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CCT > Sepsis/shock > Flashcards

Sepsis/shock Flashcards

1
Q

Three parts of cellular respiration

A

glycolysis,the citric acid cycle, and election transport chain

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2
Q

Mircrocirculation

A

the nexus between the arterioles and venules consisting of the capillaries the course between cells of the various orgons

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3
Q

% of oxygen bound, locations

A

97% hemoglobin

3%plasma

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4
Q

Oxygen carrying capacity formula

A

HgB 1.39= oxygen carrying capacity

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5
Q

Cao2 formula

A

Arterial oxygen content(Cao2) =(HgBx1.39xSao2)+(0.0031xPao2)

Normal value= 17-20 mL/100 mL aterial blood

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6
Q

DO2

A

Oxygen delivery
Combines arterial oxygen content with cardiac output
DO2=COxCao2

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7
Q

VO2

A

Oxygen consumption
VO2= COxHgbx13.9x(Sao2-Svo2)
Normal value 180-280 mL/min

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8
Q

ERo2

A

Oxygen extraction ratio
Vo2/Do2
Normal Value 25%

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9
Q

Factors that affect transport of blood

A

blood volume,viscosity, and arterial elasticity

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10
Q

Systolic blood pressure relies on

A

Cardiac output(the force and volume of bloodejected from the ventricles during systole

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11
Q

Cardiac output is dependent on

A

Heart rate and the components of stroke volume ( preload,afterload, and contractility

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12
Q

Diastolic blood presszure depends on

A

peripheral resistance, which is determined by ateriolar vasoconstriction

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13
Q

2,3 DPG

A

2,3 biphosphglycerate

a chemical that bings to deoxygenated Hgb which helps red blood cells relase oxygen

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14
Q

4 stages of shock

A

1,Initial (early shock)
2.Compensatory
3, decompnsatory or progressive
4. irreversible or refractory

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15
Q

Neural Compensation

A

Decreased cardiac output—-> Decreased blood pressure—->Sympathetic nervous system activation—->
Blood vessels (constriction of Integumentary system, renal system, and GI tract)
Skeletal muscle dilation,
coronary arteries dilation,
sweat glands diphoresis
heart increased rate
lungs increased rate and depth of respiration
pupils dilation

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16
Q

Hormonal compensation

A

Kidney
Decreased renal blood flow—->renin production—> release of aldosterone—-> sodium and water retention

Hypothalamus

  1. Posterior pituitary—-> release of ADH—-> sodium and water retention
  2. Anterior pituitary—-> release ofadrencorticotropic hormone—-> relase of cortisol—–> hyperglycemia
  3. Adrenal medulla—-> release of epi and norepi
17
Q

Chemical compensation

A

Decreased cardiac output—-> decreased blood flow to lungs—–> increased physiologic dead space—->decreased arterial Pao2—->stimulates chemoreceptors—-> increased rate and depth of respirations/ increased PaCO2, increased sympathetic response—->Respiratory alkalosis—-> cerebral vasoconstriction—> cerebral ischemia—-> decreasedlevel of consciousness

18
Q

Compensatory mechanisms are divided into

A

neural, hormonal, and chemical mechanisms

19
Q

Capillary pressure is dependent on

A

adequate MAP

20
Q

Marked change in hydrostatic pressure in microcirculation during progressive shock leads to

A

blood pooling due to increased hydrostatic pressure, and edema and third spacing (mottled skin)

21
Q

CVP is a direct measure of

A

Right atrial pressure and an indirect measure of preload of the right ventricle

22
Q

PCWP reflects

A

Left atrial pressure

23
Q

Primary MODS

A

Results from direct insult such as trauma

24
Q

Secondary MODS

A

is the more common cause of organ failure and is slower, more progressive insult to organs
Frequently results from the sepsis cascade

25
Q

Mortality rates with MODS

A

2 failing organs are 22 to 33% chance of recovery

4 or more organs the mortality rate is nearly 100%

26
Q

Renal failure increases the risk of death by what percent

A

30%

27
Q

Classifications of shock

A

Cardiogenic, hypovolemic, and distributive

28
Q

Cardiogenic shock

A

failure of the heart to pump blooc effectively
A sustained systolic blood pressure of 80 to 90 mmhg for greater then 30 min
A MAP of 30 mmhg below baseline or less then 65 mmhg over time
a severe reduction in cardiac index(18mmhg or right ventricular fillingpressure of >10 to 15 mmhg

29
Q

5 major determinants of myocardial oxygen consumption

A

contractility,preload,wall tension,afterload,and heart rate

30
Q

Primary management of cardiogenic shock is focused on

A

enhancing CO while decreasing left ventricular workload

31
Q

Findings ins Left ventricular heart failure

A 
Heart rate: Increased
Blood pressure:WNL initial, decreased with severity
Pulse pressure:narrow
CVP:WNL
PCWP:increased
CO/CI:decreased
SVR:increased
Svo2:decreased
Urinary output:decreased
JVD:absent
Heart sounds:S3
Edema:pulmonary
32
Q

Findings in right ventricular heart failure

A 
Heart rate: Increased
Blood pressure:WNL initial, decreased with severity
Pulse pressure:narrow
CVP: Increased
PCWP:decreased
CO/CI:decreased
SVR:increased
Svo2:decreased
Urinary output:decreased
JVD:present
Heart sounds:normal
Edema:Peripheral
33
Q

Findings in Biventricular Heart Failure

A 
Heart rate: Increased or decreased
Blood pressure:Decreased
Pulse pressure:narrow
CVP: Increased
PCWP:Increased
CO/CI:decreased
SVR:increased
Svo2:decreased
Urinary output:decreased
JVD:present
Heart sounds:S3 or S4
Edema:systemic
34
Q

Findings in hypovolemic shock

A 
Heart rate: Increased
Blood pressure:WNL initial, decreased with severity
Pulse pressure:narrow
CVP: decreased
PCWP:decreased
CO/CI:decreased
SVR:increased
Svo2:decreased
Urinary output:decreased
JVD:flat
Hct:Decreased with hemmorage/ increased with dehydration
35
Q

Class I hemmorage 70 kg male

A 
blood loss(ml):30
Fluid replacement:crystalloid
36
Q

Class II hemmorage 70 kg male

A 
blood loss(ml):750-1500
%blood loss:15-30
HR:.>100
blood pressure:Normal
pulse pressure:Narrow
Cap Refill:delayed
RR:20-30
CNS:mildly anxious
Skin:cool,pale
Urine output:20-30
Fluid replacement:crystalloid
37
Q

Class III Hemmorage 70 kg male

A 
blood loss(ml):1500-2,000
%blood loss:30-40
HR:>120
blood pressure:Low
pulse pressure:Narrow
Cap Refill:delayed
RR:30-40
CNS:anxious and confused
Skin:cold,pale, moist
Urine output:5-15
Fluid replacement:crystalloid and blood
38
Q

Class IV hemmorage

A 
blood loss(ml):>2000
%blood loss:>40
HR:>140
blood pressure:low
pulse pressure:very narrow
Cap Refill:absent
RR:>35
CNS:confused and lethargic
Skin:cold,cyanotic
Urine output:minimalor none
Fluid replacement:crystalloid and blood

CCT (10 decks)

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