Shock

Question 1

Shock

Answer 1

A syndrome of impaired tissue oxygenation and perfusion due to a variety of etiologies

If left untreated, leads to irreversible injury, organ dysfunction, and death

Question 2

Hypotension

Answer 2

traditionally defined as a systolic blood pressure of 90 mm Hg or less or a MAP of less than 60–65 mm Hg

Question 3

Presentation

Answer 3

high HR
high R
low BP

Question 4

Hypovolemic Shock

Answer 4

there is low blood volume due to non-hemorragic or hemorrhagic events

serum lactate level >2 mmol/L

Cardiac Output: reduced; not very much blood to be pumped

Jugular Venous Pressure: normal or low

Central Venous Pressure: low

Systemic Vascular Resistance: high; vascular constriction occurs to compensate for the low blood volume

Diastolic Pressure: elevated; due to systemic vascular resistance

Pulse Pressure: narrow

Question 5

Cardiogenic Shock

Answer 5

cardiogenic means produced by the heart; the heart has suffered trauma so it cannot adequately pump blood out

Cardiac Output: decreased; heart is not pumping enough blood out

Jugular Venous Pressure: elevated

Central Venous Pressure: elevated

Systemic Vascular Resistance: high; vasoconstriction to get oxygen to where it needs to be

Diastolic Pressure: elevated

Pulse Pressure: narrow; the volume of blood is still there, but the lack of pressure (due to the bad pump) causes back-up of blood, so pulse pressure is narrow

Question 6

Obstructive Shock

Answer 6

outflow is obstructed due to impaired cardiac filling and excessive afterload (cardiac tamponade, tension pneumothorax, massive pulmonary embolism)

Jugular Venous Pressure: elevated

Central Venous Pressure: elevated

Systemic Vascular Resistance: high

Diastolic Pressure: elevated

Pulse Pressure: narrow

JPV, CVP, SVR are all high because everything is backed-up

Question 7

Distributive Shock

Answer 7

everything is leaking and excessive amount of vasodilation (widening of vessels)

warm shock

Question 8

Septic Shock

Answer 8

caused by infection (gram + or - bacteria in hospitals)

bacteria cause release of vasodilators and damage endothelial cells causing them to be leaky

hypotension does not respond to fluid

serium lactate level > 2mmol/L

Cardiac Output: low

Jugular Venous Pressure: variable

Central Venous Pressure: variable

Systemic Vascular Resistance: low

Diastolic Pressure: low

Pulse Pressure: normal or widened

Question 9

Systemic Inflammatory Response

Answer 9

a systemic response to a nonspecific infectious or noninfectious insult (burns, pancreatitis, an autoimmune disorder, ischemia, or trauma)

Criteria: Presence of two or more of the following:
 Body temperature higher than 38°C (100.4°F) or lower than 36°C (96.8°F)
 HR > 90 bpm
 RR > 20 breaths per min or hyperventilation with an arterial carbon dioxide tension (Paco2) < 32 mm Hg
 Abnormal white blood cell count (greater than 12,000/mcL or less than 4000/mcL or greater than 10% immature [band] forms)

categorized as sepsis if source of infection is found

Question 10

Neurogenic Shock

Answer 10

o persistent hypotension despite adequate volume resuscitation in the presence of central nervous system injury