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CV Quiz 2 > Shock > Flashcards

Shock Flashcards

1
Q

Definition of shock:

A

acute circulatory failure with inadequate or inappropriately distributed tissue perfusion resulting in generalized tissue hypoxia

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2
Q

Name the 6 types of shock:

A

1) hypovolemic 2) cardiogenic 3) distributive (septic, anaphylactic) 4) neurogenic 5) traumatic 6) obstructive

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3
Q

What is the pathophysiology of shock in general?

A

tissue hypoperfusion causing a cellular energy deficit; supply/demand imbalance resulting in neuroendocrine and inflammatory responses

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4
Q

What are the 4 stages of shock?

A

1 initial 2 compensatory 3 progressive 4 refractory

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5
Q

What are the characteristics of the initial stage of shock?

A

Hypo-perfusion, tissue hypoxia, lactic acidosis

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6
Q

What are the characteristics of the compensatory stage of shock?

A

Cytokine release, hyperventilation for CO 2 removal, endogenous catecholamine release (norepinephrine and epinephrine)

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7
Q

What are the characteristics of the progressive stage of shock?

A

Failing compensatory mechanisms, worsening capillary leakage and metabolic acidosis, increased blood viscosity, micro-sludging, worsening organ dysfunction (MODS)

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8
Q

What are the characteristics of the refractory stage of shock?

A

Irreversible organ damage, cell death, degradation of ATP to adenosine

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9
Q

4 different categories of hemodynamic shock?

A

hypovolemic, cardiogenic, distributive, obstructive

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10
Q

Possible causes of hypovolemic shock?

A

hemorrhagic, GI/UT volume loss, third spacing

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11
Q

Cause of cardiogenic shock?

A

myocardial pump failure

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12
Q

Causes of distributive shock?

A

sepsis, anaphylaxis, spinal cord injury, corticosteroid insufficiency

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13
Q

Possible causes of obstructive shock?

A

tamponade, tension pneumothorax, PE all lead to equalization of diastolic pressures with filling pressures

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14
Q

What is the mortality of shock?

A

hypovolemic - variable cardiogenic - 60-90% spetic - 35-40%

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15
Q

What are the determinants of shock?

A

Loss of circulating intravascular volume • Inadequate capillary and tissue perfusion (micro circulation) • Disturbed cell metabolism • Mismatch of oxygen delivery and oxygen demand

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16
Q

The body’s systemic physiological reaction to shock:

A

– Progressive vasoconstriction – Increased blood flow to vital organs: Shunt of skin, acral regions, splanchnic system – Increase in CO/CI – Increase in respiratory rate and tidalvolume – Reduced urine production – Reduction gastric and intestinal activity

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17
Q

What does shock do to the kidneys?

A

Acute kidney injury: tubular necrosis and subsequent kidney failure

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18
Q

What does shock do to the liver?

A

congestion with elevated liver enzymes and coagulopathy

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19
Q

What does shock do to the GI tract?

A

Gastrointestinal ischemia: GI hemmorhage, peritonitis

20
Q

Definition of cardiogenic shock:

A

Protracted severe malperfusion of tissues due to an acute, critical reduction in myocardial pump capacity Need to exclude other correctible factors: hypovolemia, arterial hypoxia, vasovagal rxn

21
Q

What percent of MI pt end up with cardiogenic shock?

A

5-10% and Cardiogenic shock is considered the cause of death in 50-90% of these patients

22
Q

What are the clinical signs of cardiogenic shock?

A

• Signs of centralized circulation and organ dysfunction • Agitation • Pale, cool, clammy skin • Oliguria (< 20ml/h) • RV dysfuntion (e.g. PE, RCA MI) : – Elevated venous pressures, jugular distention • LV dysfunction (e.g. LAD/Cx MI, acute AI/MR): – Pulmonary edema

23
Q

The etiology of cardiogenic shock can be one of two categories:

A

myocardial or mechanical

24
Q

Pathophysiology of ischemic cardiogenic shock?

