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Block 4: Pathophys > Shock > Flashcards

Shock Flashcards

1
Q

Shock is a pathophysiologic state with reduced systemic _______ causing tissue hypoxia

A

tissue perfusion

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2
Q

shock results in what 5 things?

A
  1. Compromised function (e.g., CNS, renal)
  2. Acidemia
  3. Inflammation
  4. Coagulopathy
  5. Cellular injury (reversible or irreversible):
    Endothelial injury / dysfunction (enhanced coagulation)
    Leakage of intracellular contents (e.g., LDH, ALT, AST – lab tests)
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3
Q

Four primary causes of shock

A
  1. Hypovolemic: intravascular volume loss
  2. Cardiogenic: pump failure
  3. Distributive: vasodilation (“hyperdynamic” shock)
  4. Obstructive: blood vessels and heart
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4
Q

Reversal of the cause of shock can reverse the ______ effects on tissues if it is recognized and treat quickly

A

hypoxic

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5
Q

Systemic tissue perfusion is KEY (think ABC – A_____, B_____, C_____)

A

Airway, Breathing, Circulation

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6
Q

Perfusion is determined by what 2 things?

A
  1. Cardiac output (CO) = heart rate (HR) x stroke volume (SV)
  2. Systemic vascular resistance (SVR)
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7
Q

Systemic vascular resistance (SVR) is affected by what 3 things?

A 
Vessel length (e.g., obesity)
Vessel diameter (constriction vs dilation)
Blood viscosity (e.g., hemoconcentration)
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8
Q

Stroke Volume is affected by what 3 things?

A

preload (volume remaining in ventricle), afterload (resistance to ejection), and myocardial contractility (affected by cardiomyopathy)

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9
Q

shock is caused by decreased __ or decreased ___.

A

Caused by decreased CO or decreased SVR

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10
Q

Changes in CO or SVR will result in a compensatory change in the other factor, attempting to maintain _________ (e.g., decreased CO will result in an increase in SVR)

A

tissue perfusion

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11
Q

______ results when the compensation is unable to maintain tissue perfusion at an adequate level

A

Shock

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12
Q

reduction in perfusion due to vasodilation (e.g., decreased SVR due to anaphylaxis) may not be fully compensated for by increased ___(i.e., increased CO)

A

HR

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13
Q

Hypovolemic Shock is Due to _______ compared to the total vascular capacity

A

reduced blood volume

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14
Q

Hypovolemic Shock is Due to reduced blood volume compared to the total vascular capacity. This can be caused by what?

A

low diastolic filling pressure (reduced preload)

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15
Q

Hypovolemic Shock causes

A

Rapid or excessive fluid loss:
Dehydration
Burns
Gastroenteritis (e.g., vomiting, diarrhea)

Blood loss:
Hemorrhage
Solid organ injury (e.g., spleen or liver rupture)
Abdominal aortic aneurysm (AAA) rupture
Other hemorrhage

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16
Q

Signs and symptoms of Hypovolemic Shock

7 things

A
  1. Hypotension (decreased blood volume)
  2. Rapid, thready pulse (increased HR with decreased CO and difficult-to-feel pulse)
  3. Pale, clammy skin (blood diversion to core organs)
  4. Intense thirst (hypothalamic thirst response; elevated electrolytes, low water, hyperosmotic plasma with dehydration)
  5. Tachypnea (caused by increased CO2, reduced O2 vs tissue needs) patient is becoming acidodic
  6. Change in mental status (CNS hypoxia)
  7. Decreased urine output (reduced GFR from reduced renal perfusion)
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17
Q

Hypovolemic Shock: Renal Response

Decreased GFR leads to increased ____secretion

A

renin

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18
Q

Decreased GFR leads to increased renin secretion. this Results in increase of what two things?

A

increased angiotensin and increased SVR

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19
Q

increased angiotensin and increased SVR leads to ________ of arteriolar smooth muscle, and ________ secretion resulting in Na+ retention and K+ loss

A

Vasoconstriction
Aldosterone

Vasoconstriction of arteriolar smooth muscle
Aldosterone secretion resulting in Na+ retention and K+ loss

20
Q

what will Inadequate renal perfusion will result in?

A

loss of renal function

– azotemia, acidemia, etc.

21
Q

in Cardiogenic Shock, _____failure results in decreased CO

A

Cardiac pump

22
Q

causes of Cardiogenic Shock (4)

A
  1. Increased ventricular filling pressure (e.g., restrictive cardiomyopathy)
  2. Ventricular dilation (e.g., dilated cardiomyopathy)
  3. Heart failure leading to hypotension and pulmonary edema
  4. Myocardial infarction
23
Q

Compensatory mechanism in cardiogenic shock is to increase___ to ensure end organ/tissue perfusion

A

SVR

24
Q

Compensatory mechanism in Cardiogenic Shock is to increase SVR to ensure end organ/tissue perfusion. what is a negative aspect about this?

