Shock

Question 1

What are the two peices of data used to diagnose shock?

Answer 1

Hemodynamics andmixed venous O2

Question 2

A reflection of LAP, which, in the absence of mitral valve disease, is an indication of

Answer 2

LVEDP and LVEDV

Question 3

Left ventricular failure, aortic valve disease, mitral valve disease, and cardiogenic shock are conditions w/ increased

Answer 3

PCWP AND LAP

Question 4

When LAP is greater than 20 mmHG, we will likely see

Answer 4

Pulmonary Edema

Question 5

What is an example of a condition with increased PCWP but LOW left atrial pressure?

Answer 5

Pulmonary Artery Hypertension

Question 6

CO x the amount of oxygen in the arterial blood gives us the

Answer 6

Oxygen delivery to tissues

Question 7

CO x amount of oxygen in the venous blood gives us

Answer 7

Oxygen returne to the heart

Question 8

Mixed venous oxygen content is derived from the

Answer 8

Fick equation

Question 9

What is the Fick equation?

Answer 9

(CaO2 - CVO2)/CaO2

Question 10

If oxygen delivery declines than we see an increase in

Answer 10

Extraction ratio

Question 11

What are three factors that affect oxygen delivery?

Answer 11

CO, Hb, and PaO2

Question 12

Reflects the balance between oxygen delivery and oxygen demand

Answer 12

SvO2

Question 13

A physiological state characterized by insufficient oxygen delivery to the tissues

Answer 13

Shock

Question 14

We see no protein or RNA synthesis w/ low levels of

Answer 14

ATP

Question 15

Low ATP levels also causes failure of membrane ion pumps which leads to loss of

Answer 15

mb potential

Question 16

The cytosolic proton burden increases when we have low ATP levels. This causes

Answer 16

Acidosis

Question 17

Clinical shock is often accompanied by

Answer 17

Hypotension

Question 18

MAP less than 60 mm Hg in a previously normotensive person

Answer 18

Clinical Shock

Question 19

What are the two compensatory responses ot hypotension

Answer 19

Broreceptor response and renin-angiotensin system

Question 20

The baroreceptor respopnse autoregulates

Answer 20

Blood Pressure

Question 21

Decrease in arterial pressure leads to decreased baroreceptor firing in the

Answer 21

Carotid sinus and aortic arch

Question 22

Hypotension disinhibits the

Answer 22

Vasomotor center

Question 23

Decreased baroreceptor firing causes a decrease in inhibitory neurons which leads to increased sympathetic tone and increased

Answer 23

HR and contratility

Question 24

In response to low BP, the kidney releases

Answer 24

Renin

Question 25

Renin then causes activation of

Answer 25

AN-II

Question 26

AN-II then leads to which 3 things?

Answer 26

1. ) Vasoconstriction 2. ) Na+ resorption 3. ) Net water resorption

Question 27

Metabolic rates of heart and brain are high with low nutrient stores. Therefore they are critically dependent on blood flow for

Answer 27

Oxygen delivery

Question 28

What are the visual features of low CO shock?

Answer 28

Cool, clammy skin, pale or gray color

Question 29

The cool, clammy skin and pale or gray color seen in low CO shock are the result of vasoconstriction which shunts blood from

Answer 29

Periphery to vital organs

Question 30

We can also see agitation/anxiety; "sense of impending doom" confusion; obtundation w/

Answer 30

Low CO shock

Question 31

Normal capillary refill time is less than

Answer 31

2 seconds

Question 32

What are some abnormal findings as far as vascularity to the hands?

