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Anesthesiology Round 2!!! > Shock > Flashcards

Shock Flashcards

1
Q

Shock definition:

A

Inadequate oxygen delivery to meet metabolic demands… results in… global tissue hypoperfusion and metabolic acidosis

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2
Q

Shock can/ can not occur with a normal BP:

A

Can

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3
Q

Pathophysiology:

A

The lack of adequate energy supply leads to a build up of waste products and failure of energy-dependent functions, release of ccellular enzymes, accumulation of calcium and ROS -> cellular injury and cell death

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4
Q

Stages of shock:

A
  • Initial compensated stage - sympathoadrenal system, cortisol secretion, ACTH, vasopressin, RAAS, endothelin and vasoconstrictor production
  • Decompensated reversible stage - organ damage symptoms appear - hypotension, hypoxia, tachypnea, oliguria, acidosis, altered mentation
  • Decompensated irreversible stage - Multi-organ faliure
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5
Q

Organ response (microcirculation):

A

Systemic vascular resistance rises - NE acts on a-1 receptors as a VC

Reduced filtration

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6
Q

Organ response (cellular response):

A

Decreased ATP
Accumulation of H+, lactate

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7
Q

Organ response (neuroendocrine response):

A

Vasoconstriction
Reduced vagal activity
ACTH release
Increased renin release

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8
Q

Organ response (Cardiovascular response):

A

Decreased ventricular filling (decreased preload)
Impaired myocardial contractility which reduced SV
Elevated systemic vascular resistance

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9
Q

Organ response (Pulmonary response):

A

Increased pulmonary vascular resistance (septic shock)
Tachypnoea but restricted ventilation
Atelectasis
ARSD

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10
Q

Organ response (renal response):

A

Reduced renal blood flow and reduced GFR
Reduced urine volume, oliguria, ARF
Acute tubular necrosis

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11
Q

Organ response (Inflammatory responses):

A

Activation of coagulation cascade causes microvascular thrombosis
TNF-a
IL-8
Thromboxan A2

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12
Q

Compensation:

A
  1. Mobilization of 11L interstitial fluids
  2. SNS activation
  3. RAAS activation, ADH secretion
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13
Q

Types of distributive shock:

A

Septic
SIRS
Neurogenic
Anaphylatic
Drug-/toxin-induced
Endocrine

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14
Q

Mild shock:

A

Loss of 10-15%
Collapse of subcutaneous vv. of extremities
Patient is thirsty and cold

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15
Q

Moderate shock:

A

Loss of 20-30%
Mild tachycardia
Narrow pulse pressure
Tachypnea
Anxiety
Oliguria
Drowsy
Confused

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16
Q

Severe shock:

A

Unconscious
Loss of >40%
Anuria
Rapid pulse
Hypotension

17
Q

ET Intubation can _____ hypotension

A

worsen

18
Q

Shock treatment goals:

A

BP (MAP>65mmhg)
CVP (8-12mmh2O)
Urine (>0.5ml/kg/hr)
Central venous O2 sat. > 70%, or mxed venous sat. >65%

19
Q

Maintain Hg>__d/l

A

10

20
Q

First step in treatment of shock:

A

Crystalloids 1000ml or
colloids 300-500ml in 30m

21
Q

Hypovolemic shock treatment:

A

Crystalloids
- normal saline or lactate ringers
- up to 2-2.5L
- Consider catecholamines

22
Q

Sepsis criteria:

A

HR > 90
RR > 20
WBC >12,000 or <4,000

23
Q

Sepsis initial treatment:

A

20-40mL/lg bolus

24
Q

Cardiogenic shock parameters:

A

SBP <90mmhg
CI < 2.2L/m/m2
PCWP > 18mmHg

25
Q

Loss of __% LV function causes clinical shock

A

40

26
Q

Intubation will ______ preload

A

decrease

27
Q

Anaphylaxis is ___ mediated

A

IgE

28
Q

How to distinguish anaphylaxis from anaphylactoid rxn clincally?

A

You can’t dumbass

29
Q

Cause of anyphylactoid rxn?

A

Anasthetics, stings, food, AB

30
Q

Anaphylactic shock treatment?

A

0.3mg IM Epi-pen
Repeat every 5-10mins as needed
Caution w/ beta-blockers > HTN due to unopposed alpha stimulation
CV collapse 1mg IV 1:10,000
If refractory, start IV drip

31
Q

Injury above __ can cause neurogenic shock

A

T1

32
Q

In neurogenic shock keep MAP at _______

A

85-90

33
Q

For blunt spinal cord injury consider

A

methylprednisolone

34
Q

Infusion of one litre of 0.9% NaCl adds ___mL to the plasma volume and ___mL to the interstitial volume

A

275
825

35
Q

Crystalloids

A

Contain electrolytes
First line
25% in plasma, 75% in interstitial volume
short HL: 30-60mins

36
Q

Colloids:

A

Large solute molecules do not pass readily from plasma to interstitial fluid

75% expands plasma volume
25% expands interstitial volume
HL 2-4h
Suitable for small-volume rescuscitation

37
Q

Indications for whole blood:

A

Hemorrhage (25% or more volume loss)
Exchange transfusion
Patients who bleed after 4 units of packed RBC’s

38
Q

Indications for packed cell transfusion:

A

Symptomatic chronic anemia w/o hemorrhage
Acute sickle cell crisis
Cardiac faliure
Acute blood loss
Perioperative anemia

39
Q

Autologous vs Allogenic blood transfusion:

A

Autologous - same person
Allogenic - another person

Anesthesiology Round 2!!! (30 decks)

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