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Pathophysiology Loyola > Shock > Flashcards

Shock Flashcards

1. Define cardiovascular shock 2. Describe mechanisms that maintain oxygen delivery 3. Describe the major symptoms of cardiovascular shock 4. Describe 4 major forms of cardiovascular shock 5. Name 3 forms of distributive shock and distinguish their characteristics from hypovolemic shock 6. Describe three mechanisms of cardiogenic shock 7. Describe the difference between mechanical cardiogenic shock and obstructive shock 8. Distinguish between hemorrhagic and non-hemorrhagic forms of hypovolemic

1
Q

Define shock

A

State of cellular and tissue hypoxia due to reduced oxygen delivery and/or increased oxygen consumption or inadequate oxygen utilization

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2
Q

CO X TPR = ?

A

MAP

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3
Q

HR X SV X TPR = ?

A

MAP

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4
Q

List some mechanisms that maintain oxygen delivery

A

Baroreceptor reflex, cardiopulmonary receptors, changing TPR

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5
Q

What are the 3 stages of shock

A

Pre-shock, shock, end-organ dysfunction

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6
Q

What are the symptoms of pre-shock

A

compensatory tachycardia, peripheral vasoconstriction

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7
Q

What are the symptoms of shock?

A

Symptoms of organ dysfunction: tachycardia, dyspnea, restlessness, diaphoresis, metabolic acidosis, hypotension, oliguria, cool and clammy skin

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8
Q

What is the first most important symptom of shock?

A

Oliguria (lack of urine production)

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9
Q

What are the symptoms of end-organ dysfunction?

A

Irreversible organ damage: acute renal failure, acidemia, depressed CO, resistant hypotension, obtundation and coma

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10
Q

What phase of shock is death common in?

A

End-organ dysfunction

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11
Q

What are the 4 major forms of cardiovascular shock?

A

Distributive, cardiogenic, hypovolemic, and obstructive

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12
Q

Describe distributive shock

A

blood vessels dilated

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13
Q

Describe cardiogenic shock

A

genesis of shock is from the heart

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14
Q

Describe hypovolemic shock

A

Loss of blood volume (decreases CO)

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15
Q

Describe obstructive shock

A

Obstruction outside of the heart

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16
Q

How would you categorize pericardial tamponade

A

Obstructive

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17
Q

How would you categorize ventricular failure

A

Cardiogenic shock

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18
Q

What are 3 forms of distributive shock?

A

Septic shock, neurogenic shock, and anaphylactic shock

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19
Q

What is the most common form of shock in the ICU?

A

Septic shock

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20
Q

What causes septic shock?

A

infection

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21
Q

How does sepsis cause vasodilation?

A

it increases iNOS activity, increasing NO production

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22
Q

What is a secondary vasodilator in sepsis?

A

macrophage releasing prostaglandins, leukotrienes, proteases, and oxidants

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23
Q

What vital sign is most affected in hypovolemic shock

A

diastolic pressure

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24
Q

Why does systolic pressure drop in hypovolemic shock?

A

As a consequence of diastolic pressure dropping

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25
Q

What happens when you vasoconstrict a dehydrated person?

A

Worsened peripheral blood flow

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26
Q

What should you give someone in septic shock before giving them vasoconstrictors?

A

Fluids to increase blood volume

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27
Q

How does neurogenic shock happen?

A

In instances of severe traumatic brain or spinal cord injury

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28
Q

How does neurogenic shock affect tone?

A

Reduces sympathetic drive to peripheral vessels but maintains tone

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29
Q

What will an injury to the hypothalamus do to sympathetic drive?

A

Reduce sympathetic drive to blood vessels

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30
Q

Sympathetic nervous system depends on the integrity of what part of the CNS?

A

Spinal cord

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31
Q

In neurogenic shock, would you expect tachycardia?

A

No, you would expect bradycardia due to decreased sympathetic tonic input. Parasympathetic input will still be in tact.

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32
Q

What level of spinal cord injury results in unstable blood pressure?

A

T6 or higher.

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33
Q

What is the cause of anaphylactic shock?

A

Severe allergic reaction

34
Q

What are some symptoms associated with anaphylactic shock?

A

Swelling, hives, itchiness, flushing, vasodilation, mucus generation

35
Q

What is the primary response in anaphylactic shock?

A

Degranulation

36
Q

What are the primary mediators released in degranulation during anaphylactic shock?

A

Histamine, proteases, chemotactic factors (ECF, NCF)

37
Q

What effect do secreted cytokines have during anaphylactic shock?

A

Inflammatory

38
Q

What are secondary mediators involved with anaphylactic shock

A

leukotrienes (B4, C4, D4) and prostaglandin

39
Q

Define cardiogenic shock

A

Shock due to intracardiac causes of cardiac pump failure

40
Q

What are the three types of cardiogenic shock?

