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Surgery M4 part 1 > Shock > Flashcards

Shock Flashcards

1
Q

What is shock?

A

inadequate tissue perfusion resulting in decreased oxygen delivery & oxygen consumption leading to cell death

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2
Q

What is the pathophysiology of shock?

A

1) inadequate perfusion
2) cell hypoxia

3) lactic acid accumulation & fall in pH -> anaerobic
metabolism
4) metabolic acidosis

5) cell membrane dysfunction & failure of sodium pump

6) intracellular lysosomes release digestive enzymes ->
efflux of potassium & influx of sodium & water

7) toxic substance enter circulation
8) capillary endothelium damaged
9) further destruction, dysfunction & cell death

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3
Q

What are the pro-inflammatory mediators of shock?

A
  • IL-1 alpha & beta
  • IL-2
  • IL-6
  • IL-8
  • interferon
  • TNF
  • Platelet activating factor
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4
Q

What are the anti-inflammatory mediators of shock?

A
  • IL-4
  • IL-10
  • IL-13
  • Prostaglandin E2
  • TGF beta
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5
Q

What is the main trigger of shock?

A

loss of blood volume

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6
Q

What are the types of shock?

A
  • hypovolemic (reduced preload)
  • restrictive (obstructive)
  • redistributive (severe peripheral vasodilatation0
  • cardiogenic
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7
Q

What are the causes of hemorrhagic hypovolemic shock?

A

HEMORRHAGIC

  • traumatic vascular injury
  • multiple fractures
  • ruptured abdominal aortic or left ventricle aneurysm
  • gastrointestinal bleeding
  • aortic-enteric fistula or ruptured hematoma
  • hemorrhagic pancreatitis
  • postpartum hemorrhage
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8
Q

What are the non-hemorrhagic causes of hypovolemic shock?

A
  • diarrhea or vomiting
  • burns
  • diabetes (urinating a lot)
  • third space losses into extravascular space or body
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9
Q

What is the normal amount of blood in an average person?

A

80cc per kg

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10
Q

losing <750mL of blood will lead to what stage of hypovolemic shock?

A

Class I

<15%

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11
Q

How much blood is lost in Class II hypovolemic shock?

A 
750-1500mL
15-30%
tachycardia 
BP is orthostatic 
patient is anxious
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12
Q

What are the 3 vital organs?

A

brain
heart
kidney

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13
Q

What’s the normal urine output?

A

1mL-2mL / Kg / hour

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14
Q

How do we know a patient is in class III hypovolemic shock?

A 
patient is confused 
tachycardia
hypotension 
loss of 1500-2000mL of blood
30-40%
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15
Q

What occurs in class IV of hypovolemic shock?

A 
loss of >2000mL of blood
>40%
tachycardia 
severe hypotension 
obtunded patient
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16
Q

What are the causes of obstructive shock?

A

pulmonary vascular (right ventricular failure)

  • hemodynamically significant pulmonary embolism
  • severe pulmonary hypertension
  • severe stenosis of pulmonary or tricuspid valve

mechanical

  • tension pneumothorax
  • pericardial tamponade
  • constrictive pericarditis & restrictive cardiomyopathy
  • abdominal compartment syndrome
17
Q

What is the most common cause of distributive shock?

A

SIRS —> septic shock (infection)

vasodilation

18
Q

What are the causes of distributive (septic) shock?

A
  • burns
  • pancreatitis
  • post-myocardial infarction, cardiac arrest, or coronary bypass
  • viscus perforation
  • fat embolism, idiopathic systemic capillary leak syndrome
19
Q

What are the types of distributive shock?

A
  • SIRS
  • Septic shock
  • Neurogenic shock
  • Anaphylactic shock
20
Q

What occurs in neurogenic shock?

A
  • spinal injury at or above thoracolumbar sympathetic nerve roots leading to interruption of autonomic pathways
  • loss of sympathetic tone to vascular system causing vasodilation
21
Q

What is the cause of anaphylactic shock?

A

severe IgE mediated allergic reactions to insect stings, food, & drugs

22
Q

What are the cardinal signs of anaphylactic shock?

A

bronchospasm & increased airway resistance

hemodynamic collapse

23
Q

What are the types of cardiogenic shock?

A
  • cardiomyopathic
  • arrhythmic
  • mechanical
24
Q

What are the causes of cardiomyopathic shock?

A
  • MI is most common
  • severe right ventricular infarction
  • acute heart failure with severe dilated cardiomyopathy
  • myocardial depression due to advanced septic or
    neurogenic shock
  • myocarditis
25
Q

What is the cause of arrhythmic cardiogenic shock?

A

Atrial & ventricular tachyarrhythmias & bradyarrhytmia may induce hypotension
- when CO is severely compromised by significant rhythm disturbances, cardiogenic shock may develop

26
Q

What are the causes of mechanical cardiogenic shock?

A
  • severe aortic or mitral valve insufficiency
  • acute valvular defects due to rupture of a papillary
  • mitral valve defect or retrograde dissection of ascending aorta into aortic valve ring
  • abscess of aortic ring
  • severe ventricular septal defects
  • acute rupture of intraventricular septum or ventricular free wall aneurysm
27
Q

What is the presentation of ruptured ventricular aneurysm?

A
  • cardiogenic shock
  • obstructive shock
  • hemorrhagic shock
28
Q

What are the manifestations of shock?

A
  • tachycardia
  • tachypnea
  • hypotension
  • oliguria or anuria
  • abnormal mental status
  • cool, clammy, cyanotic skin
  • weak peripheral pulses & prolonged capillary refill
  • narrowing of pulse pressure <25mmHg
29
Q

What is the first step in management of shocked patient?

A

ABC

  • stabilize airway & breathing with oxygen & mechanical ventilation when necessary
  • if patient has respiratory distress or hemodynamic instability -> INTUBATE
  • IV access should be secured to treat with fluids to restore tissue perfusion (14 to 18 gauge catheters or intraosseous)
30
Q

How should tension pneumothorax be managed?

A

Needle decompression using 14 or 16 gauge IV catheter followed by immediate tube thoracostomy

31
Q

How should pericardial tamponade be treated?

A

Pericardiocentesis (should not be attempted in patients with pericardial effusion due to aortic dissection or myocardial rupture)

32
Q

How should MI be treated?

A
  • Administration of anti platelet agents & heparin
  • coronary revascularization procedures (balloon angioplasty)
  • intraaortic balloon pump
33
Q

How should a patient presenting with hemorrhagic shock be treated?

A
  • External hemorrhage controlled with direct pressure

- internal hemorrhage requires further diagnostic tests & surgical interventions

34
Q

How should a patient presenting with anaphylactic shock be managed?

A
  • intramuscular 0.3mg of 1:1000 epinephrine every 5 to 15 minutes as needed
  • anti histamines, nebulized albuterol, & methyprednisolone

Surgery M4 part 1 (47 decks)

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