Shock Flashcards
What is shock?
Shock is a state of tissue hypoperfusion due to inadequate oxygen delivery, increased oxygen consumption, or inadequate oxygen utilization, leading to cellular dysfunction and organ failure.
Why is shock a critical medical condition?
Shock can lead to cellular dysfunction, organ failure, and high morbidity and mortality if not identified and treated early.
What are the traditional classifications of shock?
Hypovolemic shock, cardiogenic shock, distributive shock, and obstructive shock.
What causes hypovolemic shock?
It is caused by hemorrhage or fluid loss.
What causes cardiogenic shock?
It occurs due to cardiac pump failure, such as myocardial infarction or arrhythmias.
What causes distributive shock?
It is caused by vasodilation, including septic, anaphylactic, and neurogenic shock.
What causes obstructive shock?
It results from mechanical obstruction to circulation, such as cardiac tamponade or pulmonary embolism.
What is a more modern classification of shock?
Metabolic shock, which results from mitochondrial dysfunction and impaired cellular energy utilization seen in sepsis.
What are the traditional methods of hemodynamic monitoring in shock?
Blood pressure, heart rate, urine output, and mental status.
What are newer methods of hemodynamic monitoring in shock?
Dynamic Fluid Responsiveness Tests (Passive leg raise, PPV, SVV), Advanced Hemodynamic Monitoring (PiCCO, LiDCO, echocardiography), and Microcirculatory Monitoring (Sidestream dark field imaging, sublingual capillary assessment).
What is personalized fluid resuscitation?
A strategy that avoids excessive fluid administration to prevent fluid overload and capillary leak syndrome.
What fluids are preferred in resuscitation?
Balanced crystalloids such as lactated Ringerโs and Plasmalyte are preferred over normal saline.
What is the first-line vasopressor for septic and distributive shock?
Norepinephrine.
What adjunctive agents can be used in catecholamine-resistant shock?
Vasopressin and angiotensin II.
Which inotropic agents are used for cardiogenic shock with low cardiac output?
Dobutamine and milrinone.
What is metabolic resuscitation in shock management?
The use of vitamin C, thiamine, and hydrocortisone in septic shock; sodium bicarbonate therapy in severe lactic acidosis; glucose control with a target blood glucose of 140-180 mg/dL.
What are some novel therapies in shock management?
Immunomodulatory therapies (IL-6 inhibitors, JAK inhibitors), beta-blockade in septic shock (esmolol), hemadsorption and cytokine removal (Polymyxin B, CytoSorb), and gene therapy/stem cell therapy.
What is the role of esmolol in septic shock?
It is used for heart rate control and improving cardiac efficiency.
What is the purpose of hemadsorption and cytokine removal in shock management?
It helps to remove inflammatory mediators using therapies like Polymyxin B hemoperfusion and CytoSorb.
Why is understanding new concepts in shock management important?
To improve patient outcomes through individualized therapy, advanced hemodynamic monitoring, and novel pharmacological interventions.
What is the primary goal in the management of shock?
To restore adequate tissue perfusion and oxygen delivery to prevent organ failure.
What is the minimum mean arterial pressure (MAP) target in shock resuscitation?
MAP > 65 mmHg.
What are the key features of septic shock?
Sepsis with persistent hypotension requiring vasopressors and elevated lactate levels despite fluid resuscitation.
Why is restrictive fluid resuscitation preferred in septic shock?
To prevent fluid overload and capillary leak syndrome while maintaining adequate perfusion.
What is the preferred initial fluid for resuscitation in shock?
Balanced crystalloids such as lactated Ringerโs or Plasmalyte.
What is the role of sodium bicarbonate therapy in shock?
Used in severe lactic acidosis when pH < 7.2 to correct acidosis and improve hemodynamics.
What are some dynamic tests for assessing fluid responsiveness?
Passive leg raise test, pulse pressure variation (PPV), and stroke volume variation (SVV).
What are advanced hemodynamic monitoring techniques used in shock?
PiCCO (Pulse contour cardiac output), LiDCO (Lithium dilution cardiac output), and echocardiography-guided assessment.
What is the function of IL-6 inhibitors like tocilizumab in shock management?
They help modulate the immune response in sepsis-induced immune dysregulation.
How does mitochondrial dysfunction contribute to metabolic shock?
Impaired cellular energy utilization leads to inadequate ATP production and organ dysfunction.
What is the significance of sublingual capillary assessment in shock monitoring?
It provides insights into microcirculatory perfusion and tissue oxygenation.
What is the role of JAK inhibitors in shock management?
They regulate inflammatory pathways in sepsis-induced immune dysregulation.
What are the main components of metabolic resuscitation?
Vitamin C, thiamine, and hydrocortisone.
How does beta-blockade with esmolol benefit patients in septic shock?
It helps control heart rate, improves cardiac efficiency, and reduces oxygen consumption.
What is CytoSorb therapy used for in shock management?
It is used for cytokine removal to modulate the inflammatory response in sepsis and shock.
What is the purpose of early vasopressor use in shock?
To maintain adequate perfusion pressure and prevent prolonged hypotension.
What is the role of gene therapy and stem cell therapy in shock?
They are emerging treatments for mitochondrial dysfunction and endothelial repair.
Why is early identification and treatment of shock crucial?
Delays can lead to irreversible organ damage and increased mortality rates.
What are the common causes of neurogenic shock?
Spinal cord injury, brain trauma, or anesthesia-related autonomic dysfunction.
How does cardiac tamponade lead to obstructive shock?
It compresses the heart, reducing venous return and cardiac output, leading to circulatory collapse.
