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Critical Care > Shock > Flashcards

Shock Flashcards

1
Q

shock is circulatory failure causing inadequate ______ delivery to cells.

A

oxygen

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2
Q

What is the quick and dirty beside evaluation for shock? (think: CHAOS)

A
  • Cardiogenic
  • Hypovolemic
  • Adrenal (distributive)
  • Obstructive
  • Septic (distributive)
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3
Q

Which of the following subdivisions of shock DOES NOT lead to reduced cardiac output?

a. hypovolemic
b. obstructive
c. cardiogenic
d. distributive

A

d. distributive

* distributive leads to low peripheral resistance*

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4
Q

What defines preload?

a. Load imposed on resting muscle that stretches the muscle to a new length
b. Velocity of muscle contraction when muscle load is fixed
c. Load which muscle must act against during contraction

A

a. Load imposed on resting muscle that stretches the muscle to a new length

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5
Q

What defines afterload?

a. Load imposed on resting muscle that stretches the muscle to a new length
b. Velocity of muscle contraction when muscle load is fixed
c. Load which muscle must act against during contraction

A

c. Load which muscle must act against during contraction

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6
Q

What defines contractility?

a. Load imposed on resting muscle that stretches the muscle to a new length
b. Velocity of muscle contraction when muscle load is fixed
c. Load which muscle must act against during contraction

A

b. Velocity of muscle contraction when muscle load is fixed

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7
Q

What are the 3 stroke volume determinants?

A
  • preload
  • contractility
  • afterload
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8
Q

Contractility is the ______ ability for your heart to squeeze.

A

intrinsic

regardless of what the preload is

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9
Q

Delivery of oxygen (DO2) is related to what 2 factors?

A

CaO2 (arterial oxygen content) x Q (perfusion)

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10
Q

Normal arterial oxygen content (CaO2) is equal to _______ mL O2/dL.

A

20 mL O2/dL

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11
Q

Oxygen consumption (VO2) is equal to what?

A

VO2 = SaO2 (arterial) - SvO2 (venous)

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12
Q

What 3 factors determine your arterial oxygen content?

A
  • hemoglobin
  • SaO2 (arterial oxygen saturation)
  • PaO2 (arterial oxygen tension)
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13
Q

What are 3 common etiologies of hypovolemic shock?

A
  • hemorrhage
  • third spacing (e.g. burns, pancreatitis)
  • dehydration
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14
Q

What are 3 common causes of obstructive shock?

A
  • cardiac tamponade
  • PE
  • tension pneumothorax
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15
Q

What are the 4 common causes of distributive shock?

A
  • septic shock
  • adrenal insufficiency
  • neurogenic shock
  • anaphylaxis
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16
Q

What is the mechanism of hypovolemic shock?

a. reduced ability of the heart to pump blood forward
b. reduced venous return leading to reduced preload and reduced C.O.
c. mechanical obstruction to normal venous return C.O.
d. dilatation of vasculature

A

b. reduced venous return leading to reduced preload and reduced C.O.

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17
Q

What is the mechanism of distributive shock?

a. reduced ability of the heart to pump blood forward
b. reduced venous return leading to reduced preload and reduced C.O.
c. mechanical obstruction to normal venous return C.O.
d. dilatation of vasculature

A

d. dilatation of vasculature

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18
Q

What is the mechanism of cardiogenic shock?

a. reduced ability of the heart to pump blood forward
b. reduced venous return leading to reduced preload and reduced C.O.
c. mechanical obstruction to normal venous return C.O.
d. dilatation of vasculature

A

a. reduced ability of the heart to pump blood forward

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19
Q

What is the mechanism of obstructive shock?

a. reduced ability of the heart to pump blood forward
b. reduced venous return leading to reduced preload and reduced C.O.
c. mechanical obstruction to normal venous return C.O.
d. dilatation of vasculature

A

c. mechanical obstruction to normal venous return C.O.

