Shock

Question 1

what is the definition of shock

Answer 1

ineffective delivery of oxygen to the tissue infective perfusion

Question 2

what is the goal with shock

Answer 2

to optimize oxygen delivery amount

Question 3

what are the 4 types of shock

Answer 3

hypovolemic, cardiogenic, obstructive, dstributive

Question 4

what is hypovolemic shock

Answer 4

inadequate circulating volume -> decreased perfusion

Question 5

what are common causes of hypovolemic shock

Answer 5

hemorrhage, v/d, third spacing loss

Question 6

what is cardiogenic shock

Answer 6

results from heart failure, exclude factors outside the heart (only the heart this deals with)
-pumping function is severely impaired -> circulatory failure

Question 7

what are some factors of cardiogenic shock

Answer 7

structural problems, arrhythmias, ineffective forward flow

Question 8

what are the structural problems of cardiogenic shock

Answer 8

valvular insufficiency (back flow)
HCM - felines, diasystolic failure
DCM - canines, weakened contractions, poor contractility

Question 9

what is obstructive shock

Answer 9

obstruction of blood flow from/returning to the heart -? diminished blood volume

Question 10

what are some causes of obstructive shock

Answer 10

GDV, caval syndrome, pulmonary embolism, pericardial effusion/pneumothorax

Question 11

what is distributive shock

Answer 11

flow maldistribution - vascular compartment expands (hypoperfusion despite adequate blood volume)

• loss of vessel tone
• injected mm

Question 12

what are some potential causes of distributive shock

Answer 12

sepsis, SIRS, anaphylaxis, neurogenic disorder

Question 13

what is SIRS

Answer 13

systemic inflammatory reponse

Question 14

what are the clinical signs of systemic inflammation in response to infectious or noninfectious insults

Answer 14

trauma, pancreatitis, burns, venom, neoplasia, heart stroke

Question 15

what is sepsis

Answer 15

the clinical syndrome caused by infection and the host’s systemic inflammatory response to it
(may be bacterial, viral, protozoal, or fungal origin)

Question 16

what are the perfusion parameters

Answer 16

mentation, mm/crt, HR, pulse quality, extremity temp, BP

Question 17

how is the shock index calculated

Answer 17

HR over systolic blood pressure, higher than 1 = patient in shock

Question 18

what are the stages of shock

Answer 18

compensatory stage, early decompensatory stage, decompensatory stage (terminal)

Question 19

what si the compensatory stagge

Answer 19

animal attempts to maintain O2 delivery to the tissue

Question 20

what are the 2 responses in the compensatory stage

Answer 20

sympathetic and neurohormal

Question 21

what is the sympathetic response in the compensatory stage

Answer 21

increased CO by increased HR and SV

Question 22

what is the neurohormonal response in the compensatory stage

Answer 22

water retention and fluid shift from interstitial to intravascular space

Question 23

what may happen in the compensatory stage

Answer 23

splenic contraction may occur to increase number of circulating RBCS, more RBCS = more oxygen to be able to be carried

Question 24

what are the clinical signs of the compensatory stage

Answer 24

tachycardia, tachypnea, normal rec temp, normal to slow hypertensive, pink mm, cool extremities, normal mentation, prolonged CRT

Question 25

if the compensatory stage is untreated due to inadequate intravasculcar volume what happens

Answer 25

decreased systemic vascular resistance, cardiac dysfunction, patient goes into early decompensatory

Question 26

what are the clinical signs of the early decompensatory stage

Answer 26

tachycardia, prolonged CRT, weak pulse, pale mm, possible decrease in temp, decreasing BP< dull mentation (caused by lacatate acidosis)

Question 27

what are the clinical signs of terminal stage/ late decompensatory stage

Answer 27

as a result of organ failure - bradycardia, pale/cyanotic mm, absent CRT, weak or no pulse, hypotheromic, anuria

Question 28

what is the terminal stage

Answer 28

happens with the stage before is not treated effectively, severe intravascular volume loss, autoregulatory escape, multi-organ failure, sympathetic center of the brain doesnt work

Question 29

what is the autoregulatory escape

Answer 29

local responses override sympathetic response, massive vasodilation in all organ - complete circulatory collapse

Question 30

what is the early decompensatory stage

Answer 30

redistribution of blood flow to preferred organs (heart and brain), overwhelmed liver, myocardial depressant factor, hypoxia,lactic acid production