A

Cardiomyopathic, arrhythmic, and mechanical

41
Q

Define cardiomyopathic shock

A

Cardiogenic shock that is not associated with major cardiac risk factors (hx of MI, HTN)

42
Q

An idiopathic dilated heart is an example of what type of shock?

A

Cardiomyopathic

43
Q

Hypertrophic septum is an example of what form of shock?

A

Cardiomyopathic

44
Q

Restrictive heart (ventricle failing to relax due to amyloidosis) is an example of which form of shock?

A

Cardiomyopathic

45
Q

Why do arrhythmias cause shock?

A

There is virtually no CO because of dys-synchronized contraction

46
Q

What form of shock may ventricular tachycardia cause?

A

Arrhythmic

47
Q

What form of shock may ventricular fibrillation cause?

A

Arrhythmic

48
Q

Which type of arrhythmia is unlikely to cause shock on its own?

A

Bradyarrhythmia

49
Q

Aortic valve insufficiency (valve stiffening) can cause which form of shock?

A

Mechanical, cardiogenic

50
Q

Severe mitral valve insufficiency can cause which form of shock?

A

Mechanical, cardiogenic

51
Q

Dissecting aneurysm can cause which form of shock?

A

Mechanical, cardiogenic

52
Q

Severe ventricular septal defect can cause which form of shock?

A

Mechanical, cardiogenic

53
Q

Ventricular free wall aneurysm can cause which form of shock?

A

Mechanical, cardiogenic

54
Q

Define obstructive shock

A

Outflow from right or left side of the heart is physically obstructed due to extracardiac mechanical alteration

55
Q

What causes pulmonary vascular sources of obstructive shock?

A

PE or pulmonary HTN

56
Q

Tension pneumothorax can cause what form of shock?

A

Obstructive

57
Q

Pericardial tamponade can cause what form of shock?

A

Obstructive

58
Q

Constrictive pericarditis can cause which form of shock?

A

Obstructive

59
Q

Define hypovolemic shock

A

Reduced intravascular volume (reduced preload) and thus reduced CO

60
Q

Define hemorrhagic shock

A

Reduced intravascular volume from blood loss

61
Q

Define non-hemorrhagic hypovolemic shock

A

Reduced intravascular volume from fluid loss other than blood

62
Q

What are common sources of non-hemorrhagic, hypovolemic shock

A

GI,, skin, renal third space

63
Q

Diarrhea may lead to which form of shock?

A

Non-hemorrhagic, hypovolemic shock

64
Q

Vomiting may lead to which form of shock?

A

Non-hemorrhagic, hypovolemic shock

65
Q

External drainage may lead to which form of shock?

A

Non-hemorrhagic, hypovolemic shock

66
Q

Common sources of dehydration may lead to which form of shock?

A

Non-hemorrhagic, hypovolemic shock

67
Q

Heat stroke, burns, and Stevens-Johnson syndrome lead to which form of shock?

A

Non-hemorrhagic, hypovolemic shock

68
Q

Drug-induced osmotic diuresis, salt-wasting, nephropathies, and hypoaldosteronism may lead to which form of shock?

A

Non-hemorrhagic, hypovolemic shock

69
Q

Post-operative, trauma, intestinal obstruction, crush injury, pancreatitis, and cirrhosis may lead to which form of shock?

A

Non-hemorrhagic, hypovolemic shock

70
Q

What are the clinical manifestations of Non-hemorrhagic, hypovolemic shock

A

volume depletion, electrolyte abnormalities, low arterial blood pressure, low jugular venous pressure, low urine volume, hematocrit and serum albumin concentration

71
Q

What would be the first step a provider would take in treating anaphylactic shock?

A

Opening up the airway

72
Q

Why would a patient with anaphylactic shock experience low diastolic pressure?

A

Vasodilation caused by histamine release during degranulation

73
Q

Why would a patient with anaphylactic shock have low systolic pressure?

A

Follows the drop in diastolic pressure

74
Q

Would a patient undergoing anaphylactic shock have increased, decreased, or unchanged pulse pressure?

A

Unchanged (normal)

75
Q

Why would someone with septic shock have scant urine production?

A

Insufficient blood flow to kidneys due to dilated vessels

76
Q

Would a patient undergoing septic shock have increased, decreased, or unchanged pulse pressure?

A

increased due to vascular dysfunction

77
Q

What would you expect the vitals of a person with septic shock to look like?

A 
PP: large
SBP: low
DBP: VERY low
HR: elevated (compensatory)
RR: high due to metabolic acidosis
78
Q

What is the first step in treating a patient with cardiogenic shock?

A

Provide oxygen

79
Q

How would you expect the systolic pressure to be impacted in cardiogenic shock?

A

Decreased

80
Q

How would you expect the diastolic pressure to be impacted in cardiogenic shock?

A

Unchanged

81
Q

How would the pulse pressure change in cardiogenic shock

A

decrease

82
Q

How would the respiratory rate change in cardiogenic shock?

A

Increase

Pathophysiology Loyola (7 decks)

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