Shock

Question 1

Cardiogenic shock

Answer 1

decreased cardiac output due to pump failure

Question 2

hypovolemic shock

Answer 2

decreased cardiac output due to loss of circulating voluume

Question 3

anaphylactic shock

Answer 3

widespread vasodilation and increased vascular permeability form IgE hypersensitivity reaction

Question 4

Neurological shock

Answer 4

neural control of vasomotor tone is lost resulting in generalized vasodilation

Question 5

what is systemic inflammatory response syndrome (SIRS)

Answer 5

exaggerated and generalized manifestation of local inflammatory reaction, often fatel

Question 6

(SIRS) massive inflammatory reaction is due to what

Answer 6

cytokines

Question 7

how does one diagnose (SIRS)

Answer 7

two or more signs of systemic inflammation (fever, tachycardia)

Question 8

what is sepsis

Answer 8

is (SIRS) with a culture-proven infection or obvious infection

Question 9

what is septic shock

Answer 9

clinical sepsis severe enough to lead to organ dysfunction and hypotension

Question 10

name 2 things that trigger a septic shock

Answer 10

1. gram postive bacterial infections

2. gram negative bacterial and fungal

Question 11

Septic shock: inflammatory mediators: toll-like receptors

Answer 11

on leukocytes, recognize microbial elements

Question 12

Septic shock: inflammatory mediators: TNF, IL-1, gamma, 12 and 18

Answer 12

create pro-inflammatory state

Question 13

Septic shock: inflammatory mediators: prostaglandins and PAF

Answer 13

activate endothelial cells, causing adhesion molecule synthesis and PRO-COAGULANT state

Question 14

Septic shock: inflammatory mediators: complement cascade

Answer 14

activated by microbial components contributes to the hyperinflammatory state

Question 15

septic shock: what are 3 major consequences for endothelial cell activation and injury

Answer 15

1. thrombosis
2. increased vascular permeability
3. vasodilation

Question 16

thrombosis: inflammatory mediators stimulate what

Answer 16

tissue factor and PAI-1 production

Question 17

thorbosis decreases what

Answer 17

tissue factor pathway inhibitor, thormbomodulin and protein C

Question 18

increased vascular permeability causes what

Answer 18

“3rd spacing” and edema which increases interstital fluid pressure which impedes blood flow into tissues= tissue hypofusion and stasis

Question 19

what causes vasodilation

Answer 19

Increased NO synthesis and vasoactive inflammatory mediators

Question 20

what does vasodilation lead to

Answer 20

hypo-tension and tissue hypo per fusion

Question 21

Septic shock: name 2 broad metabolic abnormalities

Answer 21

hyperglycemia and insulin-resistance

Question 22

cytokines, stress hormones and catecholamines rise what metabolic abnormality

Answer 22

gluconeogensis

Question 23

pro-inflammatory cytokines give what metabolic abnormality

Answer 23

suppress insulin release and promote insulin resistance

Question 24

hyper inflammatory state can activate what in the immune system

Answer 24

counter-regulatory immunosuppressive mechanisms, not sure if its helpful or hurtful

Question 25

what does septic shock do to myocardium contractility

Answer 25

weakened by cytokines and decrease cardiac output

Question 26

tissue hypoperfusion has what effect

Answer 26

starves organ of oxygen and nutrients

Question 27

which organs are effected by septic shock

Answer 27

kidney, liver, lungs, and heart

Question 28

septic shock can cause what syndrome

Answer 28

adult respiratory distress syndrome (ARDS) by decrease cardiac output, increase vascular permeability and endothelial injury

Question 29

what are the 3 stages of shock

Answer 29

nonprogressive
progressive
irreversible

Question 30

nonprogressive stage

Answer 30

reflex mechanisms compensate and tissue perfusion is maintained SIRS

Question 31

progressive stage

Answer 31

tissue hypoperfusion ensues with worsening circulatory and metabolic imbalances including acidosis

Question 32

irreveresible state

Answer 32

extent of cellular and tissue injury to great that is inevitable

Question 33

clinical outcome

Answer 33

depends