Shock Flashcards
What is shock defined as?
inability of the circulatory system to meet the oxygen and nutrient needs of body tissues
Fill in the blank:
The cause for shock is; ___________ __________ does not meet _________ _________.
Tissue 02 supply does not meet 02 demand
what is the conceptual framework of shock?
relationship between 02 supply (delivery) and 02 demand (consumption)
What state is the body in during shock?
hypermetabolic; the body is using a lot of energy
What does the hypermetabolic state of shock cause?
skewed electrolytes
elevated blood glucose
pale and cool skin
decreased capillary refill
what is shock?
a condition in which tissue perfusion is inadequate to deliver oxygen and nutrients to support vital organs and cellular function
which body systems does shock effect?
ALL OF THEM
Shock effects all body systems
What are some potential causes for shock?
- Ineffective pumping
- insufficient volume
- massive vasodilation vascular bed
Physiological changes regarding shock?
- hypoperfusion of tissues
- hypermetabolism
- activation of inflammatory response
What is a sign the inflammatory response has been activated?
An elevated CRP is the main sign
CRP worsens the metabolic state because it requires steroids to treat; then worsens the hypermetabolic state causing the BG, and electrolytes to be elevated
requires an insulin drip to regulate BG
What is common to all shock states:
A. BP of 90mmHg, HR >100
B. Loss of blood volume
C. Decreased 02 delivery with decreased 02 consumption
D. Inadequate 02 delivery to meet cellular demands
The answer is d.
this is the biggest defining trait between all types of shock
With hypermetabolic, you will have increased oxygen consumption
What is the pathophysiology of shock? (4)
- diminished tissue perfusion
- widespread vasodilation
- cellular dysfunction
- compensatory mechanisms
- multiple organ dysfunction syndromes (MODS)
some major traits related to the pathophysiology of shock? (6)
- inadequate 02 to cells
- anaerobic metabolism
- acidotic environment
- Na-K pump malfunction
- cell structures damaged
- cell death
How long does it take MODS to reverse?
THIS IS A TRICK QUESTION
MODS IS NON REVERSIBLE BECAUSE TISSUE DEATH IS NON REVERSIBLE
tests to identify that compensatory mechanisms have begun working? (2)
ABG’s
Lactic Acid
How much of a window do we have for treating shock?
think time=muscle!!!
very narrow window for treatment of shock
signs of shock?
increased temperature increased HR low BP dizzy, cool and pale skin decreased UOP, and perfusion
What are the cellular effects of shock? (7)
- cellular edema
- Efflux of K+
- Increased membrane permeability
- lysosomal membrane rupture
- influx of Na and H20
- cell damage and death
- mitochondrial damage and swelling
What are cytokines?
any number of substances, such as interferon, interleukin, and growth factors, that are secreted by certain cells of the immune system and have an effect on other cells
What is perfusion dependant on?
MAP
What is the compensatory mechanism related to cytokines?
Cytokines are released by the cells and stimulate vasodilation or vasoconstriction depending on the need for cell oxygen and nutrients
What works together on the cellular level to increase CO?
interaction of neural, chemical, and hormonal regulators work together to adjust cardiac output and peripheral resistance
what is cardiogenic shock?
the heart is unable to pump enough blood to meet the needs of the body
Common causes of cardiogenic shock?
- Left ventricular failure
- Myocardial Infarction
- any condition stressing the myocardium (maybe coronary or noncoronary)