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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
Q

How can stroke volume be increased?

A

Increased Blood volume

Decreased Vascular resistance

26
Q

What is the basic principle behind the frank starling curve?

A

The greater the End Diastolic Volume the greater the ventricular ejection.

27
Q

End Diastolic Volume

A

Pre Load

How much blood has filled the ventricle by the end of diastole.

28
Q

Why does someone with heart failure often present with signs of pulmonary congestion?

A

Reduction in Inotropy - Reduced stroke volume
Increased EDV to maintain the stroke volume
Backlog into pulmonary vessels

29
Q

Addition of ionotropes does what to the frank starling curve?

A

Curve is shifted up

30
Q

What is the basic principle behind cariogenic shock?

A

Heart does not pump properly.

31
Q

What are the most common causes of cariogenic shock?

A

Acute MI

Also acute valve dysfunction

32
Q

What are some clinical signs of poor forward flow due to cardiogenic shock?

A

Hypotension
Fatigue
Syncope

33
Q

What are some clinical signs of back pressure flow due to cardiogenic shock?

A

Pulmonary oedema
Elevated JVP
Hepatic congestion

34
Q

What drugs are inotropic?

A

Beta agonist

Dopaminergic stimulation

35
Q

Give a list of drugs which are ionotropes?

A 
Dobutamine
Adrenaline
Dopamine
Dopexamine
Milrinone
Levosimendan
36
Q

When is an intra aortic balloon pump used?

A

Cardiogenic shock

37
Q

How does intra aortic balloon pump work?

A

Inflates in diastole
Deflates during during systole
Increases the volume of blood in the heart and reduces after load.

38
Q

What is the basis behind obstructive shock?

A

Something in the way a physical obstruction of the heart and great vessels.

39
Q

List three causes of obstructive shock.

A

PE
Cardiac tamponade
Tension Pneumothorax

40
Q

How is a PE treated?

A

Antiocoagulation +/- thrombosis

41
Q

How is cardiac tamponade treated?

A

Pericardial drainage

42
Q

How is tension pneumothorax treated?

A

Decompression and chest drainage

43
Q

What is the basic principle behind distributive shock?

A

The system is too big.

44
Q

List the three common causes of distributive shock?

A

Septic
Anaphylactic
Neurogenic

45
Q

What is the cause is septic shock?

A

Bacterial endotoxin

46
Q

What is the cause of Anaphylactic shock?

A

Mast cell degranulation

47
Q

What is the cause of neurogenic shock?

A

Thoracic sympathetic innovation is lost

48
Q

If an increase in lactate levels are detected what can this indicate?

A

Hypo-perfusion before hypotension occurs in septic shock.

49
Q

List two key dictators of survival in septic shock

A

Every hour delay in abx increases mortality by 7.5%

Early Vasopressor increases perfusion and minimises excessive fluid volume.

50
Q

Why does uncontrolled histamine release result in shock?

A

Histamine causes vasodilation and increased outward net filtration.
Net result is blood volume is decreased.

51
Q

What is the first line drug used to treat acute anaphylactic shock?

A

Adrenaline - Vasoconstrictor and mast cell stabiliser

52
Q

What biochemical is used to confirm diagnosis of anaphylactic shock?

A

Serum tryptase

53
Q

What is a common cause of neuronal shock?

A

Spinal chord trauma

54
Q

Why does hypotension follow spinal chord trauma?

A

Inappropriate vagal tone as unopposed parasympathetic output.
Loss of sympathetic tone within blood vessels.

55
Q

What is the mainstay of treatment for neuronal shock?

A

Dopamin

Vasopressers

CLASP - Sudden Death (3 decks)

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