A

inadequate myocardial perfusion (decreased duration of diastole) excessive increase in myocardial oxygen consumption (tachycardia and increse wall tension) metabolic derangement (lactic acidosis)

25
Q

Activation of SNS during ischemic cardiogenic shock is triggered by what and results in what?

A

triggered by critical decrease in stroke volume causes increased preload and afterload

26
Q

What tests are used to diagnose ischemic cardiogenic shock?

A

• 12-channel- EKG: Signs of ischemia?, arrhythmias ? if Normal EKG: cardiogenic shock due to MI unlikely • Chest X ray • Arterial blood gas (VBG) • Basic chem, CBC, cardiac enzymes • Serial lactate levels (indicator of perfusion)

27
Q

Cardiogenic shock general management goals?

A

Optimize ventricular filling Improve coronary perfusion pressure With acute MI as cause: coronary angiography and immediate revascularization

28
Q

Drugs that can be used to improve coronary perfusion pressure:

A

Vasopressors (norepinephrine, phenylepinephrine) Inotropics (dobutamine, epinephrine, milrione) IABP, mechanical circulatory support

29
Q

What is SIRS?

A

Systemic inflammatory response syndrome

30
Q

What is MODS?

A

Multi organ dysfunction syndrome – inflammatory injury involving more than one vital organ

31
Q

What is the criteria for SIRS?

A

at least 2 of the following criteria • Tachypnea >20 breaths per minute Or PaCO2 < 32 mmHg • WBC < 4000cells/mm3 or > 12000 cells/mm3 • Heart rate > 90 beats per minute • Fever > 38.0 °C (100.4 °F) or hypothermia < 36.0 °C (96.8°F)

32
Q

What is sepsis?

A

SIRS with infection usually with at least one of the following: Alteration in mental state Hypoxemia Elevated plasma lactate level Oliguria

33
Q

What is septic shock?

A

the result of dysfunction of the endothelium and vasculature secondary to circulating inflammatory mediators and hypotension results from failure of the vascular smooth muscle to constrict appropriately

34
Q

What is severe sepsis?

A

sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion

35
Q

What is primary MODS?

A

Direct result of insult, organ dysfunction occurs early in the course and can be directly attributable to insult

36
Q

What is secondary MODS?

A

Consequence of a host response (e.g cytokine release) Inflammatory host response to toxins and other components of microorganisms -> clinical manifestations of sepsis

37
Q

What is cardiogenic shock?

A

defined as circulatory pump failure leading to diminished cardiac output and subsequent tissue hypoxia

38
Q

What are the hemodynamic findings of cardiogenic shock?

A

Hemodynamic criteria include sustained hypotension (SBP <90 mmHg ), reduced cardiac index (<2.2 L/min per square meter), and elevated pulmonary artery wedge pressure (>15 mmHg).

39
Q

What are the causes of cardiogenic shock?

A

Acute myocardial infarction (most common), cardiomyopathies, myocarditis, acute and chronic valve disease, severe arrhythmias, etc.

40
Q

What is obstructive shock?

A

caused by a number of different etiologies that result in mechanical obstruction of venous return decreasing ventricular filling

41
Q

Etiologies of obstructive shock?

A

pericardial tamponade, pulmonary embolism, tension pneumothorax, IVC obstruction, venous air embolism, etc.

42
Q

diminished tissue perfusion as a result of loss of vasomotor tone usually secondary to spinal cord injuries that disrupt sympathetic regulation is what kind of shock?

A

Neurogenic

43
Q

systemic response after trauma, combining the effects of soft tissue injury, long bone fractures, and blood loss is what kind of shock?

A

Traumatic

44
Q

hypoperfusion deficit in traumatic shock is magnified by what?

A

proinflammatory activation that occurs following the induction of shock via inflammatory mediators released in response to tissue injury

45
Q

What is hemorrhagic shock?

A

Loss of oxygen supply/delivery

46
Q

Treatment for hemorrhagic shock?

A

Volume therapy!!!!!
– Cristalloid solutions
– Colloid solutions (HAES)
– PRBC
– FFP
– SDPs
– Small Volume Resuscitation

CV Quiz 2 (16 decks)

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