Shock Flashcards
Products of anaerobic metabolism?
Ethanol and lactate
What can cause shock?
- anaemia
- hypoxaemia
- cardiovascular disturbance
3 causes of CV shock?
> blood pressure - systemic vascular resistance > stroke volume - preload - after load - contractility > heart rate and rhythm
Clinics, signs of shock
- HR
- pulse quality
- mm colour
- capillary refil
- extremity /body temperature
- mentation
What can different heart rates tell you about the patient?
>normal -dogs 60-120 - cats 160-200 > tachycardia - compensation > bradycardia - decompensation shock - cats (do whatever they want!!)
Ddx tachycardia
- hypoxaemia
- anaemia
- pain
- tachyarythmias
Ddx bradycardia
Bradyarrythmia, ^ ICP
Use of ECG for shock?
- diagnose cause
- monitor
What makes the pulse quality change? Which pulses should be felt?
Difference between systolic and diastolic BP
- femoral pulse (palpate alongside auscultation)
- metatarsal (medial aspect)
> can be increased or decreased in shock
How can mm appear in shock? CRT? Ddx?
> pale - anaemia, hypoxaemia > injected - gingivitis > CRT CAN BE ^\v
How may temperature differ in shock?
> decreased extremity in mild to mod
decreased whole body
- common in cats
- means very severe in dogs
Levels of mentation
- obtained
- stupendous (painful stimulus only)
- comatose (not even pain)
Ddx : NEURO 1* dz
4 types of shock
> hypovolaemic - preload too low > vasodilatory - low systemic vascular resistance - LOOKS INJECTED MM (cf others look pale) > obstructive - not enough return to RA > cardiogenic - arrythmias
3 types of vasoconstrictive shock? Causes?
> hypovolaemic - dehydration - VD+ - haemorrhage - 3rd spacing - PU > obstructive - GDV - pericardial, effusion - pneumothorax > cardiogenic - arrythmias - systolic dysfunction
What must be remembered about stages of shock.
Only typical ^HR etc. In compensation stage, as they become decompensated HR DECREASES. Serious.
How is vasoconstrictive shock classified?
>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
How will hypovolaemic shock present? Further diagnostics?
> PE - dehydration - pleural effusion - abdo distension - rectal palpation > ultrasound - free fluid
Tx hypovolaemia shock
IVFT
- control haemorrhage
Presentation and further diagnostics of obstructive shock?
- distended abdo
- v heart and lung sound s
> radiographs and ultrasound chest
Tx obstructive shock
- receive obstruction
+- IVFT
PE findings and further diagnostics cardiogenic shock?
- auscultation heart and lungs
- jugular distension
> ECG
> cardiac ultrasound - LA:aorta (large LA shows cardiogenic shock risk)
- contractility
- pericardial effusion
Normal LA:Ao ratio
Tx cardiogenic shock?
NO FLUIDSS!!!!
- antiarrhythmics
- positive inotropes
What are the different types of ventricular arrythmias?
- VPCs
- accelerated idioventricular rhythm (HR 180)
When can ventricular arrythmias occour?
- cardiogenic shock
- hypovoameic shock
- obstructive shock
- vasodilatory shock
> challenging to tx as may or may not require fluid to tx underlying cause
Types of vasodilatory shock?
- SIRS (systemic inflammatory response syndrome)
- sepsis
- anaphylaxis
- anaesthesia
How does vasodilatory shock present differently to vasoconstrictive? Stages?
> mild - pulse bounding - CRT quicker - mm injected > moderate > decompensated
What causes SIRS?
- severe trauma
- immune mediated disease
PE vasodilatory shock and further diagnostics
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
Tx vasodilatory shock
- IVF (careful can overload leaky vessels)
- vasopressors to improve systemic vascular resistance (adrenaline, vasopressin, DA)
Other markers of shock?
> 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
Can multiple types of shock be present in one animal?
Yes!
- eg. GDV with arrythmia, septic peritonitis, obstructive and V+ -> hypovolaemia
What is shock?
Inadequate oxygen delivery to cells -> inadequate cellular energy production, cellular dysfunction and organ dysfunction
