Shock

Question 1

Adrenaline

Answer 1

Increases myocardial force of contraction (positive inotrope) and HR (positive chronotropic) occur as a result of B1 receptor stimulation.
Used in profound bradycardia
Sepsis, anaphylactic and Cardiogenic shock
Asytole, and PEA
Acute asthma, bronchospasm/stridor
VF/VT

Question 2

Four classifications of shock

Answer 2

Hypovolaemic shock
Cardiogenic shock
Obstructive shock
Distributive shock

Question 3

Define shock

Answer 3

Decreased tissue perfusion. Shock is a state of cellular and tissue hypoxia due to reduced oxygen delivery and or increased oxygen consumption or inadequate oxygen utilisation. Ultimately results in organ failure

Question 4

Cardiogenic shock

Answer 4

Inability of the heart to pump adequate blood to tissues and end organs

Question 5

What are the 3 types of distributive shock

Answer 5

(Systemic vasodilation)
Septic shock
Anaphylactic shock
Neurogenic shock

Question 6

Causes of hypovolemic shock

Answer 6

Loss of intravascular volume - from whole blood (haemorrhage), plasma (burns), or interstitial fluid (vomiting or diaphoresis)
Begins when circulating blood volume is decreased by approx 15%

Question 7

Clinical manifestations hypovolaemic shock

Answer 7

Tachy, hypotension, decreased urine output, cool, pale, absent peripheral pulses

Question 8

Cardiogenic shock

Answer 8

Inability of the heart to pump adequate blood to tissues and end organs. Reduced contractility from MI, LBBB, myocarditis, toxins, drugs, cardiomyopathy, myocardial contusion.
Inadequate filling from diastolic dysfunction, RV infarction
Arrhythmias and bradycardia

Question 9

Clinical manifestations of Cardiogenic shock

Answer 9

Tachypnoea, increased WOB, possible APO
Tachycardia, hypotension, distended next veins
Cool extremities, prolonged cap refill anxiety, peripheral oedema, mottled skin

Question 10

Distributive shock: Neurogenic

Answer 10

Caused by trauma to spinal cord - T5 and above, head injury, depressive drugs, anaesthetic drugs
Clinical manifestations: low HR, Low BP along with indicators of excessive parasympathetic activity

Question 11

Distributive shock: Anaphylaxis

Answer 11

Widespread hypersensitivity to an allergen
Clinical manifestations: angioedema, stridor, SOB, bronchospasm, wheeze, vasodilation- hypotension, cardiovascular collapse, abdominal cramps, diarrhoea, flushing and pallor, urticaria, coagulopathy, peripheral pooling and tissue oedema

Question 12

Distributive shock: Sepsis

Answer 12

Clinical manifestations: early- Tachypnoea, decreased to normal BP, Tachy, threads pulse, febrile, anxious
Late: lethargic to comatose, Tachypnoea, shallow resps, hypotension, Tachy, arrhythmias, cool pale skin, oliguria to anuria, abnormal clotting factors, decreased CVP, decreased body temp

Question 13

Obstructive shock

Answer 13

Cardiac tamponade, tension pneumothorax, pulmonary embolism

Clinical manifestations: JVD, global swelling, pulmonary oedema, SOB, Tachy, hypotension

Question 14

Positive inotropes

Answer 14

Strengthen the force of the heart beat there for increase SV and CO

Question 15

Negative inotropes

Answer 15

Weaken the force of the heartbeat

Beta blockers, calcium channel blockers. Class 1A and 1C anti arrhythmic drugs

Question 16

Define positive chrinotrope

Answer 16

Increases the heart rate

Question 17

Define negative chronotrope

Answer 17

Decreases the HR

Question 18

Adrenaline

Answer 18

Is a positive inotrope (increases the force of heartbeat) as well as a positive chronotrope (increases HR)

Question 19

Metaraminol

Answer 19

Positive inotrope (increases the force of the heartbeat- increasing SV and CO)
No chronotrope effect

Question 20

Isoprenaline

Answer 20

Positive inotrope ( strengthening The force of the Heart beat increasing SV and CO)
Positive chronotrope- increasing HR

Question 21

Location and action of dopaminergic receptors

Answer 21

Increases blood supply to the kidneys, increasing the GFR and the excretion of sodium in the urine. Increases HR
Location: CNS, kidney and vaculature

Question 22

Agonist

Answer 22

Drugs that bind to receptors and produce a response

Question 23

Antagonist

Answer 23

Drugs that bind to receptors but do not activate them. Used to block the action of other endogenous transmitters or hormones