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Cardiovascular 2 > SHOCK > Flashcards

SHOCK Flashcards

1
Q

What is shock

A

life-threatening, generalised form of acute circulatory failure with inadequate oxygen delivery to, and consequently oxygen utilisation by, the cells

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2
Q

Shock defined by:

A

Low BP
Tissue hypoperfusion
raised serum lactate

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3
Q

Equations

A

BP = CO x Resistance to Blood flow
CO = SV X HR

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4
Q

What is shock essentially

A

Ischaemia on global scale - circulatory failure of whole body

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5
Q

What is hypovolaemic shock

A

induced by a low fluid volume of blood. A loss of around 20% of total blood volume can be enough to induce hypovolaemic shock

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6
Q

2 types of hypovolaemic shock

A
  • Non-haemorrhagic: the loss of fluid volume isn’t from bleeding e.g. dehydration, burns
  • Haemorrhagic: loss of blood volume through ruptured blood vessels (i.e. loss of blood volume from bleeding) - e.g. GI bleeding, trauma, peri/post-operative
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7
Q

What does hypovolaemia lead to

A
  • Total volume filling of heart goes down > SV goes down > decreased CO > decreased BP
  • When CO goes down > epi and norepinephrine, ADH, Ang II are released > cause vasoconstriction of BVs
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8
Q

What does vasoconsctriction of BVs do?

A

increases vascular resistance and heart rate, and in turn, this increases cardiac output. These combined effects increase blood pressure.

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9
Q

Indicator of hypovolaemic shock

A

Decreased mived venous oxygen (MVO2)

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10
Q

What type of shock is hypovolaemic shock

A

Cold - BF also provides heat to the tissues, when it’s down, the skin starts to feel cool and clammy

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11
Q

S + S of hypovolaemic shock

A
  • Cold and clammy skin
  • Confusion and drowsiness
  • Increased sympathetic tone
  • Tachycardia or bradycardia: depending on stage
    Initially narrow pulse pressure and weak pulse until there is compensation, and then again when there is failure of compensation
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12
Q

What is cardiogenic shock

A

shock related to pathology of the heart, which prevents it from pumping enough blood to the tissues

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13
Q

Causes of cardiogenic shock

A
  • Acute MI - most common cause
  • Pericardial effusion
  • Cardiac tamponade
  • arrhytmias
  • Pulmonary embolus
  • Pneumothorax
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14
Q

Signs of cardiogenic shock

A
  • HF
  • Raise JVP
  • Pulmonary oedema
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15
Q

Cardiogenic shock pathophysiology

A

Same as hypovolaemic
Body release vasoconstrictors to increase vascular resistance to maintain BP
MVO2 down
Reduction in CO leads to lowered BF - Cold shock

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16
Q

Distributive shock

A
  • There is typically leakiness of blood vessels and an excessive amount of arteriole vasodilation.
  • If arterioles dilate, vascular resistance to blood flow goes down, so blood pressure goes down, leading to less perfusion and distribution of blood to organs and tissues.
17
Q

What happens in septic shock

A
  • Endotoxins on pathogens (gram - usually) cause cascade leading to lowered perfusion - damage endothelial cells releasing vasodilators
  • Activate complement > activate mast cells + IM cell prod inflam cytokines > causes release of Platelet activating factor and ROS > Damage endothelial cells and increase vascular permeability so vesssels more leaky
18
Q

What do endothelial cells also express in septic shock?

A
  • Procoagulant - TF - these combined with decrease of anti-coags leads to increase in coag + clotting - further blockages and adds to perfusion
19
Q

MVO2 and type of shock septic shock is

A

Warm due to increase in flow to peripheral BVs
MVO2 normal

20
Q

S + S of septic shock

A
  • Warm and flushed skin
  • Pyrexia and rigors
  • Nausea and vomiting
  • Bounding pulse
21
Q

What happens in an anaphylactic shock

A
  • An allergic reaction that causes dangerously low blood pressure.
  • Massive release of histamine and other vasoactive mediators causes hemodynamic collapse.
22
Q

S + S of anaphylactic shock

A
  • Warm and flushed skin
  • Itching
  • Sweating
  • May be breathlessness and wheeze
  • Cyanosis
  • Low BP
  • Tachycardia
23
Q

What happens in neurogenic shock

A

The nervous system gets damaged and can’t control the body’s blood pressure.

e.g. spinal cord injury, epidural or spinal anaesthesia

24
Q

Anaemia + Cytotoxic shock

A
  • Anaemic shockNot enough oxygen being carried in blood
  • Cytotoxic shockCells are poisoned
25
Q

Treatment of shock

A
  • ABC
    • Airways: intubation if necessary
    • Breathing: give O2
    • Circulation: establish IV access, raise legs if hypovolaemic, fluid resuscitation and blood transfusion if necessary, ensure haemostasis
26
Q

Septic shock treatment

A

Antibiotics

27
Q

Anaphylactic shock treatment

A

remove causative agent + adrenaline, chlorphenamine and hydrocortisone

28
Q

Cardiogenic shock treatment

A

may require revascularisation

29
Q

Complications of shock

A
  • Organ failure: due to prolonged hypotension
    • Kidneys - acute tubular necrosis
    • Lung - Acute Respiratory Distress Syndrome (ARDs)
    • Heart - myocardial ischaemia and infarction
    • Brain - confusion, irritability and coma

Cardiovascular 2 (10 decks)

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