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20
Q

What is the first sign of critical illness?

A

tachypnea

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21
Q

What is the first sign of shock?

A

oliguria (low urine output)

22
Q

What 2 labs do you want to get for shock?

A
  • lactate

- SVO2/ScVO2 (venous oxygenation)

23
Q

If O2 delivery is impaired tissues compensate by ___________.

A

increasing extraction

24
Q

If O2 delivery is impaired tissues compensate by increasing extraction. This results in what?

A

reduced venous saturation returning to the right heart

25
Q

A “mixed” venous saturation (SVO2) is sampled from where?

A

distal to RV = pulmonary artery

26
Q

A central venous saturation (ScVO2) is sampled from where?

A

cavoatrial junction

27
Q

What is the relationship between SVO2 and ScVO2?

A
  • ScVO2 is 5-10% lower than SVO2

* however, serial values track same as SVO2*

28
Q
  • What is “normal” SVO2?
  • What does a low SVO2 <60% indicate?

What does a high SVO2 >80% indicate?

A
  • normal: 60-80%
  • low: O2 supply insufficient for demand
  • high: adequate supply, but tissue unable to extract O2 (e.g. cyanide toxicity causing mitochondrial dysfunction)
  • lactate will be elevated in low or high SVO2
29
Q

What device do you need to measure a SVO2?

A

pulmonary catheter

30
Q

What device do you need to measure a ScVO2?

A

centra line

31
Q

What may be the only clinical signs of preshock?

A
  • increase in HR

- small decrease in BP

32
Q

What causes a metabolic acidosis in shock?

A

elevated lactate

33
Q

What changes in preload, CO, and SVR do you see in hypovolemic shock?

A
  • decrease preload
  • decrease CO
  • increase SVR
34
Q

What changes in preload, CO, and SVR do you see in cardiogenic shock?

A
  • increase preload
  • decrease CO
  • increase SVR
35
Q

What changes in preload, CO, and SVR do you see in obstructive shock?

A
  • increase or decrease preload
  • big decrease in CO
  • increase SVR
36
Q

What changes in preload, CO, and SVR do you see in distributive shock?

A
  • decrease in preload
  • increase/decrease in CO
  • DECREASE SVR

only subtype of shock that decreases SVR = distributive

37
Q

What are the 3 stages of shock?

A
  • “warm shock” = pre-shock
  • shock
  • end-organ dysfunction
38
Q

What is the main treatment for shock?

A

treat underlying cause

39
Q

What is the first line treatment for volume resuscitation?

A
  • isotonic crystalloids (normal saline, LR)
40
Q

What type of gauge needle do you want to use for a peripheral IV in a patient with shock?

A

short + fat

41
Q

What is a safe way to administer vasopressors?

A

central venous catheter

42
Q

Stimulating A1 receptors result in what?

A

vasoconstriction

43
Q

Stimulating A2 receptors results in what?

A

vasodilatation

44
Q

Stimulating B1 receptors results in what 2 things?

A

increase in inotropy and chronotropy

45
Q

Stimulating B2 receptors results in what?

A

smooth muscle relaxation

46
Q

Stimulating dopaminergic receptors (DA1/DA2) results in what?

A

varying effects based on dose

47
Q

What is the main adverse effect of vasopressors?

A

distal ischemia

48
Q

Phenylephrine has what receptor activity?

A

alpha-1 = causes vasoconstriction

49
Q

Norepinephrine has what receptor activity? (2)

A
  • strong alpha-1 = vasoconstriction

- modest Beta-1 = increase CO

50
Q

Epinephrine has what receptor activity? (3)

A
  • strong alpha-1 = vasoconstriction
  • strong beta-1
  • modest beta-2
51
Q

Dobutamine has what receptor activity?

A
  • strong beta-1 and beta 2 activity
52
Q

Isoproterenol has what receptor activity?

A
  • strong beta-1 and beta-2 activity

Critical Care (8 decks)

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