Shock

Question 1

Define shock

Answer 1

a physiologic state where oxygen delivery to the tissues is inadequate to meet metabolic requirements, causing global hypoperfusion. It may also be thought of as an imbalance between tissue oxygen supply and demand.

Question 2

Compensated vs uncompensated shock

Answer 2

Normal BP + inadequate perfusion = compensated

Question 3

Hypovolemic shock physiology and examples

Answer 3

Decreased circulatory volume. Hemorrhage or fluid loss

Question 4

Cariogenic shock physiology and examples

Answer 4

Decreased heart pump function. Acute coronary syndrome, valve failure, dysrhythmias

Question 5

Distributive shock physiology and examples

Answer 5

Pathologic peripheral blood vessel vasodilation. Anaphylaxis, septic, neurogenic

Question 6

Obstructive shock physiology and examples

Answer 6

Non-cardiac obstruction to blood flow. Pulmonary embolus, tension pneumothorax, tamponade

Question 7

What is the shock index?

Answer 7

HR / systolic bp. Normal is 0.5-0.7. Values over 1.0 indicate decreased left ventricular function

Question 8

Cariogenic physiology

Answer 8

Inc HR, CVP and SVR

Decreased Contractility

Question 9

Hypovolemic physiology

Answer 9

Inc HR
Dec CVP
same or Inc Contractility
Inc SVR

Question 10

Distributive (sepsis) physiology

Answer 10

Inc HR
Dec CVP
+/- Contractility
Dec SVR (vasodilation)

Question 11

Obstructive physiology

Answer 11

Inc HR
\+/- Inc CVP
\+/- Contractility
Inc SVR (tamponade and PE)
Dec SVR (Tension Pneumothorax)

Question 12

When have you achieved a resuscitation of the shock state

Answer 12

normalization of hemodynamic state (BP, HR, and urine output)
lactate decreases by half in the first couple of hours
normal volume status restored
maximal tissue oxygenation
resolution of acidosis and return to normal metabolic parameters