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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

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2
Q

dissociative shock

A

oxygen getting to cell - but cell cannot utilize it

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3
Q

CO =

A

SV x HR

4-8L/min normal

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4
Q

CI =

A

CO / BSA
-body surface area

2.6-4.2 normal

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5
Q

SV =

A

SV = CO / HR

50-100mL/beat normal

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6
Q

SVR =

A

([MAP - RAP] / CO) x80

afterload heart pumps against

700-1600 dynes normal

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7
Q

PVR =

A

(PAP - PCWP) / CO x 80

20-130 dynes normal

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8
Q

LVSW

A

left ventricular stroke work

SV ( MAP - PCWP) x 0.0136

60-80 normal

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9
Q

RVSW

A

right ventricualr stroke work

SV (PAP - RAP)

10-15 normal

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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

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11
Q

normal JVP height

A

2-4cm

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12
Q

hormone mediating cool and clammy skin

A

epinephrine

body goal - perfuse the brain

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13
Q

mild hypovolemic shock

A

loss <20% blood volume

cool extremity
increased cap refill
diaphoresis
collapsed veins
anxiety
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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

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15
Q

severe hypovolemic shock

A

loss of >40% blood volume

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

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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
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17
Q

class I

A

anxious

normal pulse pressure

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18
Q

class II

A

mild anxious

decreased pulse pressure

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19
Q

class III

A

anxious, confused

decreased pulse pressure

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20
Q

class IV

A

confused, lethargic, coma

decreased pulse pressure

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21
Q

pulse pressure

A

difference between systolic and diastolic

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22
Q

MAP

A

= DBP + 1/3 PP

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23
Q

hypovolemia receptors

A

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

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24
Q

affect of efferents

A

with hypotension

  • increase sympathetics
  • decreased PS

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

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25
hormones on vascular tone
ADH - vasoconstriction ANG II - vasoconstriction
26
how to correct for blood loss
1 renal fluid conservation 2 stimulation of thirst 3 net cap reabsorption (transcapillary refill)
27
what promotes renal retention of Na and H2O
increased sympathetics -renal vasoconstriction > renin release increased ANG II -thirst increase increased aldosterone -Na reabsorption ADH/vasopressin -H2) reabsorption
28
transcapillary refill
correction for blood loss - net reabsorption of fluid - from interstitial fluid > caps - reabsorption of interstitial fluid helps replace lost blood volume result - initial hemodilution
29
mechanism of transcap refill
cap hydrostatic low | -works to promote reabsorption
30
hypovolemic shock
tahycardia hypotension arteriolar vaso and veno constriction oliguria
31
negative feedback mechanisms
compensatory - baroreceptor and chemoreceptor reflexes - transcap reabsorption - renal conservation of Na and water
32
positive feedback mechanisms
de-compensatory - cardiac failure - acidosis - CNS depression decreased coronary perfusion > decreased contractility > futher decreased CO
33
outcome of acute blood loss
depends on gains of different feedback mechanisms balanced between compensatory and de-compensatory mechanisms
34
irreversible hemorrhagic shock
due to multiple failures: - vasoconstrictor response - cap refill - heart failure - CNS response
35
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
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
obstructive shock
tension pneumothorax obstruct vena cava - obstructed preload
37
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
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
give fluid and CO goes own
``` give diuretics (loop - furosemide) -to get rid of fluid ```
39
normal mixed venous SaO2
should be around 70%
40
SVR
should be 700-1600
41
LAFP
should be 8-10
42
frank starling curve
normal LVEDV and SV -increased end diastolic volume > increased SV if heart failure - lose this relationship
43
LV heart failure
elevated PCWP > pulmonary edema due to increased pulmonary cap hydrostatic pressure -promotes increased filtration
44
pulmonary edema on right side of heart
distended jugular veins - pitting edema - hepatomegaly
45
NE
alpha1 with no beta2 vasoconstriction with reflex bradycardia - increased PS
46
Epi
beta 2 vasodilation
47
low dose Epi
increased HR
48
isoproterenol
beta selective -vasodilation refex tachycardia
49
drug for septic shock, cardiogenic shock, pulmonary embolism
norepinephrine adverse - myocardial ischemia, tissue hypoxia, necrosis, decreased urine output, tachyarrhythmia
50
phenylephrine
alpha1 agonist to support BP
51
dopamine
D1 > beta1 > alpha1 increased renal blood flow higher - beta1 inotropic heart effects even higher - alpha1 - vasoconstriction (undesirable effect) monitor BP carefilly
52
dobutamine
beta1 selective agonist -postive inotropic effect short term use - cardiogenic shock, MI, decompensated HF
53
vasopressin
ADH
54
first drug for cardiogenic shock
vasopressor agent first (NE) | -then inotrope (dobutamine)
55
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
septic shock
56
sepsis
SIRS components pulse, temp, RR, WBC tachycardia, tachypnea, fever, elevated WBC two of those and source of infection
57
severe sepsis
organ damage one organ
58
septic shock
hypotension
59
host response
PAMPs - endo and exotoxins trigger TLRs
60
PAMPs
gram + DNA, LP, PG, LTA gram - DNA PG, LPS, flagellin
61
TLR signalling
MyD88 NF-kappa B - transcription factor -pro-inflamatory cytokine incrase and vascular adhesion molecules
62
acute local inflammation
leukocyte extravasation - altered endo cell junctions - warmer, erythema, edema
63
pro-inflammatory cytokines
TNF -alpha IL I IL 6 - recruit neutrophils and monos - activate endo cells - induce apoptosis
64
systemic effects
moderate quantity of TNF brain fever, liver acute phase proteins, bone marrow leukocytes
65
high quantity TNF
septic shock
66
TNF
can activate apoptosis
67
CNS TNF
hypothalamus -febrile response PGE2 - prostaglandin
68
liver IL-6
acute phase response -for opsonization of bacteria clinically - CRP
69
cardio vascular TNF
NO and prostaglandins -hypotension decreased CO - TNF-alpha - induces PS activity - activated vagus nerve
70
iNOS
inducible nitric oxide synthase
71
tissue factor
increased thrombosis | -further ischemia
72
GI effects
more fluid - more bacteria | -to liver
73
elevated mixed venous SaO2
seen in septic shock
74
Tx of septic shock
if hypovolemic - give fluid - see what it does - 2 to 3L - antibiotics - vasopressor - NE
75
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
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
beta blocker with shock
will block the compensatory tachycardia
77
new murmur with inferior MI
papillary muscle - chordae tendinae rupture
78
mixed venous SaO2
low hypovolemic high septic low cardiogenic

PCM II Exam 1 (6 decks)

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