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CVR Biweekly 2 > Shock > Flashcards

Shock Flashcards

1
Q

when O2 supply< O2 demand and leads to organ dysfunction

A

shock

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2
Q

OER (O2 extraction)=

A

VO2/DO2

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3
Q

VO2=

A

CO(CaO2-CvO2)

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4
Q

DO2=

A

COxCaO2

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5
Q

what happens if cardiac output (CO) decreases

A

DO2 and VO2 decrease

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6
Q

total O2 content in arterial blood

A

CaO2

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7
Q

CaO2=

A

(Hbx1.34xSaO2/100)+(0.003xPaO2)

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8
Q

depends on pulmonary gas exchange

A

PaO2

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9
Q

the supply of O2 depends on

A

CaO2

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10
Q

systemic O2 demand increases in what situations

A

stress, pain, fever, exercise

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11
Q

shock that has decrease in blood volume and CO

A

Hypovolemic shock

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12
Q

2 types of hypovolemic shock

A

hemorrhagic and fluid loss

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13
Q

2 types of hemorrhagic hypovolemic shock

A

traumatic: spleen rupture
non-traumatic: bleeding ulcer

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14
Q

types of fluid loss hypovolemic shock

A

diarrhea, vomiting
burn
ascites
polyuria

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15
Q

type of shock dealing w/ heart not functioning properly

A

cardiogenic shock

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16
Q

main ways cardiogenic shock can happen

A

MI
myocarditis
arrythmia
aortic and mitral regurgitation

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17
Q

shock due to blood not flowing (venodilation)

A

distributive shock

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18
Q

most common form of shock and fatal form

A

septic shock

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19
Q

3 main types of distributive shock

A

septic
anaphylactic
neurogenic

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20
Q

shock due to diastolic filling not happening due to restriction

A

obstructive shock

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21
Q

tension pneumothorax
cardiac tamponade
restrictive pericarditis
pulmonary embolism
aortic dissection
all lead to what shock

A

obstructive shock

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22
Q

best example of obstructive shock due to fluid in pericardial sac

A

cardiac tamponade

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23
Q

leads to obstructive shock due to L ventricle basically empty due to oxygenated blood unable to come back from lungs

A

pulmonary embolism

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24
Q

shock due to O2 not being able to be utilized/consumed

A

Dissociative shock

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25
Q

2 main things that can lead to dissociative shock

A

CO poisoning
Cyanide poisoning

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26
Q

contractility (inotropy) of heart depends on what

A

Ca2+ sensitivity and binding to troponin C

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27
Q

sarcomere length based on diastolic filling (preload)

A

Starling effect

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28
Q

preload is measured by what

A

pulmonary artery catheter

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29
Q

end diastolic sarcomere length=

A

preload

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30
Q

how to measure pulmonary capillary wedge pressure

A

catheter goes from SVC all the way to pulmonary a. and is measured based on end diastolic sarcomere length

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31
Q

decrease in SVR (primary); CO increases (secondary)

A

distributive shock

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32
Q

decrease in CO (primary); SVR increases (secondary)

A

cardiogenic shock
obstructive shock
hypovolemic shock

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33
Q

difference b/t cardiogenic LV and cardiogenic RV shock

A

cardiogenic LV has increased PCWP (wedge pressure)
cardiogenic RV has decreased PCWP (wedge pressure)

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34
Q

ultimately what happens to compensate in shock

A

baroreceptor reflex and chemosensors respond (sympathetic activation)

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35
Q

one of the earliest and very important signs of shock (most sensitive indicator of shock)

A

tachycardia

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36
Q

what happens to HbO2 curve to compensate for shock

A

shifts to the R (O2 unloading)

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37
Q

when DO2 decreases in shock, what compensates

A

increase in OER (O2 extraction)

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38
Q

what happens if increasing OER doesn’t meet systemic O2 demands

A

switch metabolism to anaerobic (lactic acidosis)

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39
Q

critical lab to order and diagnose shock

A

lactate

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40
Q

stage of shock that is reversible; tissue hypoperfusion

A

compensated

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41
Q

stage of shock where there is vital organ failure

A

progressive

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42
Q

stage of shock that is irreversible and has multisystem organ failure

A

decompensated

43
Q

could be the only sign to diagnose shock

A

compensatory tachycardia (>100 BPM)

44
Q

MAP when diagnosing shock

A

<65 mmHg

45
Q

levels of lactic acidosis that would diagnose shock

A

> 2 mmol/L

46
Q

2 main organ dysfunctions due to hypoperfusion

A

brain (anxiety/confusion) and kidneys (oliguria)

47
Q

sign of heart failure

A

S3 gallop

48
Q

shock index=

A

HR / SBP (systolic bp)

49
Q

shock index of 1.5 means what

A

patient in shock

50
Q

most common type of shock

A

distributive (vasodilatory) shock

51
Q

main vasodilator in distributive shock

A

NO

52
Q

NO binds what receptor

A

B2 (Gs signaling)

