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RESIDENCIA CIRUGIA GENERAL > Shock > Flashcards

Shock Flashcards

1
Q

What is the definition of  shock?

A

Inadequate tissue perfusion

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2
Q

What are the different types of shock (5)?

A

Hypovolemic Septic Cardiogenic Neurogenic Anaphylactic

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3
Q

What are the signs of shock?

A

Pale,diaphoretic,coolskin Hypotension, tachycardia, tachypnea T mental status and pulse pressure, Poor capillary refill,
Poor urine output

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4
Q

What lab tests help assess tissue perfusion?

A

Lactic acid (elevated with inadequate tissue perfusion),base deficit, pH rom ABG (acidosis associated with inadequate tissue perfusion)

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5
Q

What is the defInition of hipovolemic shock

A

Decreased intravascular volume

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6
Q

What are the common causes of hypovolemic shock?

A
  • Hemorrhage
  • Burns
  • Bowel obstruction
  • Crush injury
  • Pancreatitis
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7
Q

What are the signs of hypovolemic shock?

A

Early—Orthostatic hypotension, mild tachycardia, anxiety, diaphoresis, vaso- constriction (decreased pulse pressure with increased diastolic pressure)
Late—Changed mental status, decreased BP, marked tachycardia

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8
Q

What are the signs/ symptoms with:
Class I hemorrhage
(  15%or 750 cc blood loss)?

A

Mild anxiety, normal vital signs

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9
Q

What are the signs/ symptoms with:

Class II hemorrhage (15%–30%or 750– 1500 cc blood loss)?

A

Normal systolic BP with decreased pulse pressure, tachycardia, tachypnea, anxiety

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10
Q

What are the signs/ symptoms with:

ClassIIIhemorrhage (30%–40%or1500– 2000 cc blood loss)?

A

Tachycardia(heartrate. 120),tachypnea (respiratoryrate. 30),decreasedsystolic BP, decreased pulse pressure, con usion

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11
Q

What are the signs/ symptoms with:

Class IV hemorrhage (  40%or 2000 cc bloodloss)?

A

Decreased systolic BP, tachycardia (heart rate . 140), tachypnea (respiratory rate
. 35),decreasedpulsepressure,conused and lethargic, no urine output

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12
Q

What is the treatment of hypovolemic shock?

A
  1. Stop the bleeding
  2. Volume: IVF (isotonic LR) then blood
    products as needed
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13
Q

What usually causes failure of resuscitation of hypovolemic shock?

A

Persistentmassivehemorrhage,requiring emergent surgical procedure

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14
Q

Why does decreased pulse pressure occur with early hypovolemic shock?

A

Pulse pressure (systolic–diastolic BP) decreases because o  vasoconstriction, resulting in an elevated diastolic BP

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15
Q

What is the most common vital sign change associated with early hypovolemic shock?

A

Tachycardia

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16
Q

What type of  patient does not mount a normal tachycardiac response to hypovolemic shock?

A

Patients on B -blockers, spinal shock (loss o sympathetic tone), endurance athletes

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17
Q

Should vasopressors be used to treat hypovolemic shock?

A

No

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18
Q

Should patients with hypovolemic shock be put into the Trendelenburg position?

A

No

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19
Q

What is the definition of septic shock?

A

Documented in ection and hypotension

20
Q

What is the specific etiology of septic shock??

A

Most common—gram-negative septicemia Less common—gram-positive septicemia,
fungus

21
Q

What actorsincreasethe susceptibility to septic shock?

A

Any mechanism that increases susceptibility to infection (e.g., trauma, immunosuppression, corticosteroids, hematologic disease, diabetes)

22
Q

Whatcomplicationsaremajor risks in septic shock?

A

Multipleorgan ailure,DIC,death

23
Q

What are the signs/ symptoms of septic shock?

A

Initial—vasodilation, resulting in warm skin and ull pulses;normal urine output
Delayed—vasoconstriction and poor urine output; mental status changes; hypotension

24
Q

Whatpercentageo blood cultures is positive in patients with bacterial septic shock

A

Only about 50%!

