Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PCM II Exam 1 > Shock > Flashcards

Shock Flashcards

1
Q

shock

A

inability to deliver or utilize oxygen by body

produces substance - lactic acid - measurable in blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

dissociative shock

A

oxygen getting to cell - but cell cannot utilize it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CO =

A

SV x HR

4-8L/min normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CI =

A

CO / BSA
-body surface area

2.6-4.2 normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SV =

A

SV = CO / HR

50-100mL/beat normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SVR =

A

([MAP - RAP] / CO) x80

afterload heart pumps against

700-1600 dynes normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PVR =

A

(PAP - PCWP) / CO x 80

20-130 dynes normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

LVSW

A

left ventricular stroke work

SV ( MAP - PCWP) x 0.0136

60-80 normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

RVSW

A

right ventricualr stroke work

SV (PAP - RAP)

10-15 normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

25yo gunshot wound abdomen, anxious, collapsed neck veins, abdomen distended, cool and clammy, cap refill 4-5 seconds

A

hypovolemic

EGK - supraventricular tachycardia - compensating for being in shock
-also ST depression ischemic event

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

normal JVP height

A

2-4cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

hormone mediating cool and clammy skin

A

epinephrine

body goal - perfuse the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

mild hypovolemic shock

A

loss <20% blood volume

cool extremity
increased cap refill
diaphoresis
collapsed veins
anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

moderate hypovolemic shock

A

loss 20-40% blood volum

cool, increased cap refill, diaphoresis, collapsed veins, anxiety

also tachypnea, tachycardia, oliguria, postural changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

severe hypovolemic shock

A

loss of >40% blood volume

same as other two, plus hemo instability, hypotension, mental status deterioration (coma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ATLS class of shock

A 
class I - loss 750mL blood
class II - loss 750-1500 mL
class III - loss 1500-2000 mL
class IV - loss >2000mL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

class I

A

anxious

normal pulse pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

class II

A

mild anxious

decreased pulse pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

class III

A

anxious, confused

decreased pulse pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

class IV

A

confused, lethargic, coma

decreased pulse pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

pulse pressure

A

difference between systolic and diastolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

MAP

A

= DBP + 1/3 PP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

hypovolemia receptors

A

high pressure baroreceptors
low pressure baroreceotprs
renal JG apparatus
central.peripheral chemocreceptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

affect of efferents

A

with hypotension

  • increase sympathetics
  • decreased PS

effectors - increased HR, contractility, TPR, circulating epinephrine, renin, sweat gland activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

hormones on vascular tone

A

ADH - vasoconstriction

ANG II - vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

how to correct for blood loss

A

1 renal fluid conservation
2 stimulation of thirst
3 net cap reabsorption (transcapillary refill)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what promotes renal retention of Na and H2O

A

increased sympathetics
-renal vasoconstriction > renin release

increased ANG II
-thirst increase

increased aldosterone
-Na reabsorption

ADH/vasopressin
-H2) reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

transcapillary refill

A

correction for blood loss

  • net reabsorption of fluid
  • from interstitial fluid > caps
  • reabsorption of interstitial fluid helps replace lost blood volume

result - initial hemodilution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

mechanism of transcap refill

A

cap hydrostatic low

-works to promote reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

hypovolemic shock

A

tahycardia
hypotension
arteriolar vaso and veno constriction
oliguria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

negative feedback mechanisms

A

compensatory

  • baroreceptor and chemoreceptor reflexes
  • transcap reabsorption
  • renal conservation of Na and water
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

positive feedback mechanisms

A

de-compensatory

  • cardiac failure
  • acidosis
  • CNS depression

decreased coronary perfusion > decreased contractility > futher decreased CO

33
Q

outcome of acute blood loss

A

depends on gains of different feedback mechanisms

balanced between compensatory and de-compensatory mechanisms

34
Q

irreversible hemorrhagic shock

A

due to multiple failures:

  • vasoconstrictor response
  • cap refill
  • heart failure
  • CNS response
35
Q

55yo M stabbed 5th ICS MAL, pain in left chest, diminished heart sounds, no murmurs, decreased breath sounds on left with rhonchi, JVP 5cm, trachea midline

A

X-ray - deteriorates to code

EKG - electrical alterans - cadiac tamponade

ventricle can’t expand - low diastolic filling (obstructive shock**) - to inflow into ventricle

