Brainscape's Knowledge GenomeTM

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


See full index

Cardiovascular System > Shock > Flashcards

Shock Flashcards

1
Q

What is shock?

A

Inadequate tissue perfusion marked by decreased delivery of required metabolic substrates and inadequate removal of cellular waste products

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

Untreated shock leads to…

A

Organ dysfunction, organ failure, and death

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

6 types of shock?

A

Hypovolemic

Cardiogenic

Septic

Neurogenic

Traumatic

Obstructive

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

What are the four different categories of shock based on hemodynamic findings?

A

Hypovolemic (hemorrhagic, GI/UT volume loss, third spacing)

Cardiogenic (myocardial pump failure)

Distributive (sepsis, anaphylaxis, spinal cord injury, corticosteroid insufficiency)

Obstructive (cardiac tamponade, tension pneumothorax, PE)

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

Hypovolemic shock

HR:

MAP:

CVP:

PAOP:

SVR:

A

HR: high

MAP: low

CVP: low

PAOP: low

SVR: high

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

Cardiogenic Shock (Left ventricular failure)

HR:

MAP:

CVP:

PAOP:

SVR:

A

HR: Increased

MAP: Variable

CVP: normal

PAOP: High

SVR: High

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

Cardiogenic shock (right ventricular failure)

HR:

MAP:

CVP:

PAOP:

SVR:

A

HR: High

MAP: variable

CVP: High

PAOP: Normal

SVR: High

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

Cardiogenic Shock (Biventricular failure)

HR:

MAP:

CVP:

PAOP:

SVR:

A

HR: High

MAP: Variable

CVP: High

PAOP: High

SVR: High

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

Distributive Shock (Early vs Late)

HR:

MAP:

CVP:

PAOP:

SVR:

A

HR: Both High

MAP: Both Low

CVP: low or normal (early); high or normal (late)

PAOP: Low or normal (early); high or normal (late)

SVR: Low for both

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

Obstructive shock

HR:

MAP:

CVP:

PAOP:

SVR:

A

HR: high

MAP: low

CVP: high

PAOP: high

SVR: high

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

Chance of mortality with shock

Hypovolemic:

Cardiogenic:

Septic:

A

Hypovolemic: Very variable

Cardiogenic: 60%-90%

Septic: 35% - 40%

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

What are some determinants of shock?

A
  • Loss of circulating intravascular volume
  • Inadequate capillary and tissue perfusion
  • Disturbed cell metabolism
  • Mismatch of oxygen delivery and oxygen demand
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the four stages of shock?

A

Initial

Compensatory

Progresive

Refractory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What happens during each stage of shock?

Initial:

Compensatory:

Progressive:

Refractory:

A

Initial: hypo-perfusion, tissue hypoxia, lactic acidosis

Compensatory: cytokine release, hypervent. endogenous catecholamine release

Progressive: failing compensation, capillary leakage and metabolic acidosis, increased blood viscosity, organ dysfunction (MODS)

Refractory: irreversible organ damage, cell death, degradation of ATP

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

What is the systemic response to shock?

A
  • Progressive vasoconstriction
  • Increased BF to vital organs
  • Increase in CO/CI
  • Increase in respiratory rate and tidal volume
  • Reduced urine production
  • Reduction in gastric and intestinal activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What types of organ dysfunction are associated with shock?

A

Acute kidney injury

Liver congestion

Gastrointestinal ischemia

ARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is cardiogenic shock?

A

Critical reduction in myocardial pump capacity (loss of > 40%) leading to malperfusion of tissues

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

What differential factors should be excluded in cardiogenic shock?

A

Hypovolemia

Arterial hypoxia

Vasovagal reaction

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

What percentage of patients with acute MI develop a cardiogenic shock?

A

5-10%

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

What are some of the clinical signs of cardiogenic shock?

A
  • Signs of centralized circulation and organ dysfunction
  • Agitation
  • Pale, cool, clammy skin
  • RV dysfunction
  • LV dysfunction (leads to pulmonary edema)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hemodynamic effects of Cardiogenic shock?

A

Systolic BP < 90mmHG or blood pressure drop by 30mmHG for > 30 min

May need inotropic therapy or balloon pump to stabilize BP

Increased LVEP

Reduced cardiac index

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

Myocardial etioligies of Cardiogenic shock

A

Acute MI

Myocarditis

Cardiomyopathy

RV pump failure

Myocardial depressoin

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

Mechanical etiologies of cardiogenic shock

A

Acute mitral insufficiency

Aortic insufficiency

Rupture of ventricular septum

Rupture of free ventricular wall

Obstruction

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

Ischemic Cardiogenic shock progression

A

Decreased perfusion → Cardiac injury → Decreased stroke volume → Increased catecholamines → increased Heart rate → decreased perfusion… etc

