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Physiology I > SCT III - Circulatory Shock > Flashcards

SCT III - Circulatory Shock Flashcards

1
Q

What is circulatory shock?

A

A medical emergency that results in inadequate oxygen perfusion and tissue oxygenation

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2
Q

What are the factors influencing tissue perfusion (flow)?

A

Flow (Q) = Pressure (P) x Resistance (R)

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3
Q

What are the four types of circulatory shock?

A
  • Hypovolemic
  • Cardiogenic
  • Obstructive
  • Distributive
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4
Q

What is hypovolemic shock?

A

Severe fluid/blood loss leads to inadequate blood volume, causing insufficient oxygen delivery to tissues

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5
Q

What could cause hypovolemic shock?

A
  • Hemorrhage
  • Dehydration (vomiting, diarrhea, extreme sweating, burns)
  • Trauma (contusion: ruptured blood vessels, bruise)
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6
Q

What is cardiogenic shock?

A

Heart fails to pump blood effectively, leading to insufficient oxygen delivery to tissues

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7
Q

What could cause cardiogenic shock?

A
  • Decreased pump function (ischemia, cardiomyopathy)
  • Valve diseases (obstructive, regurgitant)
  • Dysrhythmia (Arrythmia)
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8
Q

What is obstructive shock?

A

Factors extrinsic to myocardium & cardiac valves lead to insufficient oxygen delivery to tissues (i.e. blood clot stops a muscle from getting blood/nutrients)

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9
Q

What may cause obstructive shock?

A
  • Decreased Venous Return:
    1. Pericardial tamponade
    2. Venacava obstruction
    3. Pneumothorax
    4. Pulmonary embolism
    5. Coarctation of aorta
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10
Q

What is distributive shock? What are the types of distributive shock?

A

Abnormal blood distribution/blood vessel dilation leads to inadequate perfusion to other tissue (despite normal blood volume)

3 types:
- Neurogenic
- Anaphylactic
- Septic

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11
Q

What is neurogenic shock?

A

Subtype of distributive shock: damage to spinal cord/nervous system leads to loss of sympathetic tone (widespread Vasodilation)
- Spinal transection
- Brain damage
- Fever

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12
Q

What is anaphylactic shock?

A

Subtype of distributive shock: allergic reaction which releases lots of histamine that causes widespread vasodilation and increased capillary permeability

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13
Q

What is septic shock?

A

Subtype of distributive shock: caused by a severe infection, leading to lots of inflammation, vasodilation, low blood pressure, and impaired blood flow (perfusion) to organs

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14
Q

What are the three stages of shock?

A
  1. Non-progressive (Compensated)
  2. Progressive (Decompensated)
  3. Irreversible
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15
Q

What is meant by compensatory and decompensatory stages?

A

Compensatory means the body attempts to compensate to the damage

Decompensatory means that the body failed at its attempt

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16
Q

What are the cellular effects of inadequate tissue perfusion?

A
  • ATP Depletion
  • Na+/K+ ATPase slowes
  • Intracellular Na+ accumulation
  • Intracellular Calcium accumulation
  • Cell swelling
  • Mitochondrial swelling
  • Endoplasmic reticulum swelling

Decrease in intracellular pH
- Accumulation of lactic acid
- Accumulation of inorganic phosphates
- Accumulation of ROS

APOPTOSIS

17
Q

What happens during the first stage of circulatory shock?

A

Non-progressive - Compensatory
Normal circulatory compensatory mechanisms eventually cause full recovery without the need of outside therapy

18
Q

What are the symptoms of first stage circulatory shock?

A

Non-progressive - Compensatory
- Depends on amount of blood-loss
- Pale, cold, sweaty skin
- Rapid breathing
- Tachycardia (weak pulse)
- Maintained blood pressure
- Mild anxiety, restlessness, irritability

19
Q

What is the key response of the body to the first stage of circulatory shock?

A

Non-progressive - Compensatory
- Negative feedback: which brings CO and MAP back to normal level

20
Q

What takes place during the activation of negative feedback in the compensation of first stage circulatory shock?

A

Seconds
- Baroreceptor reflex
- Chemoreceptor reflex
- CNS ischaemic reflex (cushing’s)

Minutes/Hours
- Cardiopulmonary baroreceptor reflex
- RAAS
- ADH/Vasopressin
- ANF

21
Q

Baroreceptor Reflex

A
22
Q

Chemoreceptor Reflex

A
23
Q

What is the MAP difference between the skull and the heart in an orthostatic position?

A

10-15 mmHg less than the level of the heart

24
Q

CNS Ischemic Response (Cushing’s)

A
25
Q

Cardiopulmonary Baroreceptor Reflex

A
26
Q

Long Term Regulatory Factors Summary

A
27
Q

Role of SNS in Negative feedback

A
28
Q

What are the neuroendocrine responses during circulatory shock?>

A

Corticotropin Releasing Hormone ↑
- Adenocroticotropin Hormone (ACTH) ↑
- Which Cortisol from Adrenal Cortex ↑

Adrenal Medulla
- Adrenaline & Noradrenalin ↑

Pancreas
- Glucagon ↑
- Insulin ↓

Pituitary gland
- ADH/Vasopressin ↑

29
Q

What are the symptoms of second stage circulatory shock?

A

Progressive - Decompensated
- Pale, cold, sweaty skin
- Marked tachycardia
- Low blood pressure
- Empty neck veins
- Altered mental status (confusion, anxiety, etc.)
- Thirst
- Oliguria (low urine output)
- Hyperventilation
- Lactic acid ↑ (Acidosis)

30
Q

What cycle could occur in second stage circulatory shock?

A

Progressive - Decompensated
- Without therapy = death
- Vicious positive feedback cycles are developed (decreasing CO & MAP)
- Blood supplies only most important organs

31
Q

What happens to the cardiac pump function during progressive circulatory shock?

A

Deteriorates

32
Q

What happens to tissue and blood during second stage circulatory shock?

A

Tissue
- Heart: CO ↓
- Kidney: Uremia (Declining renal function)
- CNS: Vasomotor failure
- Acidosis
- ATP ↓

Blood
- Thrombosis ↑
- Endothelial collapse

33
Q

What happens during the third stage circulatory shock?

A

Irreversible Stage
Shock has progressed to such an extent that all forms of known therapy are inadequate to save the person’s life.

34
Q

What are the symptoms of third stage circulatory shock?

A

Irreversible Stage
- Cold, sweaty, extremely pale skin
- Extreme tachycardia (>140) w/ barely palpable pulse
- Reduced blood pressure
- Confusion, unconsciousness
- Anuria (Absence of urine prod.)

35
Q

What happens during third stage circulatory shock?

A

Irreversible Stage
- Endothelial dysfunction
- Inflammation
- Advanced disseminated intravascular coagulation (DIC)
- Therapy resistant cardiac depression (falling systolic and diastolic pressure)
- Marked capillary dilation, increased permeability
- Stagnation of blood in the extremities

Physiology I (16 decks)

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