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Mechanisms of Disease > Shock > Flashcards

Shock Flashcards

1
Q

What is “third spacing”?

A

Fluid (not blood) escapes from blood into extravascular space.

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2
Q

How is hypovolemia manifested? (4 things)

A

Tachycardia (bradycardia in cats)
Prolonged CRT
Poor peripheral pulses
Decreased urine output

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3
Q

What are 3 causes of hypovolemia?

A

Blood loss
Severe dehydration
Redistribution of fluids in the body

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4
Q

What causes circulatory shock?

A

Intravascular compromise

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5
Q

What does hypovolemic shock result in?

A

Inability of the body to perform circulatory functions.

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6
Q

What are the 3 failures of the CV system?

A

Failure of the pump
Failure of the tubing
Failure of the fluid

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7
Q

Failure of the pump = ?

A

Cardiogenic shock

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8
Q

Failure of the tubing = ?

A

Distributive shock

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9
Q

Failure of the fluid = ?

A

Hypovolemic shock

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10
Q

What are the 5 classifications of circulatory shock?

A 
Hypovolemic
Cardiogenic
Vasodilatory or distributive
Obstructive
Combination
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11
Q

What are 3 types of fluid loss?

A

Hemorrhagic
Non-hemorrhagic
Redistribution (edema)

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12
Q

Which type of circulatory shock is most commonly associated with sepsis?

A

Vasodilatory or distributive shock

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13
Q

When do you see obstructive shock? (4 things)

A

GDV
Pericardial effusion
Venous thrombosis
Tension pneumothorax

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14
Q

What are 3 things that cause cardiogenic shock?

A

Severe acquired heart disease
Severe congenital heart disease
Anesthetic overdose

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15
Q

Where is the obstruction usually in obstructive shock?

A

In the venous return

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16
Q

How do you fix obstructive shock?

A

Remove the obstruction and use IV fluids

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17
Q

What causes vasodilatory/distributive shock?

A

Inflammatory mediators associated with SIRS (systemic inflammatory response syndrome)

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18
Q

What are the major causes of vasodilatory.distributive shock? (6 things)

A 
Sepsis
Endotoxemia
Massive muscle trauma
Emboli
Thrombi
Anaphylaxis
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19
Q

What is sepsis?

A

Systemic infection

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20
Q

What is severe sepsis?

A

Sepsis + dysfunction of one or more organs

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21
Q

What is septic shock?

A

Body reacts via immune and inflammatory responses when cell wall of G- bacteria is destroyed.

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22
Q

T/F: G- bacteria don’t normally live in the gut.

A

False

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23
Q

Can G+ bacteria cause sepsis?

A

Yes

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24
Q

What are the two phases of sepsis?

