating volume to meet metabollic demands.

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3
Q

Why does a reduction in circulating volume result in shock?

A

Reduced cardiac output and preload

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4
Q

How is hypovolaemic shock usually brought about?

A

Loss of blood interstitial flood or rarely pure water

Bleeding Sweating Vomiting

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5
Q

What are some of the best ways to monitor and grade someones hypovolaemic shock?

A

Measure there BP and Urinary output

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6
Q

How are young people affected by hypovolaemic shock?

A

Young people compensate really well up to certain level at which they rapidly degenerate.

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7
Q

List 4 compensatory mechanisms in action during hypovolaemic shock?

A

Baroreceptors
Sympathetic Neurohormonal
Capillary Absorption
Hypothalmo-pituitary-adrenal responce

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8
Q

How do Baroreceptors work to restore Cardiac Output in hypovolaemic shock?

A

Afferent impulses sent to CV complex in medulla are reduced.
Reduction in parasympathetic (Vagus)
Increase in Sympathetic

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9
Q

Where are the two main groups of Baroreceptors located and to which nerves are they linked?

A

Carotid Sinus CNIX Glossopharyngeal

Aortic Arch CNX Vagus

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10
Q

What is Chronotropy?

A

Heart Rate

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11
Q

What is Ionotropy?

A

Force of Contraction

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12
Q

What are Chronotropy and Ionotropy controlled by?

A

Sympathetic nerves

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13
Q

What hormones are released as a result of increased sympathetic activity in response to fluid loss?

A

Adrenaline
Angiotensin
Norad
Vasopressin

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14
Q

What is the function of the vasoconstriction in regards to fluid loss?

A

Reducing fluid levels in peripheral tissues.

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15
Q

What other process helps drive the response in hypovolaemic shock?

A

Lactic Acidosis - Enhances response

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16
Q

How does Capillary Absorption help negate hypovolaemic shock?

A

Reduced Capillary Hydrostatic pressure
Increased Inwards net filtration
Increased Volume of blood

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17
Q

Where is Renin released from?

A

JGA

Juxto Glomerular Apparatus

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18
Q

What detects reduced Blood pressure with the kidney s?

A

Intrarenal baroreceptors

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19
Q

What is the function of Renin?

A

Converts Angiotensin to Angiotensin I

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20
Q

What converts Aniotensin I to II?

A

ACE

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21
Q

What are the two functions of ACE?

A

Vasoconstriction

Release of Aldosterone from Adrenal glands

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22
Q

What does Aldosterone do?

A

Increased Reabsorption of Na+ and water in the kidneys.

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23
Q

Activation of Renin Angiotensin system in hypovolaemic shock does what?

A

Increased blood volume - Aldosterone

Increased SV - Increased Vascular resistance in peripheral tissues

24
Q

What two things dictate Cardiac Output?

A

Heart Rate

Stroke Volume

25
How can stroke volume be increased?
Increased Blood volume | Decreased Vascular resistance
26
What is the basic principle behind the frank starling curve?
The greater the End Diastolic Volume the greater the ventricular ejection.
27
End Diastolic Volume
Pre Load | How much blood has filled the ventricle by the end of diastole.
28
Why does someone with heart failure often present with signs of pulmonary congestion?
Reduction in Inotropy - Reduced stroke volume Increased EDV to maintain the stroke volume Backlog into pulmonary vessels
29
Addition of ionotropes does what to the frank starling curve?
Curve is shifted up
30
What is the basic principle behind cariogenic shock?
Heart does not pump properly.
31
What are the most common causes of cariogenic shock?
Acute MI | Also acute valve dysfunction
32
What are some clinical signs of poor forward flow due to cardiogenic shock?
Hypotension Fatigue Syncope
33
What are some clinical signs of back pressure flow due to cardiogenic shock?
Pulmonary oedema Elevated JVP Hepatic congestion
34
What drugs are inotropic?
Beta agonist | Dopaminergic stimulation
35
Give a list of drugs which are ionotropes?
``` Dobutamine Adrenaline Dopamine Dopexamine Milrinone Levosimendan ```
36
When is an intra aortic balloon pump used?
Cardiogenic shock
37
How does intra aortic balloon pump work?
Inflates in diastole Deflates during during systole Increases the volume of blood in the heart and reduces after load.
38
What is the basis behind obstructive shock?
Something in the way a physical obstruction of the heart and great vessels.
39
List three causes of obstructive shock.
PE Cardiac tamponade Tension Pneumothorax
40
How is a PE treated?
Antiocoagulation +/- thrombosis
41
How is cardiac tamponade treated?
Pericardial drainage
42
How is tension pneumothorax treated?
Decompression and chest drainage
43
What is the basic principle behind distributive shock?
The system is too big.
44
List the three common causes of distributive shock?
Septic Anaphylactic Neurogenic
45
What is the cause is septic shock?
Bacterial endotoxin
46
What is the cause of Anaphylactic shock?
Mast cell degranulation
47
What is the cause of neurogenic shock?
Thoracic sympathetic innovation is lost
48
If an increase in lactate levels are detected what can this indicate?
Hypo-perfusion before hypotension occurs in septic shock.
49
List two key dictators of survival in septic shock
Every hour delay in abx increases mortality by 7.5% | Early Vasopressor increases perfusion and minimises excessive fluid volume.
50
Why does uncontrolled histamine release result in shock?
Histamine causes vasodilation and increased outward net filtration. Net result is blood volume is decreased.
51
What is the first line drug used to treat acute anaphylactic shock?
Adrenaline - Vasoconstrictor and mast cell stabiliser
52
What biochemical is used to confirm diagnosis of anaphylactic shock?
Serum tryptase
53
What is a common cause of neuronal shock?
Spinal chord trauma
54
Why does hypotension follow spinal chord trauma?
Inappropriate vagal tone as unopposed parasympathetic output. Loss of sympathetic tone within blood vessels.
55
What is the mainstay of treatment for neuronal shock?
Dopamin | Vasopressers

CLASP - Sudden Death (3 decks)

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