A

increases cardiac work load by increasing afterload

25
Q

Cardiogenic Shock: Myocardial Ischemia

Ischemia results in decreased ventricular contractility and reduced CO from________.

A

LV dysfunction

26
Q

in cariogenic shock, Ischemia results in decreased ventricular contractility and reduced CO from LV dysfunction.
Decreased arterial pressure results in ______ (sympathetic feedback)

A

increased HR

27
Q

As HR increases, _________ also increases

A

myocardial O2 requirement

28
Q

Increased O2 requirement results in increased HR, which in turn increases O2 requirement. this Exacerbates myocardial ischemia, resulting in severe _______. You will Need more O2 to heart: increase supply (O2 administration, NTG) or decrease use (rest)

A

cardiac decompensation

29
Q

type of shock that May result from any cardiac pump failure which reduces CO

A

Cardiogenic Shock: Other Dysfunction

examples:
Cardiomyopathy (dilated or restrictive)
Ventricular arrhythmia (flutter or fibrillation)
Mechanical abnormalities:
     Valve dysfunction
     Ventricular-septal defect
     Ruptured ventricular wall aneurysm
30
Q

in Distributive Shock, “Vasodilatory”, caused by severely decreased ____

A

SVR

31
Q

in Distributive Shock, what increases to compensate for ↓ SVR?

A

heart rate

32
Q

causes of Distributive Shock (5)

A
  1. Septic shock (most common)
  2. Systemic inflammatory response syndrome (SIRS, from burns, pancreatitis, infection)
  3. Anaphylaxis (IgE mediated)
  4. Neurogenic shock (brain/spinal cord injury)
  5. Addison disease crisis
33
Q

Sepsis and bacterial toxins (Staph aureus toxic shock syndrome) can cause what type of shock?

A

Distributive Shock

34
Q

Distributive Shock Results in aggressive acute phase response with what 4 things?

A
  1. Leukocytosis
  2. Fever
  3. Complement activation
  4. Cytokine release results in nitric oxide synthesis, causes widespread vasodilation and hypotension
35
Q

Reduced diastolic blood pressure
Widened pulse pressure
Flushed warm extremities with brisk capillary refill

the above is seen with type of shock?

A

Early septic shock or “warm shock” (Hyperdynamic)

type of Distributive Shock

36
Q

Reduced systolic and diastolic blood pressure
Pale, clammy extremities
Pressure dependent decrease in vital organ perfusion
Multiple organ dysfunction syndrome (abdominal organs, CNS, heart; also called multiple system organ failure)

the above is seen with type of shock?

A

Late septic shock or “cold shock” (Hypodynamic)

type of Distributive Shock

37
Q

characteristics of Early septic shock or “warm shock” (Hyperdynamic)
(3 things)

A
  1. Reduced diastolic blood pressure
  2. Widened pulse pressure
  3. Flushed warm extremities with brisk capillary refill
38
Q

characteristics of Late septic shock or “cold shock” (Hypodynamic)

A
  1. Reduced systolic and diastolic blood pressure
  2. Pale, clammy extremities
  3. Pressure dependent decrease in vital organ perfusion
  4. Multiple organ dysfunction syndrome (abdominal organs, CNS, heart; also called multiple system organ failure)
39
Q

Anaphylactic shock is what type of shock?

A

type of Distributive Shock

40
Q

in Anaphylactic shock, there is a Massive activation of _____ (tissue) and _____(blood) by binding of surface IgE to allergin

A

mast cells

basophils

41
Q

Anaphylactic shock causes a systemic release of what 3 things?

A

Systemic release of histamine, serotonin, leukotrienes

42
Q

Anaphylactic shock Results in _____, increased vascular permeability (loss of vascular volume to extravascular spaces)

A

vasodilation

43
Q

Anaphylactic shock signs

A

Signs of edema (angioedema), dyspnea (bronchiolar smooth muscle contraction, pulmonary edema), hypotension

44
Q

Obstructive Shock is caused how?

A

Reduced CO caused by extracardiac abnormalities:

  1. Massive pulmonary embolus (inadequate return to left atrium)
2. Tension pneumothorax (inadequate filling)
Constrictive pericarditis (inadequate filling)
  1. Pulmonary HTN (inadequate return to left atrium)
  2. Cardiac tamponade (inadequate filling)
45
Q

Prolonged Shock can lead to what two things?

A

Permanent CNS injury

Multiple organ dysfunction syndrome

46
Q

Why might Multiple organ dysfunction syndrome occur in prolonged shock?

A

Because of low pressure of abdominal organs, reduced visceral blood pressure results in kidneys, intestine, liver, heart, brain

Block 4: Pathophys (5 decks)

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