Shock Flashcards
List 5 symptoms that may be seen in a patient with suspected shock
- Confusion/Altered Mental Status (due brain being less perfused)
- Tachycardia (this is compensatory mechanism, note that patients with underlying cardiovascular disease may not display tachycardia early on.
- Decrease in urinary output (due to kidneys being subpar renal perfusion secondary to the shock)
- Tachypnea (compensatory mechanism in presence of metabolic acidosis, body “blowing off” CO2. Higher CO2 means lower pH, which means more “acidotic”. CO2 binds with water to produce carbonic acid, carbonic acid is an unstable acid that disassociates quickly and results in H+ ions, H+ ions make the blood more “acidic”.
- Increase/Decrease in JVP, this depends on the type of shock
What is the pathophysiology of elevated lactic acid levels?
Pathophysiology of lactic acidosis is oxygen debt (aka tissue Hypoperfusion). During glycolysis, glucose in converted to pyruvate, under aerobic conditions, pyruvate is converted (in the mitochondria) to acetyl CoA and then enters the Krebs cycle to produce ATP (energy), in the presence of cellular hypoxia, pyruvate cannot be oxidized, therefore it is converted to lactate.
***although most studies have been performed in patients with septic shock, there is evidence that lactate correlates with worse outcomes, a recent systemic lit review supports trending lactate/lactic acid level measurements in the evaluation of response to treatments
In shock, there is an activation of the inflammatory response. What cytokines are released as a result?
Tumor necrosis alpha, interleukins, and prostaglandins.
Name 5 potential etiologies of cardiogenic shock
STEMI papillary muscle rupture following an inferior wall MI acute mitral regurgitation
Tamponade
Valvular Disease (decompensated aortic stenosis, acute aortic regurgitation, Decompensated long standing cardiomyopathy
Ventricular Septal Wall Defect
You are managing a patient with severe sepsis and septic shock. The patient is requiring large amounts of IVF to achieve hemodynamic stability. What fluid(s) would you anticipate using in this situation?
NS or Lactate Ringers (crystalloids) because good at expanding intravascular volume without causing ion concentration disturbances,
What physiological changes occur in Stage 1 of shock?
Compensatory mechanisms. Sympathetic nervous system increases HR and RR. Blood is shunted from areas of the body that can better cope with hypoperfusion, to the core of the body, this process initially increased blood pressure
A patient with severe shock is showing evidence of liver involvement. What changes in laboratory findings do you expect to see initially?
Transaminitis
What evidence of deterioration in cardiac function will you see in the final stages of shock?
Severe hypotension and decreased cardiac output, blood shunted away from even the lungs, kidney, and liver and directed toward the heart and brain.
An exsanguinating hemorrhage can occur from what conditions?
May internal or external. Due to trauma or surgery complication.
What changes would you expect to see in each of the following lab results in a patient with shock:
Sodium – less than 135
Potassium – greater 5. (Could be due to AKI or also compensatory mechanism, where H+ moves into the cell and K+ moves out of the cell)
Glucose – Initially hyperglycemia, in later stages of shock I would expect hypoglycemia because of shock liver and impaired glucose metabolism.
What is undifferentiated shock?
Medically complex patients can have features and risk factors of several forms of shock. In undifferentiated shock, the cause is unclear.
What is the fluid of choice in patients with severe third spacing?
Crystalloids versus albumin (colloid)? Albumin will increase oncotic pressure in intravascular volume and help move fluid from 3rd space into the vascular space.
A patient with shock is euvolemic and has a normal pH and PaO2 on ABG. What is the MOST likely etiology of shock?
Hypovolemic shock
Distributive shock includes which types of shock?
Septic
Anaphylactic
Neurogenic