A

Hyperdynamic/warm

Hypodynamic/cold

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25
What is the hyperdynamic phase of sepsis? (6 things)
``` High cardiac output low peripheral resistance Leaky capillaries Increased HR, RR, temp Rapid CRT Red MM ```
26
T/F: Hyperdynamic phase is commonly seen in cats?
No, Hypodynamic phase is common in cats. Hyperdynamic phase is rarely seen in cats.
27
What is the goal in the hyperdynamic phase?
Body is trying to compensate and overcome the sepsis.
28
What is the hypodynamic phase of sepsis? (5 things)
``` Low cardiac output Increased peripheral resistance Decreased BP, HR, Central Venous Pressure Weak pulse Pale to cyanotic MM and prolonged CRT ```
29
What does the hypodynamic phase of sepsis become?
MODS (Multiple Organ Dysfunction Syndrome)
30
Can different shocks overlap?
Yes
31
What percentage of BW in dogs and large animals is blood?
8-9% (80-90mL/kg)
32
What percentage of BW in cats is blood?
5-6% (50-60mL/kg) *Note: for this class, use 45mL/kg
33
T/F: It's 50:50 RBCs:plasma
True
34
What happens in the compensated stage of shock?
Blood volume decreases = decreased vessel filling = activation of stretch and barroreceptors = increased sympathetic stimulation and vasoconstriction
35
What are the shock organs of dogs?
GI and Liver
36
What are the shock organs of horses?
GI and Lung
37
What are the shock organs of cats, ruminants and pigs?
Just the lungs
38
What happens in the decompensated stage of shock?
Local tissues that were vasoconstricted begin to vasodilate causing blood to pool and maldistribution.
39
What are the clinical signs of hypovolemic shock? (5 things)
``` Tachycardia in dogs/Bradycardia in cats Pale MM Prolonged CRT Cool limbs Weak pulse (MAP <70mmHg) ```
40
What are the clinical signs of cardiogenic shock?
Signs overlap with hypovolemia Look for signs of heart failure (loud murmur, arrhythmia, history of heart disease)
41
How do you treat hypovolemic, non-hemorrhaagic shock?
Rapid fluid replacement if no head or lung injury with a large bore, short IV catheter
42
What fluids would you use with hypovolemic shock?
Crystalloids
43
What hypovolemic patients would you give 0.9%NaCl?
Patients with projectile vomiting or metabolic alkalosis (because 0.9%NaCl is more acidic)
44
What are the fluid rates for shock patients?
Dogs: 90mL/kg/hr Cats: 45mL/kg/hr
45
How do you administer fluids to a shock patient?
``` First 1/4 of calculated dose ASAP Reassess perfusion (HR, BP, CRT, urine output) Adjust rate (give rest of dose over next hour OR give 1/4 shock dose boluses every 15 minutes followed by reassessment) ```
46
Why do you give 1/4 bolus treatment to shock patient?
First 1/4 treats perfusion issue, the rest helps treat interstitial dehydration
47
Do you give a shock dose if the dog is anemic?
Yes, if dog is in shock. If dog is obviously anemic, then hemorrhagic hypovolemic shock is present and a transfusion will be necessary.
48
What fluid types would you use in a dog that is shocky and anemic?
Crystalloids for shock, and add in colloid to help restore oncotic pressure and prevent interstitial edema.
49
Do you give a shock dose to a dog who has low albumin?
Yes, but use crystalloid for shock and add in coloid to restore oncotic pressure.
50
What fluids would you use in a patient with head trauma?
Hypertonic saline
51
How fast does hypertonic saline work?
Rapidly, but results are transient.
52
What are contraindications to using hypertonic saline?
Dehydration and heart failure
53
How do you treat hemorrhagic, hypovolemic shock?
Transfusion (whole blood or packed RBCs)
54
Is blood typing recommended for blood transfusions?
Yes
55
What is the canine universal blood donor?
DEA 1.1 neg
56
How is septic shock treated?
Same fluid therapy as hypovolemic shock, and broad spectrum antibiotics.
57
If you have septic shock and a peritonitis, what must also be done on top of fluid therapy?
Surgical exploration/drainage.
58
When is continued IV fluid administration contraindicated?
Jug is distended Crackles heard on auscultation CVP > 10 cm H2O
59
What do a distended jug, crackles on auscultation and CVP>10cm H2O mean?
Fluid overload
60
What do you do if you have fluid overload?
Vasopressors
61
What do you do if you have pericardial tamponade? (6 things)
``` O2 Minimal fluids until cardiac function can be determined Furosemide if CHF Manage arrhythmias Vasodilators Positive inotropes ```
62
What parameters do you monitor with any type of shock?
``` Mentation HR + pulse quality RR + effort Temp Urine output BP ```
63
How much urine output should you expect?
1mL/kg/hr
64
What should BP be at?
Greater than 80 mmHg
65
What is SIRS?
Systemic Inflammatory Respones Syndrome, an imbalance between pro- and anti-inflammatory mediators
66
When do you see SIRS?
When infection is not contained, whole body is affected
67
What are some non-infections causes of SIRS?
``` Hyportension Traume + hemorrhage Hypoxia + ischemia Pancreatitis Burns Neoplasia ```
68
What is the "second hit theory"?
First event (eg. HBC) primes immune system, Second even (loss of blood leading to hemorrhagic shock) results in excessive inflammatory response.
69
What is MODS?
Multiple Organ Dysfunction System
70
What is mortality of MODS?
50%+

Mechanisms of Disease (7 decks)

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