Shock

Question 1

How do you calculate mABP?

Answer 1

COxTPR
SVxHRxTPR
diasBP+0.33 PulseP
0.33sysP+0.66 diasP

Question 2

What can cause shock?

Answer 2

Fall in TPR

Fall in CO

Question 3

What is shock?

Answer 3

Acute condition of inadequate blood flow through it body. A catastrophic drop in arterial pressure leads to circulatory shock.

Question 4

What three things can cause a reduced CO leading to shock?

Answer 4

Mechanical failure- heart cannot fill
Pump fails
Low blood volume

Question 5

Mechanical shock is also known as

Answer 5

obstructive

Question 6

What is cardiogenic shock?

Answer 6

The pump is failing and the ventricle aren’t emptying properly.

Question 7

What is hypovolaemic shock?

Answer 7

Reduced blood volume- poor venous return- can’t maintain arterial pressure

Question 8

What conditions can lead to cariogenic shock?

Answer 8

MI
Serious arrhythmia (Tachy or Brady)
Sudden heart failure progression

Question 9

How can tachycardia give a reduced CO?

Answer 9

Although HR increases the filling time in diastole is reduced. This decreases stroke volume.

Question 10

Why is cardiogenic shock self propagating?

Answer 10

Coronoray artery perfusion drops- increasing the pump failure

Question 11

A patient with chest pain and dyspnoea presents in shock. They have a visible IJP what do you think the cause of the shock is?

Answer 11

Pulmonary embolism

Question 12

What are two causes of mechanical shock?

Answer 12

PE

Cardiac tamponade

Question 13

Does cardiac tamponade effect one or two sides of the heart?

Answer 13

both

Question 14

how does PE lead to shock?

Answer 14

High pulmonary artery pressure.
Right heart fails to empty.
Venous pressure rises.
Low return to left heart 
Left trail pressure low
Reduced filling of LV
reduced CO
SHOCK

Question 15

What is oliguria and why would you get it in shock?

Answer 15

v little urine production

poor perfusion of kidney

Question 16

What is a cardia arrest?

Answer 16

Pulseless unresponsiveness where the heart has either stopped or lost the ability to pump effectively.

Question 17

What basic life support do you give in cardiac arrest?

Answer 17

Chest compressions and ventilation

Question 18

What advanced life support is given in cardiac arrest?

Answer 18

Defibrillation- depolarise all cells of heart. Induce refractory period to allow coordinated beating to restart.
Adrenaline for non shockable rhythm- increase TPR and heart activity

Question 19

Name 3 cardiac arrest rhythms

Answer 19

VF- most common
Asystole- flat line
Pulseless electrical activity - electric of heart are fine its the structural mechanics that aren’t.

Question 20

How do you get a PE?

Answer 20

DVT embolising to the lungs through the right heart.

Question 21

30-40% reduction in blood volume causes …

Answer 21

serious shock response

Question 22

Some shock response is seen at a ….. drop in blood volume

Answer 22

20

Question 23

How does hyopvolaemia give shock?

Answer 23

venous pressure drops
reduced return to hear
cardiac out put falls
arterial pressure drops

Question 24

How do bro receptors attempt to help in hypovolaemia?

Answer 24

Detect low arterial pressure sympathetic trunk increases heart rate and force of contraction by stimulating Beta1 receptors. Alpha receptors in vascular smooth muscle increase TPR by vast constriction.
Veno constriction helps return blood to heart.

Question 25

What is internal transfusion?

Answer 25

Increased TPR reduces the hydrostatic pressure so fluid moves in to capillary.

Question 26

Tachycardia, weak pulse, pale skin with cold and sweaty extremities could all be signs of....

Answer 26

Hypovolaemic shock | Symapthtic system attempting to compensate.

Question 27

What can cause hypovolaemia?

Answer 27

``` Severe burns Severe diarrhoea Severe Vomiting Loss of Na+ Haemorrhage ```

Question 28

The body copes with hypovolaemia initially but what happens in decompensation?

Answer 28

Vasoconstriction reduces tissue perfusion. Hypoxia results in local metabolites increasing. Vasodialtion occurs TPR falls BP drops Vital organs not perfused Multi-system failure

Question 29

List the long term responders to hypovolaemia?

Answer 29

RAAS ADH 20% loss replaced in 3 days

Question 30

What is distributive shock?

Answer 30

Adequate blood volume but TPR drops and gives low resistance shock -too much space in vessels for normal blood volume to give adequate pressure.

Question 31

Toxic shock and anaphylactic shock can both cause.... shock

Answer 31

Distributive

Question 32

What is toxic shock?

Answer 32

``` Endotoxins released in bacteraemia vasodilation and increase vascular permeability TPR drops and blood volume drops Fall in arterial pressure poor tissue perfusion DIC ``` This will lead to shock inspire of increase sympathetic activity attempting to compensate.

Question 33

What is septic shock?

Answer 33

Persisting hypotension requiring treatment to maintain BP despite fluid rescussitation.

Question 34

List features of patients in septic shock.

Answer 34

Tachycardia Warm, red extremities initially Late stages hypo perfusion of extremities

Question 35

Outline the events of anaphylaxis

Answer 35

``` Exposure to allergen Histamine released from mast cells Vasodilation reduced TPR Sympathetic system attempts to compensate. CO increase inadequate Vital organs not perfused ``` Laryngeal oedema and bronchochonstriction from mediators cause difficulty breathing

Question 36

Collapsed patient, difficulty breathing, rapid HR with red warm extremities presents what do you give for anaphylaxis?

Answer 36

Adrenaline- vasoconctricts to increase TPR, bronchodilates to aid breathing.