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SA Emergency > Shock > Flashcards

Shock Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is shock?

A

Severe imbalance between O2 supply and demand, leading to inadequate cellular energy production

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2
Q

Oxygen delivery =

A

CO x arterial O2 content

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3
Q

Name some consequences of shock

A

Na+/K+ ATPase dysfunction
Cellular necrosis and apoptosis
Acidemia
Endothelial dysfunction
Activation of inflammatory and coagulation cascades
MODs
Death

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4
Q

Three main types of shock

A

Circulatory
Hypoxic
Metabolic

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5
Q

T/F: A vast majority of shock is metabolic

A

False - vast majority is circulatory

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6
Q

What are the four types of circulatory shock?

A

Hypovolemic
Distributive
Obstructive
Cardiogenic

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7
Q

Explain the physiology of hypovolemic shock

A

Decreased intravascular volume

Decreased preload

Decreased CO

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8
Q

Name some causes of hypovolemic shock

A

Hemorrhage

Severe dehydration (GI, Renal)

Third space fluid loss

Severe burns

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9
Q

What is meant by distributive shock?

A

Maldistribution of fluid from changes in vascular tone and increased vascular permeability

Decreased SVR +/- Preload +/- Contractility

“We’ve got fluid in the pipes, just not where it needs to be”

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10
Q

How might anaphylactic shock be classified?

A

Distributive

Histamine-induced vasodilation

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11
Q

Anaphylaxis is a kind of distributive shock. What are some other causes?

A

Septic shock
Neurogenic shock
Pheochromocytoma or extreme fear

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12
Q

What is meant by obstructive shock?

A

Compression of heart or great vessel that interferes with venous return

Decreased diastolic filling and preload

Decreased CO

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13
Q

What are some causes of obstructive circulatory shock?

A

GDV
Obstruction of vena cava
Tension pneumothorax
Cardiac tamponade
PPV

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14
Q

Physiology behind cardiogenic shock

A

Decrease in forward flow from the heart due to “pump failure”

Primary decrease in CO

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15
Q

What are some causes of cardiogenic shock?

A

Systolic failure
Diastolic failure
AV valve degeneration of defects
Brady or tachy-arryhythmias

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16
Q

What is hypoxic shock? How common is this?

A

Decreased arterial oxygen content leading to decreased tissue oxygen delivery

Significantly less common than circulatory shock

17
Q

Severe pulmonary disease, anemia, or dyshemoglobinemias can lead to ____________ shock

A

Hypoxic

18
Q

What is metabolic shock?

A

Tissues are getting enough oxygen, but for some reason aren’t able to use it

Deranged cellular metabolism leading to inappropriate O2 tissue use

19
Q

Potential causes of metabolic shock

A

Severe hypoglycemia
Mitochondrial dysfunction

20
Q

T/F: regardless of the type of shock, the body tends to respond to all shock in a similar way

A

True

21
Q

Discuss the baroreceptor reflex in response to shock

A

Baroreceptors detect decreased volume and stretch d/t decreased CO

Signal sent to increase sympathetic tone leading to direct catecholamine release from the adrenal glands

Catecholamines increase HR, contractility, and peripheral vasoconstriction

22
Q

Discuss the role of chemoreceptors in response to shock

A

Located peripherally and centrally and sense changes in blood stream components

Result in increased respiratory rate and tidal volume (faster, deeper breaths)

23
Q

What is RAAS’s role in shock?

A

Decreased BP detected and RAAS activated

Angiotensin II vasoconstricts and promotes Na reabsorption

ADH promotes water reabsorption

24
Q

What is the hallmark for shock?

A

Hypotension

25
Q

What is the hyperdynamic phase and what types of shock is it associated with?

A

Initial vasodilation instead of vasoconstriction

Seen w anaphylactic and septic shock

26
Q

What is the shock organ in cats? Dogs?

A

Cats = lungs

Dogs = GIT

27
Q

What is the overall goal for the treatment of shock?

A

Restore O2 delivery to tissues asap

28
Q

What are some good initial treatments when managing shock?

A

Flow-by O2
Obtain IV access
IV fluid bolus resuscitation (unless suspect cardiogenic shock)

29
Q

What kind of fluid bolus might we give in a shocky (non-cardiogenic) patient?

A

Isotonic crystalloid bolus

5-20mL/kg IV over 10-20 minutes

Repeat as needed up to 90mL/kg in dogs and 66mL/kg in cats

30
Q

What should you always do following a fluid bolus?

A

REASSESS

31
Q

What is the mainstay of treating obstructive shock?

A

Removing the obstruction

GDV - trocarize

Pleural effusion - thoracocentesis

Cardiac tamponade - pericardiocentesis

32
Q

A shocky patient comes in 3 days after a GI FB removal and small intestine R&A. Based on the history, you suspect dehiscence, subsequent septic peritonitis, and septicemia. What treatments can you initiate?

A

Broad-spectrum antibiotics
Vasopressors like NE (remember that hyperdynamic phase?)

33
Q

A few hours after vaccine administration, a dog presents to the ER with a swollen face and difficulty breathing. Based on the history, you believe the dog might be in anaphylactic shock. What should you do?

A

Vasopressors like E (remember that hyperdynamic phase?)

Anti-histamines

34
Q

Mainstays of treating cardiogenic shock?

A

Correct underlying etiology
O2 therapy
NO IV FLUIDS
Minimize stress

35
Q

How often should patients that have undergone resuscitation be reassessed?

A

Every 5-10 minutes or after every therapeutic intervention during stabilization

SA Emergency (11 decks)

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