Shock

Question 1

Shock is

Answer 1

Lack of tissue perfusion
Deficient oxygen delivery
Cells cannot undergo metabolism
Cell damage and death

Question 2

Causes of shock

Answer 2

Hypovolemic shock
Cardiogenic shock
Vasogenic shock

Question 3

Hypovolemic shock is

Answer 3

Most common
Loss in blood/fluid volume → inadequate circulatory volume → hypotension → decreased perfusion
Loss of plasma volume
Hemorrhagic shock- acute blood loss

Question 4

Cardiogenic shock

Answer 4

Inefficient contraction of the heart → blood is no longer moved efficiently throughout the body → hypotension → decreased perfusion
End stage chronic heart failure (CHF), arrhythmias, cardiac neoplasia, pericardial effusion, trauma, severe bradycardia

Question 5

Vasogenic or disributive shock is

Answer 5

Profound dilation of the blood vessels→ blood pools in the capillaries → hypotension → decreased perfusion
Many underlying causes

Question 6

Anaphylactic shock causes and is caused by

Answer 6

Vasogenic shock
histamine is released and enters systemic circulation → widespread dilation of the capillaries

Question 7

Endotoxic shock causes and is caused by

Answer 7

Vasogenic shock
severe Gram negative bacterial infection → release of endotoxin →> endotoxin enters the circulation and turns on inflammation

Question 8

Neurogenic shock causes and is caused by

Answer 8

Vasogenic shock
trauma to the brain and/or spinal cord → disruption of the ANS → lack of sympathetic innervation causes loss of vascular resistance (i.e., lack of vasoconstriction in the capillaries, especially in the GI tract and skin)
There may also be a slowing down of the heart that also occurs (this would be a cardiogenic component)

Question 9

Septic shock causes and is caused by

Answer 9

Vasogenic shock
systemic infection → widespread inflammatory response
Perforated GI foreign bodies, neonatal foal sepsis, and other very severe infections

Question 10

Disrubution shock causes and is caused by

Answer 10

has many causes that are not related to inflammation
Severe hypothermia, overdose with an inhalant anesthetic

Question 11

What to do when a pet is in shock

Answer 11

ALWAYS AN EMERGENCY
Patient needs to be continuously monitored till stable or deceased
Get a vet
Secure IV access
Shock rate fluids
Stop any bleeding
100% oxygen
Restore acid/base and electrolyte imbalances
Start monitoring vitals
Treat underlying problem

Question 12

Shock fluid rate for dog

Answer 12

90mL/kg

Question 13

Shock fluid rate for cat

Answer 13

50mL/kg

Question 14

Shock volume for LA

Answer 14

80mL/kg

Question 15

How to give fluids to something in shock

Answer 15

Give first ¼ of the bolus as fast as you can
Assess vitals → If systolic BP is still < 90 mmHg or MAP <60 mmHg, give the next ¼ of the bolus…assess… Allow 20 minutes between boluses (if possible) so fluids can stabilize
Continue until normal pressures reached
Then go to M+R+O
Dorsopedal pulse can be used for blood pressure, if you can feel it the MAP should be above 60

Question 16

The goal when responding to shock

Answer 16

The goal is to return blood pressure to the normal range as quickly as possible
We want to restore tissue perfusion and reduce ischemia

Question 17

Compensatory shock steps and signs

Answer 17

Trigger
Drop in BP
Compensatory mechanisms kick in
Norm BP
CRT >2sec
MM-(pale) pink
Norm temp
Inc HR, Inc RR

Question 18

Non-compensatory shock steps and signs

Answer 18

IV. No longer able to compensate
V. Blood flow shifts to heart and brain
VI. ISchemic damage to other organs
VII. Acidosis
VIII. Myocardial dysfunction
IX. CV system collapse
X. Death
Decreased BP
CRT >2 sec
MM– pale, white, cyanotic, muddy
Cool (inside mouth, extremities, core)
Inc HR, Inc RR; then Dec HR, Dec RR
Weak pulse
Stupor to coma