25
In Cardiogenic shock, the duration of diastole ______ due to \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_
decreases; compensatory tachycardia
26
In cardiogenic shock, what causes metabolic derangement?
Lactic acidosis due to systemic tissue malperfusion → cardiac dysfunction
27
What are some compensatory mechanisms for cardiogenic shock? What is the trigger?
Trigger: critical decrease in SV Activation of sympathetic nervous system Result in increased HR, increase SVR, increased catecholamine release (RAA system), aldosterone, and baroreceptor mediated ADH release
28
Overall results of compensatory mechanisms in cardiogenic shock
Increased preload and afterload - leads to worsening of myocardial function
29
Diagnostic tests for cardiogenic shock
EKG Chest x-ray arterial blood gas (VBG) CBC, cardiac enzymes Serial lactate levels
30
What are cardiac biomarkers with STEMI?
Cardiac troponin (higher with reperfusion) CKMB (higher with no reperfusion)
31
What are the goals for management of cardiogenic shock?
Optimize ventricular filling Improve coronary perfusion pressure with: vasopressors, inotropics, IABP If acute MI is the cause: coronary angiography and immediate revascularization
32
Vasoactive drugs ## Footnote Inconstrictors (inotropic action + peripheral alpha 1 adrenergic induced vasoconstriction): Inodilators (inotropic action + peripheral beta 2 adrenergic induced vasodilation):
* Inoconstrictors * Norepinephrine * Epinephrine * Dopamine * Inodilators * Dobutamine * Dopexamine * Isoproterenol * Milrinone
33
What is SIRS and what type of shock is it associated with?
Systemic inflammatory response syndrome - septic shock
34
What is MODS
multi-organ dysfunction syndrome - also associated with septic shock
35
SIRS diagnosis has what criteria? How many does it have to meet for diagnosis?
Tachypnea (\>20 breath per minute or PACO2 \< 32mmHg) WBC \< 4000cells or \> 12000 cells Heart rate \> 90bpm Temperature: fever\> 100.4º or hypothermia \< 96.8º Must meet at least 2 of the criteria
36
What manifestations of inadequate organ perfusion are found in Sepsis?
Alteration in mental state Hypoxemia Elevated plasma lactate level Olliguria (low urine output)
37
What are the characteristics of septic shock?
Persistent arterial hypotension **Despite adequate fluid resuscitation** in severe sepsis Tissue hypoperfusion Culture positive bacteremia in 30-50% of cases
38
What are Primary and Secondary MODS?
* Primary * Direct result of insult, organ dysfunction occurs early in the course * Secondary * Consequence of a host response * Inflammatory host response to toxins and other components of microorganisms
39
What are some causes of septic and vasodilatory shock?
* Systemic response to infection * Pancreatitis * Burns * Anaphylaxis * Hemorrhagic shock * Acute adrenal insufficiency
40
What are the recommendations for sepsis?
Initial resuscitation Screening of at risk patients Antimicrobial therapy Source control Infection prevention
41
Septic shock treatment (within 3 hours)
1. Measure lactate level 2. Obtain blood cultures prior to administration of antibiotics 3. Administer broad spectrum antibiotics 4. Administer crystalloid for hypotension or lactate
42
Septic shock treatment (to be complete within 6 hours)
1. Apply vasopressors (for hypotension) 2. In the event of persistent hypotension despite resuscitation 1. measure CVP 2. Measure central venous oxygen saturation 3. Remeasure lactate if initial lactate was elevated
43
How is initial resuscitation performed in septic shock patients?
Crystalloids Hydroxyethyl starches (increased incidence of renal failure) Albumin suggested in severe sepsis and septic shock when patients **require substantial amounts** of crystalloids
44
What is the first choice vasopressor for septic shock? whats is the second choice? Which is only in very select patients?
Norepinephrine = first choice Epinephrine = second choice Dopamine only in very select patients
45
When would you use inotropic support in septic shock?
In case of myocardial dysfunction (dobutamine)
46
What is hypovolemic shock?
Traumatic or hemmorhagic shock caused by burns or dehydration
47
Describe the progression of traumatic shock
Soft tissue or bony injury lead to activation of inflammatory cells and release of inflammatory mediators → Combined inflammatory response and effects of hemorrhage create a more complex and amplified deviation from hemostasis
48
Hemorrhagic shock occurs with a loss of _____ supply and delivery
oxygen
49
Oxygen delivery is calculated from ___ x ______ x 10
CO x arterial oxygen content x 10
50
How many classes of hemorrhage exist? What is their order from least blood lost to most?
* Class I (\< 750 ml - \<15%) * Class II (750 - 1500 ml - 15-30%) * Class III (1500-2000ml - 30-40%) * Class IV (\>2000ml - \>40%)
51
What therapy is used for hemorrhagic shock?
* Volume therapy * Cristalloid solutions * Colloid solutions * PRBC * FFP * SDPs * Small volume resuscitation
52
What is obstructive shock?
Form of cardiogenic shock that results from mechanical impediment to circulation Depressed cardiac output rather than primary cardiac failure
53
What are etiologies associated with obstructive shock?
Pulmonary embolism or tension pneumothorax
54
What is Neurogenic shock?
Profound vasodilation of arterial and venous blood vessels caused by injury of the brain stem, the spinal cord or traumatic brain injury
55
What is anaphylactic shock?
Distributive disturbance of the blood volume or physical, chemical or osmotic induced - hypersensitivity reaction
56
What is IgE-dependent anaphylactic shock What is IgE independent anaphylactic shock
IgE dependent = type-I-allergic anaphylactic IgE independent = anaphylactoid
57
Anaphylactic shock classification
Class 0 - locally limited cutaneous reaction Class 1 - disseminated cutaneous reaction Class 2 - Hemodynamic dyregulation Class 3 - Shock, bronchospasm Class 4 - Respiratory and circulatory arrest
58
Therapy for anaphylactic shock?
Rapid infusion of cristalloid (or colloid) solutions Epinephrine (for bronchodilation, positive inotrope, anti inflamm) Norepinephrine (refractory hypotension) Vasopressin
59
Hemodynamic Responses to different types of shock?

Cardiovascular System (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions