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Shock > Shock > Flashcards

Shock Flashcards

0
Q

Define shock

A

Inadequate perfusion of tissue with 02 rich blood

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1
Q

Define perfusion

A

The circulation of blood through an organ or tissue in amounts adequate to meet the body’s demand

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2
Q

What is another name for shock?

A

Hypovolemic shock

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3
Q

Why hemoglobin important?

A

Hemoglobin carries 02 to your cells. Binds to oxygen that is absorbed in the lungs and transports it to the tissues

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4
Q

Components of perfusion?

A

The pump, the fluid, the container

The heart, the blood, blood vessels. They are essential for circulation of oxygenated blood throughout the body

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5
Q

Define stroke volume

A

The amount of blood ejected by the heart in 1 contraction

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6
Q

Define preload

A

Volume of blood delivered to the atria prior to ventricular diastole

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7
Q

Defined afterload

A

Tension developed by the heart during contraction.

Resistance against which the left ventricle must pump and how much effort the ventricle must put forth to force blood into the systemic circulation

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8
Q

Atrial kick

A

Atrial kick occurs at the end of diastole.

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9
Q

Define frank starling mechanism

A

Law that states that the stroke volume of the heart increases in response to an increase in the volume of blood filling the heart

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10
Q

Define cardiac output? Formula? Factors that affect output?

A

The volume of blood moved by the heart in 1 minute

Stoke volume x heart rate

Stoke volume and heart rate directly affect cardiac output

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11
Q

3 layers of an artery?

A

Tunica adventitia, tunica media, tunica intima

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12
Q

What does tunica advenitia do?

A

Allows the arteries to stretch to prevent over expansion due to the pressure that is exerted on the walls by blood flow

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13
Q

What does tunica media do?

A

Controls the lumen size

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14
Q

What is tunica intima?

A

It is in intimate contact with the blood in the lumen

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15
Q

What kind of event is shock?

A

Shock is a cellular event

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16
Q

Where are baroreceptors located?

A

In the arch of the aorta, the carotid artery, and the kidneys

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17
Q

What are baroreceptors?

A

They respond to stretching of the arterial wall and manipulates BP. They are most sensitive to changes in BP. Cause vasoconstriction

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18
Q

Baroreceptors send a message to the brain stem and do what?

A

A message is related to the adrenal glands to secret epinephrine and norepinephrine into the bloodstream.

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19
Q

What are epinephrine and norepinephrine also known as? Where are they secreted and what do they interact with?

A

They are also known as catecholamines and are directly secreted into the blood stream. Eli and norepinephrine interact with alpha 1 and 2 and beta 1 and 2 receptors

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20
Q

What is a beta 2 receptor and where is it located?

A

It causes bronchodilation and located in the lung

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21
Q

In decompensated shock what do the kidneys do?

A

Kidneys stimulates the release of ADH/aldosterone (antidiuretic hormone) and increases the release of renin.

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22
Q

What is rouleaux and what happens?

A

The stacking of RBCs in misshapen chains which cause microemboli

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23
Q

What is the clotting process?

A

Vascular phase (vasoconstriction), platelet phase (agglutination and aggregation), coagulation (release of fibrin, clotting/scab, and dissolution of the clot

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24
Q

What is a transverse wound?

A

Wound is a clean cut, vessels constrict and draw inward

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25
Q

What is a longitudinal wound?

A

Constriction of smooth muscle, which enlarges wound because there is no vessel constriction which causes increased in blood loss. Ex, crushing trauma

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26
Q

What happens with aggressive fluid therapy?

A

Increases bp and can dislodge the clots, fluid dilutes body’s natural clotting factors

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27
Q

Where do baroreceptors send in pluses to?

A

The medulla aka vasomotor center

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28
Q

What nerve controls PNS?

A

The vagus nerve

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29
Q

What is a mechanism of shock?

A

Uncontrolled vasodilation

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30
Q

Types of distributive shocks?

A

Neurogenic, anaphylatic and septic shock

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31
Q

What does renin do and what is it released by?

A

It is a protein released into the bloodstream by the kidneys and responds to changes in BP to main cardiac output

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32
Q

What does aldosterone do?

A

Regulates sodium and potassium levels in the body to control blood pressure and the Balance of fluids and electrolytes

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33
Q

How does aldosterone work on the kidneys?

A

Increases sodium reabsorption into the mood to maintain cardiac output. Enhances potassium elimination in the urine (retains sodium) to raise BP

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34
Q

What does the vasomotor center oversee?

A

Changes in the diameter for the blood vessels. They vasoconstrict

35
Q

The combined effects of alpha and beta stimulation help the body increase its ______ supply by converting glycogen to glucose.

A

Energy

36
Q

What type of metabolism is being used in compensated shock?

A

Cellular metabolism, aerobic

37
Q

What is kerbs cycle?

A

Series of chemical reactions that release chemical energy in the form of ATP

38
Q

As shock continues stimulus to what system increases?

A

The sympathetic nervous system

39
Q

In decompensated shock, the kidneys kick into high gear and stimulate the release of what?

A

ADH/aldosterone

40
Q

The kidneys also increase the release of what?

A

Renin

41
Q

The release of ADH/aldosterone and renin causes increase vasoconstriction to support what?

