Shock

Question 1

What is the actual definition of shock?

Answer 1

Lack of cardiac output or effective circulating volume leads to the mal-delivery of nutrient rich blood or remove toxic waste from a specific area leads to irreversible damage.

Question 2

What are the five unifying features of shock?

Answer 2

Intracellular calcium overload
Intracellular hydrogen overload
Cellular and interstitial edema
Catabolic metabolism
Inflammation

Question 3

What specifically will lead to multi-organ failure?

Answer 3

Hypoperfusion will result in multisystem organ failure unless perfusion can be restored.

Seen in areas such as the liver, kidneys, and CNS.

Question 4

What are Rosens emperic criteria for diagnosis of shock

Answer 4

Ill appearance or decreased LOC
HR > 100
RR > 22 or PCO2 20 minute duration

*Can be in shock without being hypotensive**

Question 5

What is occuring during the nonprogressive stage of shock?

Answer 5

Body trying to maintain BP and CO

Tachycardia CO = HR x SV
Peripheral vasoconstriction
Renal Conservation of fluid (Renin-angiotensin)

Question 6

What is ocurring during the Progressive stage of shock?

Answer 6

Widespread tissue hypoxia leading to lactic acidosis and decreased vasomotor responses.

Arterioles dialate
Anoxic endothelial cell injury occurs
Confusion and decreased urinary output.

Question 7

What occurs during the irreversible stage of shock?

Answer 7

Widespread cell injury leading to..
Lysozomal leakage
Decreased myocardial contraction
Acute tubular necrosis -> renal failure

Severe fluid/electrolyte disorders occur here.

Question 8

What is the definition of cardiogenic shock?

Answer 8

Decreased CO and evidence of tissue hypoxia in presence of adequate intravascular volume.

Question 9

What is the grading of the Cardiac index in the cardiogenic shock?

Answer 9

Cardiac index

Question 10

What is Cardiogenic shock?

Answer 10

An issue with the heart in which there is an enlargening of the heart and increase volume level of the venous system.
Leads to edema
Think RV infarct

Question 11

How do you treat cardiogenic shock?

Answer 11

Small fluid bolus 250cc

Dont be shy with fluids in a RV infarct

Question 12

What is hemorrhagic shock?

Answer 12

Severe hypotension due to blood loss or volume loss (dehydration)

Question 13

What is the treatment for Hemorrhagic shock?

Answer 13

Crystaloid bollus x 2
Blood transfusion PRN
Stop the bleeding!

Question 14

What are the advantages and disadvantages of administering colloids for hemorrhagic shock?

Answer 14

Advantages: Less fluid required, more volume in vascular space, potential to draw fluid in from tissues.

Disadvantages: Expensive, allergic reactions, coagulopathies.

Question 15

What are the 3 signs of septic shock inflammation?

Answer 15

Adult respiratory distress syndrome (ARDS)
Disseminated intravascular Coagulation (DIC)
Multiple Organ System Failure

Question 16

What effects do cytokine storming following septic shock have on the vascular system?

Answer 16

Low CO
Low peripheral resistance
DIC develops

LPS, TNF, IL-1, IL-6/IL-8 In order of time.

Question 17

Define Systemic inflammatory response syndrome

Answer 17

Temp > 38 or 90

RR >20 or PaCO2 12 10 % bands.

Question 18

Define sepsis in relation to SIRS

Answer 18

SIRS + documented infection

Question 19

Define Severe Sepsis

Answer 19

Sepsis with Multi organ dysfunction

Question 20

Define Septic Shock

Answer 20

Sepsis + Hypotension refractory to volume resuscitation (requiring vasopressors)

Question 21

Describe Spinal shock

Answer 21

This is a result of cervical spine damage following cord injury leading to the loss of motor, sensory, and sympathetic function.

Question 22

What is Neurogenic shock?

Answer 22

Loss of sympathetic autonomic function due to spinal cord injury, thus the vessels remain dilated slowing blood flow. Further more, unchecked parasympathetics causes the HR to go down. Over all CO is reduced.

Question 23

Lesions at what spinal level will lead to hypotension in neurogenic shock?

Answer 23

Loss of sympathetic tone leads to hypotension and occurs at or above T6 vertebral injury.

Question 24

Lesions at what spinal level will lead to Bradycardia in neurogenic shock?

Answer 24

Unopposed Vagal tone due to injury typically at or above T4 because sympathetic innervation to the heart is at T4.

Question 25

What are the two factors at play in Anaphylaxis shock?

Answer 25

Vasodilation and Brocheoconstriction due to IgE leading to Mast cells activating and causing inflammation and hypersensitivity (Type 1)