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VMS 1005 > Shock > Flashcards

Shock Flashcards

1
Q

What is shock defined as?

A

Widespread reduction in tissue perfusion which causes cellular metabolic oxygen demands to exceed the supply

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2
Q

What is the main cause of shock?

A

A loss of support of cardiac output

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3
Q

What is hypovolaemic shock?

A

Where there is insufficient circulating volume, the primary cause is fluid loss

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4
Q

What is cardiogenic shock?

A

Failure of the heart pump, this could either be the speed or the direction of blood flow (e.g arrhythmia)

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5
Q

What is distributive shock?

A

Insufficient blood volume due to vasodilation means that blood is wrongly redistributed

Blood outside of vessels rather than inside

reduced total peripheral resistance

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6
Q

What is obstructive shock?

A

Where there is an obstruction to the flow of blood, e.g pneumothorax

or pericarditis- pericardium is pressed to the walls of the heart

This stops blood flowing in the heart

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7
Q

What are some clinical signs of shock early on in the process?

A

Panting, rapid heart rate,

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8
Q

Where is arteriolar constriction in response to shock most pronounced?

A

Skeletal muscle, Cutaneous muscle and splanchic vascular beds

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9
Q

What lowers the hydrostatic pressure in the capillaries?

A

Arterial hypotension, Arteriolar constriction, and reduced venous pressure

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10
Q

What does lowering the hydrostatic pressure in the capillaries promote?

A

It promotes the reabsorption of interstitial fluid into the vascular compartment

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11
Q

What are some clinical signs of shock found later on?

A

Pale skin and pale mucous membranes, drop in body temp and a slow respiratory rate

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12
Q

What does a reduction in arterial BP decrease?

in terms of receptors

A

Decreases the stimulation of baroreceptors in the carotid sinuses and aortic arch

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13
Q

What is essentially being lost when you have burns?

(during hypovlaemic shock)

A

Fluid loss such as blood plasma

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14
Q

What occurs during the cardiovascular response?

A

Increase in heart rate and myocardial contractility (this indirectly increases perfusion)
Autotransfusion- many other organs vasoconstrict so that more blood is supplied to the heart and the brain e.g from splanchic

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15
Q

How much vasoconstrcition occurs in the coronary/ cerebral arteries during shock?

A

Almost none, to protect them at the expense of other organs

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16
Q

What is the effect of having low hydrostatic pressure on interstitial fluid?

A

It promotes the reabsorption of interstitial fluid (as there will be less fluid leaving)

17
Q

What is the effect of interstitial fluid reabsorption on the osmotic pressure?

A

It dilutes the concentration of plasma proteins and hence reduces the osmotic pressure

18
Q

What does a low arterial BP indirectly stimulate?

A

Indirectly stimulates peripheral chemoreceptors in the aortic bodies, carotid bodies and the heart

19
Q

What do the peripheral chemoreceptors do?

A

Chemoreceptors sense pH
So they sense changes in O2 and CO2 through tissue hypoxia
and therefore enhance the existing vasoconstriction and casue respiratory stimulation (increased breathing rate)

20
Q

What are some examples of endocrine stimulation when shock occurs?

A

Release of catecholamines such as adrenaline and noradrenaline
Release of vasopressin (ADH) to stimulate the reabsorption of water Activation of the RAAS system
Release of Erythropoietin

21
Q

What is Cardiogenic shock?

A

The heart struggles to pump blood that meets the tissues demand

decreased blood volume

decreased blood volume leads to hypotension

22
Q

What is Cardiogenic shock?

A

The heart struggles to pump blood that meets the tissues demand

decreased blood volume

decreased blood volume leads to hypotension

23
Q

What are some of the clinical signs of cardiac failure?

A

coughing, exercise intolerance, swollen abdomen, changes in mucous membrane colour

24
Q

What is systolic function?

A

Impaired contractile function

25
Q

What is diastolic dysfunction?

A

Impaired filling due to stiffness or hypertrophy

26
Q

What is ejection fractioning?

A

Measuring the volume of blood both before and after it has been rejected (using the ventricle size)

27
Q

What is fractional shortening?

A

Cut the ventricles into a sheet and look at their shortening/ how much they squeeze

28
Q

How could you calculate the volume of the blood ejected each beat?

A

EDV- ESV

29
Q

What is the cardiovascular response to shock?

A

There is decreased firing in the baroreceptors (found in aortic arch and carotid sinuses)
therefore there is increased heart rate and myocardial contractility
as well as autotransfusion of blood

30
Q

What is autotransfusion of blood?

A

Occurs during the cardiovascular response
It is the redistribution of blood from other organs e.g GIT to the heart and the brain whcih are priority organs

31
Q

What is the issue with arteriolar constriction/ reduced venous pressure

in terms of hydrostatic pressure

A

Increased arteriolar constriction decreases the hydostatic pressure
Therefore there is increased reabsorption of interstitial fluid into the capillaries
This dilutes the concentration of plasma proteins in the colloid/ decreased osmotic pressure
Therefore the long-term recovery requires plasma protein synthesis in the liver and more water/ electrolyte synthesis

32
Q

What are the three different types of distributive shock?

A

Septic (toxins)
Anaphylactic (histamine)
Neurogenic

33
Q

What is the function of catecholamines?

A

They are released in response to stress
(adrenaline and noradrenaline)
they are part of the sympathetic nervous system and therefore assist in increasing blood pressure

34
Q

What is the difference between systolic and diastolic dysfunction?

A

systolic dysfunction is where the heart fails to pump out as much blood as normal (impaired contractile function)
diastolic dyfunction is where the ventricles are too stiff to fill (impaired filling)

35
Q

What is EF?

A

a measurement of how well the heart is pumping blood around the body (volumetric fraction of the hearts ability)

36
Q

What effect does low BP have on the baroreceptors?

A

decreased stimulation/firing
therefore there is generalised vasoconstriction to increase TPR and increased venoconstriction for increased venous return

venoconstriction is the generalised constriction of a vein

37
Q

When does renal venoconstriction occur?

A

only in cases of haemorrage

38
Q

What are some of the clinical signs of cardiac failure?

A

coughing, intolerance to exercise, swollen abdomen, lethargy, difficulty breathing, collapsing episodes

VMS 1005 (33 decks)

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