Tx - pericardiocentesis

36
Q

obstructive shock

A

tension pneumothorax

obstruct vena cava - obstructed preload

37
Q

50yo M - left chest pain radiates to left arm and jaw

  • with exercises, stress
  • always went away with rest, but not now
  • tobacco use, hyperlipidemia
  • JVD, cyanotic, basilar rales, peripheral pulses weak
  • cool and clammy, edema
A

cardiogenic shock
-100cc fluid challenge with shock patients

EKG - anterior/lateral MI
-vessel left main possible

LAFP 22
SVR 1500
mixed venous SaO2 - 55%

38
Q

give fluid and CO goes own

A 
give diuretics (loop - furosemide)
-to get rid of fluid
39
Q

normal mixed venous SaO2

A

should be around 70%

40
Q

SVR

A

should be 700-1600

41
Q

LAFP

A

should be 8-10

42
Q

frank starling curve

A

normal LVEDV and SV
-increased end diastolic volume > increased SV

if heart failure - lose this relationship

43
Q

LV heart failure

A

elevated PCWP
> pulmonary edema due to increased pulmonary cap hydrostatic pressure
-promotes increased filtration

44
Q

pulmonary edema on right side of heart

A

distended jugular veins

  • pitting edema
  • hepatomegaly
45
Q

NE

A

alpha1 with no beta2

vasoconstriction with reflex bradycardia - increased PS

46
Q

Epi

A

beta 2 vasodilation

47
Q

low dose Epi

A

increased HR

48
Q

isoproterenol

A

beta selective
-vasodilation

refex tachycardia

49
Q

drug for septic shock, cardiogenic shock, pulmonary embolism

A

norepinephrine

adverse - myocardial ischemia, tissue hypoxia, necrosis, decreased urine output, tachyarrhythmia

50
Q

phenylephrine

A

alpha1 agonist

to support BP

51
Q

dopamine

A

D1 > beta1 > alpha1

increased renal blood flow

higher - beta1 inotropic heart effects

even higher - alpha1 - vasoconstriction (undesirable effect)

monitor BP carefilly

52
Q

dobutamine

A

beta1 selective agonist
-postive inotropic effect

short term use - cardiogenic shock, MI, decompensated HF

53
Q

vasopressin

A

ADH

54
Q

first drug for cardiogenic shock

A

vasopressor agent first (NE)

-then inotrope (dobutamine)

55
Q

70yo F RUQ, pain, fever, chills, DM II, HTN
-jaundice, icterus, dry mucous membrane, collapsed jugular veins, rhonchi both lung fields, peripheral pulses intact, distended abdomen, RUQ tenderness, hepatomegaly, warm and flushed, dry

A

septic shock

56
Q

sepsis

A

SIRS components

pulse, temp, RR, WBC

tachycardia, tachypnea, fever, elevated WBC

two of those and source of infection

57
Q

severe sepsis

A

organ damage one organ

58
Q

septic shock

A

hypotension

59
Q

host response

A

PAMPs - endo and exotoxins

trigger TLRs

60
Q

PAMPs

A

gram +
DNA, LP, PG, LTA

gram -
DNA PG, LPS, flagellin

61
Q

TLR signalling

A

MyD88

NF-kappa B - transcription factor

-pro-inflamatory cytokine incrase and vascular adhesion molecules

62
Q

acute local inflammation

A

leukocyte extravasation

  • altered endo cell junctions
  • warmer, erythema, edema
63
Q

pro-inflammatory cytokines

A

TNF -alpha
IL I
IL 6

  • recruit neutrophils and monos
  • activate endo cells
  • induce apoptosis
64
Q

systemic effects

A

moderate quantity of TNF

brain fever, liver acute phase proteins, bone marrow leukocytes

65
Q

high quantity TNF

A

septic shock

66
Q

TNF

A

can activate apoptosis

67
Q

CNS TNF

A

hypothalamus
-febrile response

PGE2 - prostaglandin

68
Q

liver IL-6

A

acute phase response
-for opsonization of bacteria

clinically - CRP

69
Q

cardio vascular TNF

A

NO and prostaglandins
-hypotension

decreased CO

  • TNF-alpha - induces PS activity
  • activated vagus nerve
70
Q

iNOS

A

inducible nitric oxide synthase

71
Q

tissue factor

A

increased thrombosis

-further ischemia

72
Q

GI effects

A

more fluid - more bacteria

-to liver

73
Q

elevated mixed venous SaO2

A

seen in septic shock

74
Q

Tx of septic shock

A

if hypovolemic - give fluid

  • see what it does
  • 2 to 3L
  • antibiotics
  • vasopressor - NE
75
Q

75yo M hematemesis, abdominal discomfort, feels hot, cheat pain and nausea, two previous MIs, HTN

anxious, JVP normal, rhonchi and wheezes, holosystolic murmur LSB

non-distended abdomen, weak thready pulse, cool moist skin

A

EKG - inferior and posterolateral MI
-circumflex a

new murmur - pap muscle rupture with inferior MI

cardiogenic shock

PCWP - left atrial pressure - high

Tx - needs fluid - more preload to drive ventricle - to increase CO
-pressor

76
Q

beta blocker with shock

A

will block the compensatory tachycardia

77
Q

new murmur with inferior MI

A

papillary muscle - chordae tendinae rupture

78
Q

mixed venous SaO2

A

low hypovolemic
high septic
low cardiogenic

PCM II Exam 1 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions