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emergency medicine exam II > shock > Flashcards

shock Flashcards

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1
Q

What is shock

A
  • Inadequate supply of oxygen to tissues to meet the bodys metabolic demands
    • -> anaerobic metabolism -> acidosis -> hypotension
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2
Q

equation for delivery of oxygen

A

delivery of oxygen = CO x CaO2

  • cardiac output x arterial oxygen content
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3
Q

What is the normal arterial and venous O2 content

A
  • arterial: 98%
  • venous 70%
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4
Q

what is the normal o2 content in SVC and IVC? Why?

A
  • SVC: 65%
  • IVC: 75%
    • kidneys get 15-20% CO for filtering but don’t take alot of oxygen and they drain into IVC
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5
Q

What is the normal difference between arterial and venous Oxygen saturation?

A
  • < 25-30
    • the higher the difference, the worse it is
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6
Q

What are ways to increase supply of oxygen

A
  1. maximaze CO
    1. increase preload, decrease afterload, increase contractility, appropriate HR
  2. maximize CaO2
    1. Hct
    2. supplemental O2
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7
Q

What are ways to decrease demand for oxygen

A
  • tx fever
  • support respiratory effort
  • sedation/pain control
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8
Q

what is ohm’s law related to BP

A

BP = flow x resistance

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9
Q

stroke volume is composed of what two things

A
  • intravascular volume : preload
  • contractility
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10
Q

List the key clinical features of shock

A
  • tachycardia
  • tachypnea
  • +/- hypotension (depending on degree)
  • signs of poor end-organ perfusion
    • AMS
    • oliguria
    • lactic acidosis
    • cool, mottled extremities, thready pulses
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11
Q

List DDx for hypovolemic shock

A
  • hemorrhage
  • fluid loss
    • internal
    • external
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12
Q

In hypovolemic shock, how will the following parameters be affected

  • Preload
  • CO
  • Afterload
A
  • Preload: decreased
  • CO: decreased
  • Afterload: increased
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13
Q

In hypovolemic shock, how will the following parameters be affected

  • BP
  • Organ perfusion
  • A-V O2 difference
A
  • BP: low
  • Organ perfusion: decreased
  • A-V O2 difference: High
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14
Q

List the “big 5” tissues affected in shock

A
  • Cardiovascular
  • Respiratory
  • Skin
  • CNS
  • Renal
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15
Q

Is the following signs of compensated or decompensated shock

  • increased pulse
  • vasoconstriction
  • weak pulse, cool, clammy skin, anxiety, thirst, weak
A
  • compensated - early
    • baroreceptor mediated vasconstriction
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16
Q

Is the following signs of compensated or decompensated shock

  • loss of radial pulse
  • hypotension
  • loss of consciousness
  • dec RR
A

decompensated - late

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17
Q

define hypovolemic shock

A
  • reduction in intravascular volume/preload leading to decreased cardiac output and insufficienct oxygen delivery to cells
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18
Q

List DDX for non hemorrhage hypovolemic shock

A
  • vomiting, diarrhea
  • dehydration
  • evaporative -> burns
  • third spacing
  • diabetes insipidus/mellitus
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19
Q

Body can compensate for what % blood loss

A

< 20%

20
Q

what % blood loss is considered uncompensated (progressive)

A

20-40%

21
Q

what % blood loss is considered profound/irreversible

A

> 40%

22
Q

What organs take priority and perfusion to them remains normal during hypovolemic shock

A
  • brain
  • heart
  • kidneys
  • liver
23
Q

What organs become blood volume deficient and perfusion to them decreases during hypovolemic shock

A
  • skin
  • GI tract
  • skeletal muscle
24
Q

What is the most common type of shock

A
  • hypovolemic shock
25
Q

List important managment steps of acute external bleeding

A
  1. direct pressure to wound site
  2. elevate wound site above level of victim’s heart
  3. press on proximal “pressure points”
    • radial, ulnar brachial, axillary, femoral (not carotid )
  4. apply tourniquet above injury site - last resort, note time of application
26
Q

What is obstructive shock. give some examples

A
  • mechanical block to heart’s outflow/inflow
    • pulmonary embolus
    • cardiac tamponade
    • tension pneumothorax
27
Q

How are the following parameters affected in cardiogenic shock?

  • preload
  • cardiac output
  • afterload
A
  • preload: increased
  • cardiac output: decreased
  • afterload: increased
28
Q

How are the following parameters affected in cardiogenic shock?

  • blood pressure
  • organ perfusion
  • A-VO2 difference
A
  • blood pressure: low
  • organ perfusion: decreased
  • A-VO2 difference: high
29
Q

What is cardiogenic shock?

A
  • failure of heart to pump effectively
    • acute hypotension -> low CO -> inadequate LV outflow -> poor end organ perfusion
30
Q

what is the most common cause of cardiogenic shock

A

acute myocardial infarction

31
Q

What is Distributive shock

A
  • insufficient volume of blood or “relative” hypovolemia resulting from dilation of all blood vessels
    • “tank” is much larger
32
Q

List the three main types of Distributive shock

A
  1. Septic shock: overwhelming infection -> profound systemic vasodilation
  2. Anaphylactic shock
  3. Neurogenic shock: trauma to spinal cord resulting in loss of autonomic and motor reflexes below injury level
33
Q

What is septic shock

A
  • an exaggerated endogenous inflammatory response to invasive infection leading to
    • circulatory collapse
    • multiple organ failure
    • death
34
Q

What is SIRS: systemic inflammatory response syndrome? what are the criteria

A
  • systemic inflammatory response to a variety of severe clinical insults. Manifested by > or = two of the following
    1. temperature < 36 or > 38 C
    2. HR > 90 bpm
    3. RR > 20 or PaCO2 < 32 mm Hg
    4. WBC > 12,000, < 4,000 or > 10% bands
35
Q

Define infection

A

inflammatory response to microorganisms or invasion of normally sterile tissues

36
Q

define sepsis

A
  • systemic response to infection
    • i.e. confirmed or suspected infection plus
    • > or = 2 SIRS criteria
37
Q

define severe sepsis

A

sepsis associated with organ dysfunction (CV, respiratory, renal, hepatic, and/or hematologic)

38
Q

define septic shock

A
  • sepsis with refractory hypotension and impaired organ perfusion despite adequate fluid resuscitation
39
Q

what is ARDS

A

adult respiratory distress syndrome

40
Q

Are the following characteristics consistent with warm (hyperdynamic) or cold (hypodynamic) shock?

  • hypotensive
  • tachycardia
  • tachpnea
  • bounding pulse
  • warm, well perfused extremities
  • skin flushed, moist
A
  • warm hyperdynamic shock
41
Q

Are the following characteristics consistent with warm (hyperdynamic) or cold (hypodynamic) shock?

  • hypotensive
  • tachycardia
  • tachypnea
  • narrow, thready pulse
  • cold, poorly perfused extremities
  • skin pale, dry
A
  • col hypodynamic shock
42
Q

How do the following parameters change in Septic shock

  • preload
  • cardiac output
  • afterload
A
  • preload: decreased/normal
  • cardiac output: increased
  • afterload: decreased
43
Q

How do the following parameters change in Septic shock

  • blood pressure
  • organ perfusion
  • A-VO2 difference
A
  • blood pressure: normal/low
  • organ perfusion: decreased
  • A-VO2 difference: low
44
Q

How do the following parameters change in spinal shock

  • preload
  • cardiac output
  • afterload
A
  • preload: decreased
  • cardiac output: increased
  • afterload: decreased
45
Q

How do the following parameters change in spinal shock

  • blood pressure
  • organ perfusion
  • A-VO2 difference
A
  • blood pressure: low
  • organ perfusion: normal
  • A-VO2 difference: normal

emergency medicine exam II (2 decks)

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