Shock Flashcards
What is the clinical definition of shock?
Inadequate tissue PERFUSION leading to decreased OXYGENATION at a cellular level. And inadequate removal of toxic metabolic by products.
What are the three main sources of energy for cells?
Carbs, Proteins, Fats
What is the prefered source of energy for cells?
Glucose
What are the 2 processes for metabolism of glucose?
Anaerobic (glycolosis), and Aerobic (Krebs cycle and ETC)
How many ATP is made in the anerobic pathway for glucose metabolism?
2
What happens to cells in prolonged anaerobic states?
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.
What is the main goal when treating a patient in shock?
Improve cellular perfusion and oxygenation
What are 6common types of shock?
Septic
hypovolemic
obstructive
Cardiogenic
Neurogenic
Anaphylactic
What are the common causes of hypovolemic shock?
Hemorrhage
Diarrhea
Vomiting
Urination
What is one PHYISCAL finding in mechanical/cardigenic shock that will not be present in hypovolemic shock?
JVD.
What is the cause of septic shock?
Endotoxins released by microorganisms in the blood. Results in decreased vascular resistance, peripheral pooling of blood and ultimately capillary leak with fluid extravasation.
What are some important signs and symptoms to look for in sepsis?
Recent infection, urinary catheterization, pneumonia, fever or unexplained hypothermia, hypotension that may not respond to fluid, tachycardia, tachypnea.
What is anaphylactic shock?
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.
What are the physiologic responses in anaphylactic shock?
Vasodilation, capillary leak, swelling, bronchospasm, increased mucus production.
What is compensated shock?
When vital organ perfusion is adequate due to the compensatory mechanisms of shock.
What is the neurogenic compensation of shock?
Increased heart rate and contractility, as well as vasoconstriction.
Autonomic nervous system control
What are some hormonal responses in shock?
Adrenal medulla- Epi/norEpi
RAAS
Hypothalamus/anterior pituitary- adrenocorticotropic hormone, glucocorticoids.
(Glucocorticoids decrease vascular permeability)
What is the RAAS and how does it work?
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.
What is the fluid administration amount for cardiogenic shock?
10ml/kg up to a max of 1000.
