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POS 2 > Shock > Flashcards

Shock Flashcards

1
Q

Products of anaerobic metabolism?

A

Ethanol and lactate

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2
Q

What can cause shock?

A
  • anaemia
  • hypoxaemia
  • cardiovascular disturbance
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3
Q

3 causes of CV shock?

A 
> blood pressure 
- systemic vascular resistance 
> stroke volume 
- preload
- after load
- contractility
> heart rate and rhythm
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4
Q

Clinics, signs of shock

A
  • HR
  • pulse quality
  • mm colour
  • capillary refil
  • extremity /body temperature
  • mentation
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5
Q

What can different heart rates tell you about the patient?

A 
>normal 
-dogs 60-120
- cats 160-200
> tachycardia 
- compensation 
> bradycardia
- decompensation shock 
- cats (do whatever they want!!)
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6
Q

Ddx tachycardia

A
  • hypoxaemia
  • anaemia
  • pain
  • tachyarythmias
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7
Q

Ddx bradycardia

A

Bradyarrythmia, ^ ICP

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8
Q

Use of ECG for shock?

A
  • diagnose cause

- monitor

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9
Q

What makes the pulse quality change? Which pulses should be felt?

A

Difference between systolic and diastolic BP
- femoral pulse (palpate alongside auscultation)
- metatarsal (medial aspect)
> can be increased or decreased in shock

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10
Q

How can mm appear in shock? CRT? Ddx?

A 
> pale
- anaemia, hypoxaemia 
> injected
- gingivitis 
> CRT CAN BE ^\v
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11
Q

How may temperature differ in shock?

A

> decreased extremity in mild to mod
decreased whole body
- common in cats
- means very severe in dogs

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12
Q

Levels of mentation

A
  • obtained
  • stupendous (painful stimulus only)
  • comatose (not even pain)
    Ddx : NEURO 1* dz
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13
Q

4 types of shock

A 
> hypovolaemic
- preload too low 
> vasodilatory
- low systemic vascular resistance 
- LOOKS INJECTED MM (cf others look pale) 
> obstructive 
- not enough return to RA
> cardiogenic
- arrythmias
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14
Q

3 types of vasoconstrictive shock? Causes?

A 
> hypovolaemic 
- dehydration 
- VD+
- haemorrhage
- 3rd spacing
- PU
> obstructive
- GDV
- pericardial, effusion 
- pneumothorax 
> cardiogenic 
- arrythmias
- systolic dysfunction
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15
Q

What must be remembered about stages of shock.

A

Only typical ^HR etc. In compensation stage, as they become decompensated HR DECREASES. Serious.

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16
Q

How is vasoconstrictive shock classified?

A 
>mild
- pulse quality can be ^/v
- CRT can be quick
- Cats HR can ^/v
- mild obtundation
> moderate 
- pule quality always v
- cats v body temp (dogs likely only extremities until decomp) 
- moderate obtundation
> severe/decompensated
- bradycardia
- cats HR can ^/v
- stuperous
17
Q

How will hypovolaemic shock present? Further diagnostics?

A 
> PE
- dehydration
- pleural effusion 
- abdo distension
- rectal palpation 
> ultrasound 
- free fluid
18
Q

Tx hypovolaemia shock

A

IVFT

- control haemorrhage

19
Q

Presentation and further diagnostics of obstructive shock?

A
  • distended abdo
  • v heart and lung sound s
    > radiographs and ultrasound chest
20
Q

Tx obstructive shock

A
  • receive obstruction

+- IVFT

21
Q

PE findings and further diagnostics cardiogenic shock?

A
  • auscultation heart and lungs
  • jugular distension
    > ECG
    > cardiac ultrasound
  • LA:aorta (large LA shows cardiogenic shock risk)
  • contractility
  • pericardial effusion
22
Q

Normal LA:Ao ratio

A
23
Q

Tx cardiogenic shock?

A

NO FLUIDSS!!!!

  • antiarrhythmics
  • positive inotropes
24
Q

What are the different types of ventricular arrythmias?

A
  • VPCs

- accelerated idioventricular rhythm (HR 180)

25
Q

When can ventricular arrythmias occour?

A
  • cardiogenic shock
  • hypovoameic shock
  • obstructive shock
  • vasodilatory shock
    > challenging to tx as may or may not require fluid to tx underlying cause
26
Q

Types of vasodilatory shock?

A
  • SIRS (systemic inflammatory response syndrome)
  • sepsis
  • anaphylaxis
  • anaesthesia
27
Q

How does vasodilatory shock present differently to vasoconstrictive? Stages?

A 
> mild 
- pulse bounding
- CRT quicker
- mm injected 
> moderate
> decompensated
28
Q

What causes SIRS?

A
  • severe trauma

- immune mediated disease

29
Q

PE vasodilatory shock and further diagnostics

A

Signs
> mild and moderate
- pulse quality increased (cf. vasoconstrictive where likely decreased)
- mm colour injected dogs, cats injected if mild but otherwise pale (mod severe)
- very quick CRT until decompensated then slow
- extremities warm until decompensated then ^ or v
Reasons for shock

30
Q

Tx vasodilatory shock

A
  • IVF (careful can overload leaky vessels)

- vasopressors to improve systemic vascular resistance (adrenaline, vasopressin, DA)

31
Q

Other markers of shock?

A

> lactate should be under 2.5mmol/l
- can be use to check response to treatement
blood pressure
- mild-mod shock may be normal
- severe shock may be too difficult to find a pulse!!
*dont waste time, check 6 perfusion parameters)
- normal systolic 90-160mmHg, mean 60-120mmHg

32
Q

Can multiple types of shock be present in one animal?

A

Yes!

- eg. GDV with arrythmia, septic peritonitis, obstructive and V+ -> hypovolaemia

33
Q

What is shock?

A

Inadequate oxygen delivery to cells -> inadequate cellular energy production, cellular dysfunction and organ dysfunction

POS 2 (28 decks)

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