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Critical Care > Shock > Flashcards

Shock Flashcards

1
Q

Definition of shock

A

Inadequate tissue perfusion leading to cellular hypoxia of peripheral tissues with possible progression to end organs

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2
Q

Types of shock

A

Cardiogenic
Hypovolemic
Distributive
Obstructive

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3
Q

Definition of cardiogenic shock

A

inadequate tissue perforation due to myocardial dysfunction (pump failure)

PAWP > 16mmHg
SBP <90mmHg
CI < 2.2 L/min/m2

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4
Q

Definition of anaphylactic shock

A

Type 1 IgE mediated hypersensitivity reaction

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5
Q

Management of anaphylactic shock

A

Secure airway
Remove antigen
Fluid resuscitation
Adrenaline 0.5mg 1:1000 IM or 50 mcg IV
Chlorpheniramine 10mg IV
Hydrocortisone 200mg IV
Consult ICU

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6
Q

Main types of inotropes

A
  • Catecholamines
  • Phosphodiesterase inhibitors
  • Cardiac glycosides
  • Endogenous peptides
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7
Q

Clinical features of cardiogenic shock

A

Cool peripheries
Decrease urine output
Decrease consciousness
Increase JVP
Volume overload
Hepatomegaly

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8
Q

What is the mechanism of action for catecholamines?

A

Affinity for different subclasses of adrenergic receptors

  • alpha : vasoconstriction
  • beta 1: myocardial contractility
  • beta 2: increase HR (and vasodilation)
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9
Q

What is the mechanism of action for phosphodiesterase inhibitors? Examples

A
  • inotropic
  • vasodilator

Milrinone, Amrinone

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10
Q

What is the mechanism of action of cardiac glycosides?

A

Inhibit Na+/K+ ATPase in cell memebrane

Inotropic

Ex. Digoxin

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11
Q

What receptors does noradrenaline act on?

A

Alpha > Beta: alpha 1 +++, beta 1 +

Use: septic shock

SE: tachycardia/reflex bradycardia, limb/GI ischemia

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12
Q

What receptors does adrenaline act on?

A

Beta > Alpha: αlpha 1 ++, β1 +++, β2 ++

Use: cardiac arrest, low CO state

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13
Q

What receptors the phenylephrine act on?

A

Alpha 1

Pure vasoconstrictor

Used if arrhythmia is a problem

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14
Q

What receptors does dopamine act on?

A

Mainly dopaminergic (DA1 +++)

B1 and B2 +

Alpha 1+

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15
Q

What receptors does vasopressin act on?

A

V1R on vascular smooth muscles: vasoconstriction

V2R: renal + endothelium vasodilation

V3R: pituitary

Use: to increase SVR in septic shock

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16
Q

What receptors does dobutamine work on?

A

Beta 1 and 2

Use: low CO state, cardiac surgery

17
Q

Examples of inotropes

A

Adrenaline

Dobutamine

Isoprenaline

Ephedrine

18
Q

Examples of vasopressors

A

Noradrenaline

Vasopressin

19
Q

Examples of inodilators

A

Milrinone

Levosimendan

20
Q

Clinical manifestation of hypovolemic shock

A
  • Decrease BP
  • Tachycardia
  • Peripheral vasoconstriction
  • Low JVP
21
Q

Clinical manifestations of septic shock

A
  • Decrease BP
  • Tachycardia
  • Peripheral vasodilation
  • Low JVP
  • Peripheral / pulmonary edema
22
Q

Clinical manifestations of neurogenic shock

A
  • Decrease BP, no tachycardia
  • Cutaneous vasodilation
  • Narrow pulse pressure
23
Q

Clinical manifestations of anaphylactic shock

A
  • Decrease BP
  • Tachycardia
  • Edema
24
Q

Class 1 anti-arrhythmic drug

A

Sodium channel blockers

1a: moderate NA block with prolonged repolarisation ex procainamide
1b: midl NA block with shortened repolarisation ex. lidocaine, phenytoin
1c: marked Na block with no change in repolarisation. ex Flecainide

25
Q

Class 2 anti-arrhythmic drugs

A

Beta blockers

Ex. Propranolol, Metoprolol

26
Q

Class 3 anti-arrhythmic drugs

A

Potassium channel blockers

ex. Amiodarone, Sotalol

27
Q

Class 4 anti-arrhythmic drugs

A

Calcium channel blockers

Ex. Diltiazem, Verapamil

28
Q

What are inodilators

A

Increase myocardial contraction and systemic vasodilation

29
Q

What are components of a invasive monitoring system?

A
  • Intravascular catheter
  • Continuous column of fluid
  • Transducer (strain gauge connected to distensible diaphragm)
  • Amplifier
  • Display
30
Q

How do you monitor cardiac output non-invasively?

A
  • Analysis of arterial pressure waveform
  • Oesophageal Doppler monitor
  • Thoracic impedance techniques

Critical Care (12 decks)

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