53
Q

low dose effect of histamine

A

H1 (Gq) —> NO release

54
Q

high dose effect of histamine

A

H2 (Gs) VSMC relaxation

55
Q

histamine release causes bronchoconstriction how

A

H1 (Gq) BSMC contraction

56
Q

Rhoa and ROCK activation can lead to what

A

blood leaking through cells

57
Q

why Epi over NE for anaphylactic shock

A

Epi binds B2 and bronchodilates (taking care of dyspnea)

58
Q

primary cause of septic shock

A

massive vasodilation due to NO production

59
Q

caused by infection + SOFA >/= to 2 points (acute organ dysfunction)

A

Sepsis

60
Q

sepsis + circulatory failure (need vasopressors) + tissue hypoxia

A

septic shock

61
Q

worst case SOFA for each individual organ

A

4

62
Q

maximum total SOFA score

A

24 (worst case)

63
Q

main pathogens that cause septic shock

A

S. aureus
S. pneumo
E. coli

64
Q

why does uncomplicated infection become sepsis

A

damage by pathogen
host’s immune response
coagulation abnormalities
hypoxia

65
Q

clinical features of septic shock (5 things)

A

warm initially
acute lung inflammation
heart failure
acute kidney injury
CNS

66
Q

quick test to see whether patient will respond to fluids (fluid responsiveness in shock)

A

passive leg raise

67
Q

broad spectrum Ab therapy

A

VANCOMYCIN (IV)

68
Q

2 main things to monitor with shock

A

lactate and MAP

68
Q

example of distributive shock that deals with spinal cord trauma due to someone falling from a height; disruption of sympathetic outflow

A

neurogenic shock

69
Q

triad of bradycardia, hypotension, and peripheral vasodilation

A

neurogenic shock

70
Q

HR 50/min; BP 80/40 mmHg after patient fell from height

A

neurogenic shock

71
Q

2 main things to do to help w/ cardiogenic shock

A
  1. increase BP
  2. ventilation
72
Q

in RV failure, LV CO low and PCWP low means what for the lungs

A

clear lungs b/c no pulmonary congestion

73
Q

what would make RV failure cardiogenic shock worse

A

VASODILATORS

74
Q

B1 and B2 agonist and a1 agonist

A

dobutamine

75
Q

“renal dose” does not improve renal function; used in bradycardia and hypotension

A

dopamine

76
Q

used in septic shock

A

vasopressin

77
Q

vasodilatory shock; best for supraventricular tachycardia

A

phenylephrine

78
Q

1st line vasopressor for septic shock

A

NE

79
Q

used for anaphylactic shock

A

Epi

80
Q

used for cardiogenic shock and septic shock

A

dobutamine

81
Q

used in cardiogenic shock and CHF

A

milrinone

82
Q

blood loss of 750-1500 mL
tachycardia

A

class II hemorrhagic shock

83
Q

sweating
pale and cold
thirsty

A

hypovolemic shock

84
Q

3 things to do to Rx hemorrhagic shock

A

control source
give fluids
take to OR

85
Q

used to check for free fluid in abdomen

A

FAST exam

86
Q

used to replenish volume in hemorrhagic shock

A

crystalloids

87
Q

no parasympathetic input to VSMC; but how does Ach cause vasodilation

A
88
Q

sodium nitroprusside (used for HTN emergency) produces what 2 things

A

NO and cyanide

89
Q

has high affinity for complex IV (holds O2)

A

cyanide

90
Q

what can happen from administering sodium nitroprusside that causes O2 not to be able to bind complex IV (leading to dissociative shock)

A

cyanide poisoning

91
Q

drug that blocks cyanide from binding complex IV

A

hydroxocobalamin

92
Q

patient will have cherry red hue to them from what

A

cyanide bound to complex IV

93
Q

what has higher affinity for complex IV than cyanide; and how to treat effect of it

A

MetHb; methylene blue to treat Methemoglobinemia

94
Q

how to stop CN- from binding complex IV; and allows O2 to bind

A

sodium nitrite (will produce CN-Hb(Fe3+)

95
Q

hepatic enzyme that will take off CN- from MetHb and convert to sodium thiosulfate

A

Rhodanase

96
Q

kit to give patient in emergency room with cyanide poisoning

A

cyanide kit

97
Q

4 main things you can treat cyanide poisoning with after administering fluids

A

cyanide kit
hydroxocobalamin
sodium nitrite
sodium thiosulfate (has sulfur)

98
Q

in neurogenic shock, what drug to administer to increase HR (due to bradycardia)

A

M-antagonist (ATROPINE)

99
Q

sympathomimetic agent used in anaphylactic shock

A

Epi

100
Q

B1 agonist(Gs—cAMP) that is used in cardiogenic shock

A

Dobutamine

101
Q

how would propranolol affect SVR and CO when patient is in rebound HTN

A

blocking B2 (SVR increases)
blocking B1 (CO decreases)

102
Q

what will reverse effects of sodium nitroprusside overdose (cyanide poisoning)

A

sulfur

CVR Biweekly 2 (15 decks)

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