A

Preload and stroke volume

42
Q

Which hormone conserves sodium in the kidneys to conserve body water?

A

Aldosterone

43
Q

Aldosterone helps to support what?

A

Preload and stroke volume to help cardiac output

44
Q

In decompensated shock, cells and tissues become subject to increasing?

A

Hypoxemia

45
Q

In decompensated shock, the body has transitioned into what type of metabolism?

A

Anaerobic

46
Q

Define anaerobic metabolism

A

Massive amounts of waste products are produced and less ATP if created. Metabolic acids build in the body

47
Q

As metabolic acids build up in the resp system, attempts to compensate by doing what to the resp?

A

Increasing rate and depth of ventilation

48
Q

Shock continues by increasing vasoconstriction and it constricts the pre capillary sphincters which do what?

A

Shunts blood to your vital organs but traps remaining blood in capillary beds

49
Q

What happens to O2 stores in increasing shock and what happens to wastes?

A

O2 stores are rapidly depleted and waste products quickly build

50
Q

How does cellular damage occur in irreversible shock?

A

Continued buildup of metabolic acids and worsening pH

51
Q

What happens to remaining circulating blood in irreversible shock?

A

Blood becomes toxic to surrounding cells

52
Q

What happens to cell membranes in irreversible shock, what do they release, where does the fluid leak? What is the medical term for this process?

A

Cell membranes break down releasing lysosomal enzymes. The fluid leaks into interstitial space and causes microcirculation

53
Q

Once the capillary sphincters become ineffective what does this process lead to?

A

Capillary washout. It’s the release of highly toxic capillary blood into the already acidic circulation

54
Q

Define blood

A

A slurry of cells, protein, water and suspended elements

55
Q

Renin is released into the blood stream by what?

A

The kidneys

56
Q

What does renin respond to?

A

Changes to BP

57
Q

Renin stimulates the release of what?

A

Aldosterone from adrenal cortex

58
Q

What does aldosterone do?

A

Helps regulate sodium and potassium levels in the blood

59
Q

How does aldosterone work on the kidneys?

A

Increases sodium reabsorption into the blood to maintain cardiac output. It enhances potassium elimination in the urine

60
Q

What is the first and most common sign of shock?

A

Tachycardia

61
Q

How does a patient present in compensated shock?

A

Anxious, agitated and combative

62
Q

What happens to BP and RR in compensated shock?

A

Narrowing pulse pressure and increase in resp

63
Q

How does a patient present in decompensated shock?

A

Confused, disorientated, sense of impending doom

64
Q

What happens to BP and HR in decompensated shock?

A

BP drops precipitously >90 torr. HR decreases and it’s difficult to palpate

65
Q

How does a patient present in irreversible shock?

A

Unresponsive

66
Q

How does BP, HR and RR present in irreversible shock?

A

BP and HR disappear. RR are agonal, gasping and eventually cease.

67
Q

Define hypoxia at cellular level

A

Further buildup of metabolic acids and other wastes caused by anaerobic metabolism and systemic acidosis

68
Q

What causes hypovolemic shock and what’s the common cause?

A

Fluid loss due to blood, plasma and body water. Trauma is the most common cause

69
Q

Unexplained shock is best attributed to what kind of trauma?

A

Abdominal

70
Q

Define distributive shock

A

Widespread dilation of the resistance vessels, capacitance vessels or both

71
Q

Define neurogenic shock

A

Inhibition of the sympathetic nervous system. Loss of sympathetic tone. The parasympathetic continues without balance.

72
Q

How will BP and HR present in neurogenic shock?

A

BP and pulse will be slow

73
Q

Define anaphylatic shock

A

A person reacts violently to a substance in which they have been sensitized.

74
Q

What does the release of histamine cause?

A

Severe systemic vasodilation, swelling, flushing, urticaria can airway edema and swelling

75
Q

Define septic shock

A

Caused by massive infection. Toxins interfere with the vascular system ability to control and distribute blood. Vasodilation and vasopermeability

76
Q

How does BP present in septic shock?

A

Early BP there is an increase is cardiac output. Loss of peripheral vascular resistance. Late -hypotension, precipitous fall in BP.

77
Q

What can cardiogenic shock cause?

A

Pulmonary edema

78
Q

Define cardiogenic shock

A

Abnormal heart function due to failure of heart muscle, AMI, vascular insufficiency and rhythm disturbances.

79
Q

what percentage of damage is done to the left ventricle in cardiogenic shock?

A

40%

80
Q

What are some causes of obstructive shock?

A

Tension pneumo, cardiac tamponade, pulmonary edema, cardiac contusion and possible aortic dissection

81
Q

What does MODS stand for?

A

Multiple organ dysfunction syndrome.

82
Q

What is mods?

A

When enough cells die that the organs fail. Progressive impairment of 2 or more organ systems due to uncontrolled inflammatory response.

83
Q

What are the two most common causes of mods?

A

Septic shock and sepsis

84
Q

What is the pathophysiology of mods?

A

Microvascular thrombus form leading to tissue ischemia and the organ ultimately dies.

85
Q

How do patients with mods present?

A

Cannot maintain BP, fever, tachycardia, dyspnea, necrosis of kidneys and liver

Shock (2 decks)

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