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Surgery > Shock > Flashcards

Shock Flashcards

1
Q

Septic shock is the result of dysfunction of the

A

Endothelium and vasculature

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2
Q

Septic shock is secondary to

A

Circulating inflammatory mediators

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3
Q

Vasodilatory shock is characterized by peripheral vasodilation with resultant hypotension and

A

Resistance to treatment with vasopressors

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4
Q

The most frequently encountered form of vasodilatory shock is

A

Septic shock

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5
Q

In septic shock, the vasodilatory effects are due to

A

Nitric oxide synthase a vasodilator

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6
Q

Cause of septic shock

A 
Gram positive ( exotoxin )
Gram negative ( endotoxin )
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7
Q

More common source of infection

A
  1. Genito urinary female more prone
  2. Respiratory
  3. Alimentary
  4. Integumentary
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8
Q

Early septic shock

A

Warm extremity

Normovolemic

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9
Q

Early septic shock

A

Decrease BP
Increase CO, HR, RR
Respiratory alkalosis

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10
Q

Late septic shock

A

Cold extremity,

Hypovolemic

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11
Q

Late septic shock is hypovolemic due to

A

Increase vascular permeability to the interstitial and

Decrease cardiac output

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12
Q

Late septic shock

A

Increase vascular permeability ( endotoxin )
Decrease vascular output due to increased pulmonary vascular resistance ( endotoxin )
Increase right ventricular pressure due to impairment of emptying

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13
Q

Treatment for septic shock

A

Volume replacement

Antibiotic

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14
Q

Get sample in two different sites

A

Blood culture

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15
Q

Catheterize midstream catch

A

Urine culture

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16
Q

Earliest sign of gram negative infection

A

Hyperventilation
Respiratory alkalosis
Altered sensorium (late)

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17
Q

No blood loss

Problem is the central

A

Neurogenic shock

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18
Q

Neurogenic shock is due to loss of

A

Vasomotor tone to peripheral arterial beds- vasidilation

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19
Q

Vasomotor tone to peripheral arterial beds- vasidilation

This leads to

A

Increased vascular capacitance
Decreased venous return
Decreased cardiac output

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20
Q

Neurogenic shock is secondary to

A

Spinal cord injuries of cervical and hight thoracic region

Or

To anesthesia specially regional

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21
Q

Spinal cord injuries of cervical and hight thoracic region that disrupt

A

Sympathetic regulation of peripheral vascular tone

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22
Q

Cause of neurogenic shock

A

Spinal cord trauma
Spinal cord neoplasm
Spinal/ epidural anesthetic

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23
Q

Initial physiologic responses in shock are

A

Tissue hypoperfusion

Developing cellular energy deficit

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24
Q

Imbalances in shock leads to

A

Neuro-endocrine and inflammatory responses.

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25
Q

The goal of the neuroendocrine response to hemorrhage is to maintain perfusion to the?

A

Heart

Brain

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26
Q

In afferent signals, the initial inciting event usually is?

A

Loss of circulating blood volume

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27
Q

What are efferent signals

A

Cardiovascular Response

Hormonal Response

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28
Q

Cardiovascular response are

A

Increase cardiac rate
Increase heart contractility
Venous and arterial vasoconstriction

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29
Q

What receptors are activated to increase heart rate and contractility to increase cardiac output?

A

Beta-adrenergic receptors

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30
Q

What disfunction will develop if myocardial O2 consumption is continue to increased due to increased workoad?

A

Myocardial disfunction

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31
Q

Hormonal response are activations of?

A

Hypothalamic-pituitary adrenal axis
RAAS
Vasopressin or ADH

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32
Q

Factors that will increase production of ADH

A

Epinephrine
Angiotensin 2
Pain
Hyperglycemia

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33
Q

Venous return to the heart generates ventricular end-diastolic wall tension, a major determinant of cardiac output.

A

Preload

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34
Q

Force of ventricular contraction is a function of the preload volume
Forced of contraction being determined by initial muscle length

A

Ventricular contraction

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35
Q

Force that resist myocardial work during contraction

A

After load

36
Q

Is the major component of after load influencing the ejection fraction

A

Arterial pressure

37
Q

The microvascular bed is innervated by the sympathetic nervous system

A

Microcirculation

38
Q

Other vasoactive proteins that also lead to vasoconstriction to limit organ perfusion to other organs.

A

Vasopressin
Angiotensin 2
Endothelin 1

39
Q

Hypovolemic shock

A

Low pre load
Low systemic arterial pressure
Tachycardia
Increase vascular resitance

40
Q

Cellular changes in hypovolemic shock

A 
Decrease tissue perfussion
Decrease oxygen delivery
Decrease ATP
Na/K membrane pump fails
Na & Cl enters the cell
Isotonic cellular swelling
Cell death
41
Q

Hypovolemic Shock

Renal response
Normal kidneys can tolerate renal ischemia from

A

15- 90minutes

42
Q

Hypovolemic Shock

Renal response

Prolonged hypoperfusion leads to functional and anatomic changes presenting as

A

Azotemia

43
Q

Hypovolemic Shock

Renal failure index

A

1 indicates acute renal failure

44
Q

Hypovolemic Shock
Pulmonary Response

Capillary interface in case of shock acute diffuse lung injury

A

Damage alveolar

45
Q

Hypovolemic Shock
Pulmonary response

Leads to ARDS

A

Hypoxemia unresponsive elevation of FiO2
Decreased pulmonary compliance
Needs high airway pressure to attain adequate tidal volume

46
Q

Hypovolemic Shock

Pathophysiology

A

Most common

Most of the blood is lost from systemic and small veins (50%)
Decrease cardiac return
Low cardiac output
Decrease blood pressure

