Shock

Question 1

What is the clinical definition of shock?

Answer 1

Inadequate tissue PERFUSION leading to decreased OXYGENATION at a cellular level. And inadequate removal of toxic metabolic by products.

Question 2

What are the three main sources of energy for cells?

Answer 2

Carbs, Proteins, Fats

Question 3

What is the prefered source of energy for cells?

Answer 3

Glucose

Question 4

What are the 2 processes for metabolism of glucose?

Answer 4

Anaerobic (glycolosis), and Aerobic (Krebs cycle and ETC)

Question 5

How many ATP is made in the anerobic pathway for glucose metabolism?

Answer 5

2

Question 6

What happens to cells in prolonged anaerobic states?

Answer 6

Cells eventually stop receiving energy as oxygen runs out.

Accumulation of toxic by products

Intercellular structures called lysosomes (Bags of toxic enzymes) rupture and digest cell contents.

The cell membrane becomes incompetent and ruptures releasing toxic substances into the blood stream.

Question 7

What is the main goal when treating a patient in shock?

Answer 7

Improve cellular perfusion and oxygenation

Question 8

What are 6common types of shock?

Answer 8

Septic

hypovolemic

obstructive

Cardiogenic

Neurogenic

Anaphylactic

Question 9

What are the common causes of hypovolemic shock?

Answer 9

Hemorrhage

Diarrhea

Vomiting

Urination

Question 10

What is one PHYISCAL finding in mechanical/cardigenic shock that will not be present in hypovolemic shock?

Answer 10

JVD.

Question 11

What is the cause of septic shock?

Answer 11

Endotoxins released by microorganisms in the blood. Results in decreased vascular resistance, peripheral pooling of blood and ultimately capillary leak with fluid extravasation.

Question 12

What are some important signs and symptoms to look for in sepsis?

Answer 12

Recent infection, urinary catheterization, pneumonia, fever or unexplained hypothermia, hypotension that may not respond to fluid, tachycardia, tachypnea.

Question 13

What is anaphylactic shock?

Answer 13

An acute, severe systemic reaction to an allergen caused by the release of chemical mediators (Histamine, prostaglandins, leukotrienes, kinin) after an interaction with IgE antibodies on the surface of mast cells and basophils.

Question 14

What are the physiologic responses in anaphylactic shock?

Answer 14

Vasodilation, capillary leak, swelling, bronchospasm, increased mucus production.

Question 15

What is compensated shock?

Answer 15

When vital organ perfusion is adequate due to the compensatory mechanisms of shock.

Question 16

What is the neurogenic compensation of shock?

Answer 16

Increased heart rate and contractility, as well as vasoconstriction.

Autonomic nervous system control

Question 17

What are some hormonal responses in shock?

Answer 17

Adrenal medulla- Epi/norEpi

RAAS

Hypothalamus/anterior pituitary- adrenocorticotropic hormone, glucocorticoids.

(Glucocorticoids decrease vascular permeability)

Question 18

What is the RAAS and how does it work?

Answer 18

Renin angiotensin aldosterone system

Works by reacting to decreased blood flow to the kidneys.

Renins convert angiotensinogen into angiotensin I.

Angiotensin I circulates in the body and passes through the lungs were it reacts with angiotensin converting enzyme (ACE).

ACE converts angiotensin I into angiotensin II which is a potent vasoconstrictor AND stimulant for the adrenal cortex to release aldosterone.

Aldosterone causes the kidneys DCT to retain sodium.

Question 20

What is the fluid administration amount for cardiogenic shock?

Answer 20

10ml/kg up to a max of 1000.