Answer 32

Clubbing, splinter hemorrhage, and peripheral cyanosis

Question 33

A metabolic acidosis is a clasic feature of

Answer 33

Shock

Question 34

The metabolic acidosis in shock induces

Answer 34

Tachypnea

Question 35

This tachypnea results in a compensatory

Answer 35

Respiratory alkalosis

Question 36

Cardiogenic shock and myocardial infarction both decrease

Answer 36

Myocardial contractility

Question 37

A pulmonary embolism increases

Answer 37

Afterload

Question 38

Hypovolemic shock and obstructive shock are both causes of decreased

Answer 38

Preload

Question 39

Caused by a tension pneumothorax and pericardial tamponade

Answer 39

Obstructive shock

Question 40

Leading cause of death for patients with acute MI

Answer 40

Cardiogenic Shock

Question 41

Occurs in 5-7% of patients w/ acute MI

Answer 41

Cardiogenic shock

Question 42

More prominent in STEMI than NSTEMI and mortality approaches 80%

Answer 42

Cardiogenic shock

Question 43

Cardiogenic shock is the result of primary

Answer 43

Pump failure | i.e. MI in ventricle 40%

Question 44

Pathophysiology is: coronary occlusion/MI, profound depression of contractility, reduced CO, and low BP

Answer 44

Cardiogenic shock

Question 45

What are three clinical findings of cardiogenic shock?

Answer 45

Hypotension, hypoperfusion, and pulmonary congestion

Question 46

Tachycardia, faint pulses, soft heart sounds, and displaced apical impulse are the result of hypotension and low CO seen in

Answer 46

Cardiogenic shock

Question 47

Component of cardiogenic shock that causes agitation, disorientation, or lethargy w/ cool, clammy, or cyanotic extremities

Answer 47

Hypoperfusion

Question 48

Component of cardiogenic shock leading to pulmonary rales and elevated JVP

Answer 48

Pulmonary congestion

Question 49

Pulmonary congestion results in which murmur

Answer 49

S3

Question 50

Caused by intravascular volume depletion

Answer 50

Hypovolemic Shock

Question 51

Loss of blood cell mass and loss of plasma volume lead to

Answer 51

Hypovolemic shock

Question 52

The essential derangement of hypovolemic shock is

Answer 52

Decreased preload

Question 53

Class 2 hypovolemic shock can be recognized by

Answer 53

Narrow pulse pressure

Question 54

Characterized by cold, clammy skin, tachycardia, and a narrow pulse pressure

Answer 54

Hypovolemic shock

Question 55

The result of impaired venous return to the R or L ventricle -caused by pericardial tamponade and tension pneumothorax

Answer 55

Obstructive shock

Question 56

Clinically presents w/ absent breath sounds, JVD, and tracheal deviation

Answer 56

Tension pneumothorax

Question 57

What are the three types of distributive shock?

Answer 57

Septic shock, neurogenic shock, and anaphylactic shock

Question 58

Decrease in peripheral vascular resistance despite increased vasopressors

Answer 58

Septic Shock

Question 59

Loss of sympathetic tonesecondary to spinal cord injury

Answer 59

Neurogenic shock

Question 60

Histamine, leukotriene C4, prostaglandin D2 release cause profound vasodilatation

Answer 60

Anaphylctic shock

Question 61

Third leading cause of death in US (from all causes) -35-40% mortality

Answer 61

Septic Shock

Question 62

25-30% of cases of sepsis are caused by

Answer 62

Gram negative sepsis

Question 63

30-50% of cases of sepsis are caused by

Answer 63

Gram positive and mized sepsis

Question 64

Initiated by danger signals such as Pathogen-associated molecular patterns (LPS, flagellin, fimbria, DNA etc.)

Answer 64

Septic Shock

Question 65

We see distributive shock, diffuse endothelial injury, and altered microvascular flow w/

Answer 65

Sepsis

Question 66

Failure of vascular smooth muscle constriction

Answer 66

Distributive (vasoplegic) shock

Question 67

Inflammatory mediators can disrupt cell-cell contacts leading to

Answer 67

Edema

Question 68

We see a marked decrease in peripheral vascular resistance w/

Answer 68

Septic Shock

Question 69

CO and peripheral blood flow are increased w/

Answer 69

Setic shock

Question 70

Septic shock is characterized by diminished vasoconstrictor response to

Answer 70

Catecholamines