47
Q

Hemorrhagic Shock

Compensatory Mechanism

A

Adrenergic discharge
Hyperventilation
Collapse
Release of fluid from the interstitium into the vascular space
Release of vasoactive hormones
Resorption of fluid from intracellular to extracellular space
Renal conservation of body H20 and electrolyte

48
Q

Hemorrhagic Shock
Compensatory Mechanism

Displaced blood from extremity to the heart and brain

A

Collapse

49
Q

Decompensation of Hypovolemic shock

A

Relaxation of arteriolar and precapillary spasm

Deterioration of cell membrane function

50
Q

Decompensation of Hypovolemic shock

Forced H2O and electrolyte from vascular space into the interstitium

A

Relaxation of arteriolar and precapillary spasm

51
Q

Two most sensitive signs of hypovolemia are

A

Cutaneous vasoconstriction

Oliguria

52
Q

Can inhibit secretion of ADh

A

Alcohol

53
Q

Preferred position for patient in shock

A

Supine position with elevated both lower extremities

54
Q

Management in elderly patient

A

Check condition of the heart ability to compensate

55
Q

Not indicated in mngt of shock

A

Steroid

O2 inhalation

56
Q

Combining the effects of soft tissue injury, long bone fractures, and blood loss, is clearly a different physiologic insult than simple hemorrhagic shock

A

Traumatic shock

57
Q

At the cellular level, this may be attributed to the release of cellular products termed

A

DAMPs

58
Q

It increase vascular permeability lead to multiple organ failure due to poorer blood perfusion

A

DAMPs

59
Q

Traumatic shock treatment

A

Control of hemorrhage
Correct O2
Debridement
Stabilization of bony injuries and soft tissue

60
Q

Circulatory pump failure leading to diminished forward flow and subsequent tissue hypoxia, in the setting of adequate intravascular volume

A

Cardiogenic Shock

61
Q

Hemodynamic criteria include in cardiogenic shockq

A

Sustained hypotension. (

62
Q

The pathophysiology of cardiogenic shock involves a________________ that causes myocardial dysfunction, which results in more myocardial ischemia.

A

Vicious cycle of myocardial ischemia

63
Q

Sign and symptoms of myocardial ischemia

A

Increase CVP
Increase pulmonary artery wedge pressure
Decrease cardiac output
Fails to respond with fluid solution

64
Q

Treatment for cardiogenic shock

A 
Bed rest
O2 inhalation
Monitor cardiac function
Electrolyte imbalance
Narcotic analgesic
65
Q

Medications for cardiogenic shock

A

Digitalis
Dobutamine or dopamine
Lidocaine

66
Q

In cariogenic shock, low cardiac output secondary to low heartrate need

A

Cardiac pacemaker

67
Q

Caused by a number of different etiologies that result in mechanical obstruction of venous return

A

Obstructive Shock

68
Q

Obstructive shock in trauma pts is most commonly due to the presence of

A

Tension pneumothorax

69
Q

Obstructive Shock

The hemodyanamic abnormalities are due to___________ with resultant decrease in cardiac output

A

Elevation of intracardiac pressures with limitation of ventricular filling in diastole

70
Q

Obstructive Shock

Acutelt, the pericardium does not distend. Thys small volumes of blood may produce

A

Cardiac tamponade

71
Q

Obstructive Shock

Reduced filling of the right side of the heart from either tension pneumothorax or cardiac tamponade can results in

A

Decrease cardiac outout

Increased central venous pressure

72
Q

Classic findings include in tension pneumothorax

A

Respiratory distress
Hypotension
Diminished breath sounds over one hemithorax
Hyper reasonance to percussion
Jugular venous distention
Shift of mediastinal structures to the unaffected side with tracheal deviation

73
Q

Life threatening condition results from progressive deterioration and worsening of a simple pneumothorax

A

Tension pneumothorax

74
Q

Tension pneumothorax treatment

Pleural decompression with

A 
Chest tube (thoracostomy tube)
Large caliber needle (thoracenthesis)
75
Q

Thoracostomy tube most recommend placement

A

Fourth intercostal space

76
Q

Thoracenthesis in pneumothorax most recomended placement

A

2nd intercostal space

77
Q

Thoracenthesis in hydrothorax most recomended placement

A

7th intercostal space

78
Q

Results from the accumulation of blood within the pericardial sac, usually from penetrating trauma or pericardial effusion with chronic medical conditions such as heart failure or uremia

A

Cardiac tamponade

79
Q

Becks triad of cardiac compressive shock

A

Distended neck veins
Muffled heart sounds
Hypotension

80
Q

Other sign and symptoms of cardiac compressive shock

A

Tachycardia
Pulsus paradoxicus
Oliguria
Cold clammy skin

81
Q

Cardiac compressive shock

Diagnosis

A

Clinical signs
Water bottle shape (erect film) x ray
Standard two dimentional or transesophageal echocardiography
Pericardiocenthesis

82
Q

Cardiac compressive shock
Management

If unstable pt

A

Anterolateral thoracotomy with decompression of tamponade

83
Q

Cardiac compressive shock

Management

In stable pt.

A

Do pericardiocentesis, withdrawal of 50cc blood

84
Q

Cardiac compressive shock

Management

Most direct method to determine the presence of blood within the pericardium.
Best perform in gen anesthesia
Subxiphoid or transdiaphragmatic approach

A

Pericardial window

85
Q

This is the result of dysfunction ofthe endothelium and vasculature secondary to circulating inflammatory mediators.

Failure of the vascular smooth muscle to constrict appropriately

A

Septic shock (vasodilatory)

86
Q

Septic shock is characterized by peripheral vasodilation with

A

Resultant hypotension

Resistance to treatment with vasopressors

87
Q

No volume problem

A

Septic shock or vaso dilatory

Surgery (7 decks)

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