25
Q

What are the associated findings of septic shock?

A

Fever, hyperventilation, tachycardia

26
Q

What are the associated lab findings of septic shock?

A

Early—hyperglycemia/glycosuria, respiratory alkalosis, hemoconcentration, leukopenia
Late—leukocytosis, acidosis, elevated lactic acid
(Note: Identi ying organism is important to direct treatment/antibiotics)

27
Q

What is the treatment of septic shock?

A
  1. Volume (IVF)
  2. Antibiotics (empiric, then by cultures) 3. Drainage o in ection
  3. Pressors PRN
  4. Zygris®PRN
28
Q

What is the definition of cardiogenic shock?

A

Cardiac insu  ciency; le  ventricular ailure (usually), resulting in inadequate
tissue perfusion

29
Q

What are the causes of cardiogenic shock?

A

MI, papillary muscle dys unction, massive cardiac contusion, cardiac tamponade, tension pneumothorax, cardiac valve failure

30
Q

What are the signs/symptoms on exam of cardiogenic shock?

A 
Dyspnea
Rales
Pulsus alternans (increased pulse with
greater f lling ollowing a weak pulse) Loud pulmonic component o S2
Gallop rhythm
31
Q

What are the associated vital signs/parameters of cardiogenic shock?

A

Hypotension, decreased cardiac output, elevated CVP/wedge pressure, decreased urine output (low renal blood  flow), tachycardia (possibly)

32
Q

What are the signs on CXR of cardiogenic shock?

A

Pulmonary edema

33
Q

What is the treatment of cardiogenic shock?

A 
Based on diagnosis/mechanism:
1. CHF: diuretics and a afterload
reduction (e.g., ACE inhibitors),
with or without pressors
2. Left ventricular failure (MI): pressors, afterload reduction
34
Q

What are the last resort support mechanisms of cardiogenic shock?

A

Intra-aortic balloon pump (IABP), ventricular assist device (VAD)

35
Q

What is the definition of neurogenic shock?

A

Inadequate tissue perfusion from loss of sympathetic vasoconstrictive tone

36
Q

What are the common causes of neurogenic shock?

A

Spinal cord injury:

Complete transection of spinal cord Partial cord injury with spinal shock Spinal anesthesia

37
Q

What are the signs/ symptoms of neurogenic shock?

A

Hypotension and bradycardia, neurologic deficit

38
Q

Why are heart rate and BP decreased in neurogenic shock?

A

Loss of sympathetic tone

but hypovolemia [e.g., hemoperitoneum] must be ruled out

39
Q

What are the associated findings of neurogenic shock?

A

Neurologic def cits suggesting cord injury

40
Q

What MUST be ruled out in any patient where spinal shock is suspected?

A

Hemorrhagic shock!

41
Q

What is the treatment of neurogenic shock?

A

IV  fluids (vasopressors reserved  or hypotension refractory to  fluid resuscitation)

42
Q

Whatpercentageo patients with hypotension and spinal neurologic deficits have hypotensiono purely neurogenic origin?

A

About 67% (two thirds) of patients

43
Q

What is spinal shock?

A

Complete  flaccid paralysis immediately following spinal cord injury; may or may
not be associated with circulatory shock

44
Q

What is the lowest reflex available to the examiner?

A

Bulbocavernous reflex: checking or contraction of the anal sphincter upon compression o the glans penis or clitoris

45
Q

What is the lowest level voluntary muscle?

A

External anal sphincter

46
Q

What are the classic findings associatedwithspinalcord shock?

A

Hypotension
Bradycardiaorlacko compensatory
tachycardia

47
Q

What is the acronym or treatmentoptions or anaphylactic shock?

A

“BASE”:

  • Benadryl
  • Aminophylline
  • Steroids
  • Epinephrine

RESIDENCIA CIRUGIA GENERAL (13 decks)

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