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Cardiology > Shock > Flashcards

Shock Flashcards

1
Q

Circulatory shock definition

A

Abnormality of circulatory system that results in reduced organ perfusion and tissue oxygenation

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2
Q

Emotional shock definition

A

Acute stress reaction arising from a response to a traumatic event

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3
Q

Shock types

A

Reduced CO output
- Hypovolaemic
- Cardiogenic
- Obstructive

Reduced systematic vascular resistance
- Septic
- Anaphylactic
- Neurogenic

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4
Q

Hypovolaemic shock causes

A

Haemorrhage
- External vs internal
Vomiting
Diarrhoea
Diuresis
Burns

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5
Q

Cardiogenic shock causes

A

MI
Myocardial contusion
Myocarditis
Cardiac arrhythmia
Negatively inotropic drug overdose (beta blockers or CCB)

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6
Q

Cardiogenic shock causes

A

MI
Myocardial contusion
Myocarditis
Cardiac arrhythmia
Negatively inotropic drug overdose (beta blockers or CCB)

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7
Q

Cardiogenic shock causes

A

MI
Myocardial contusion
Myocarditis
Cardiac arrhythmia
Negatively inotropic drug overdose (beta blockers or CCB)

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7
Q

Cardiogenic shock causes

A

MI
Myocardial contusion
Myocarditis
Cardiac arrhythmia
Negatively inotropic drug overdose (beta blockers or CCB)

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8
Q

Obstructive shock causes

A

Tension pneumothorax
Massive PE
Cardiac tamponade

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9
Q

Pathophysiology of shock

A

BP = CO x SVR
CO = HR x SV (vol of blood pumped by heart per min)
SV = volume of blood pumped by heart per contraction
- Preload, myocardial contractibility, afterload
Preload = ventricular wall tension at end of diastole (degree of myocardial muscle stretch)

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10
Q

Blood pressure equation

A

BP = CO x SVR

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11
Q

Cardiac output equation

A

CO = HR x SV (vol of blood pumped by heart per min)

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12
Q

Stroke volume definition

A

SV = volume of blood pumped by heart per contraction
- Preload, myocardial contractibility, afterload

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13
Q

Preload definition

A

Preload = ventricular wall tension at end of diastole (degree of myocardial muscle stretch)
Determined by volume status, venous capacitance and difference between mean venous P and RA pressure

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14
Q

Frank-Starling mechanism

A

Increased fibre length (preload) leads to increased SV
Until certain point
Fibres are overstretched - further filling results in decreased SV
Eg in cardiac failure

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15
Q

Myocardial contractibility

A

Intrinsic ability of heart to work independently of preload and afterload
Positive inotropes increase this
Shifts Frank-Starling curve upwards

16
Q

Afterload

A

Ventricular wall tension at end of systole
Resistance to anterograde blood flow

17
Q

Shock pathophysiology

A

Cells switch to aerobic to anaerobic metabolism
Generates lactic acidosis
Causes myocardial depression

18
Q

Shock presentation

A

SOB
Confusion
Drowsiness
Oliguria/anuria
Symptoms of cause
Kussmaul’s breathing = hyperventilation to compensate for metabolic acidosis
Hypotension
Prolonged CRT
Tachycardia

19
Q

Investigation of shock

A

Blood gas - pH and lactate
ECG
CXR
Bloods
Echo
Trauma - pelvic XR, CT, FAST

20
Q

Shock initial mangement

A

Maintain airway
High flow O2
Attach monitoring - pulse oximetry, BP, cardiac monitoring
Large-bore IV access
Fluid resuscitation IV
Urethral catheterisation and monitoring
Refer to HDU/ICU if BP falls for central line, arterial line or vasopressor/inotrope infusion
Treat cause

21
Q

Type I haemorrhagic shock

A

Volume of blood loss > 750ml
Percentage blood loss < 15%
HR < 15bpm
BP and pulse pressure normal
RR 14-20
Urine output >30 ml/hr
Mental state: anxious

22
Q

Type II hypovolaemic shock

A

750-1500ml blood loss (15-30%)
HR 100-120
BP normal
Pulse pressure decreased
RR 20-30
Urine output 20-30ml/hr
Mental state: anxious

23
Q

Type III hypovolaemic shock

A

1500-2000ml blood loss (30-40%)
HR 120-140
BP and pulse pressure decreased
RR 30-40
Urine output 5-15
Mental state: confused

24
Q

Type IV hypovolaemic shock

A

> 2000ml blood loss (>40%)
HR >140
BP and pulse pressure decreased
RR >35
Urine output nil
Mental state: lethargic

Cardiology (15 decks)

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