Shock

Question 1

what is shock

Answer 1

the clinical syndrome of tissue hypoperfusion due to circulatory failure

Question 2

how can you calculate mean arterial pressure

Answer 2

MAP = 1/3 (systolic - diastolic) + diastolic

MAP = systolic + (2xdiastolic) / 3

Question 3

pathophysiology of hypo perfusion

Answer 3

Decreased MAP
slow flow to organs
inadequate perfusion for cellular metabolic requirements – leads to acidosis + lactate formation

Question 4

effects of hypo perfusion

Answer 4

systemic acidosis - pH < 7.35

worsening enzyme function + cellular performance

micro capillary thrombus
- patchy tissue injury

eventually cellular necrosis

Question 5

what affects MAP

Answer 5

cardiac output

systemic vascular resistance

Question 6

what affects CO

Answer 6

HR

stroke volume

Question 7

signs of tissue hypoperfusion

Answer 7

brain- altered mental state

• glasgow coma score < 15
• confusion + agitation

Urine output decrease

Increased lactate levels

mottling due to microcapillary thrombus

Question 8

what happens in cariogenic shock

Answer 8

reduced force of cardiac contraction + decreased stroke volume
therefore decreased CO + MAP

compensatory increase in systemic vascular resistance

Question 9

compensatory mechanism in cariogenic shock

Answer 9

increased systemic vascular resistance– cool clammy peripheries

Question 10

what happens in obstructive shock

Answer 10

obstruction to cardiac outflow

evidence of raised jugular venous pressure + distended neck veins may be prominent

Question 11

why might you get distended neck veins in obstructive shock

Answer 11

Cardiac output is blocked – venous back pressure – distended neck veins

Question 12

causes of obstructive shock

Answer 12

cardiac tamponade
tension pneumothorax
PE

Question 13

what happens in hypovolaemic shock

Answer 13

reduced blood volume

low venous return to the heart

reduced force of cardiac contraction + cardiac output

Question 14

what sign is seen in hypovolaemic shock

Answer 14

tachycardia

Question 15

what happens in distributive shock

Answer 15

reduced systemic vascular resistance due to vasodilation – WARM RED PERIPHERIES

reduced MAP

Compensatory Increased in CO

Question 16

signs of distributive shock

Answer 16

warm red peripheries

bounding, hyper dynamic circulation

Question 17

types of distributive shock

Answer 17

inflammatory

neurogenic

Question 18

causes of inflammatory distributive shock

Answer 18

sepsis
pancreatitis
burns
anaphylactic shock

Question 19

causes of neurogenic distributive shock

Answer 19

spinal cord damage

iatrogenic – epidural

Question 20

causes of hypovolaemic shock

Answer 20

trauma
Gi bleeding
post- op bleeding
dehydration

Question 21

causes of cardiogenic shock

Answer 21

arrhythmia 
MI
cardiomyopahty 
valve failure 
poisoning

Question 22

signs of shock

Answer 22

pale, clammy, tachycardia, hypotension, hypoxia

cold peripheries = cariogenic
warm peripheries = distributive

Question 23

Treatment of shock

Answer 23

GET HELP

IV access
Fluid replacement
Oxygen
Treat cause