Shock

Question 1

shock is a _____

Answer 1

condition

Question 2

shock is a lack of _____ and ____

Answer 2

perfusion and oxygenation

Question 3

this is no perfusion of organs

inability to oxygenate the rest of the body

Answer 3

hypoxic

Question 4

what is perfusion

Answer 4

• how good the blood flow is to the body
• *BP, color, warmth
• MAP (mean arterial pressure)

Question 5

if this is maintained, there is good perfusion

Answer 5

MAP

Question 6

describe oxedated phosporylation

Answer 6

• usually 36-38 molecules of ATP
• if NO oxygen, anaerobic cycle produces 2 molecules of ATP
• cannot survive on this

Question 7

what is the MAP formula

Answer 7

systolic + diastolic (2) / 3

Question 8

MAP must be what

Answer 8

> 70 for good perfusion to extremities, kidneys, liver, and lungs

Question 9

if workload is increased….

Answer 9

need higher MAP

Question 10

what is the oxygenated cycle

Answer 10

• lungs
• coronary arteries of heart
• carotid artery
• kidneys (1/4 blood supply)
• liver (2/3 of blood supply)

Question 11

why do you go into shock

Answer 11

d/t no oxygen to organs and eventually heart and lungs

Question 12

what is the SV

Answer 12

stroke volume

• systolic - diastolic
• normal SV=50-60
• amount of blood per beat that you can push out

Question 13

what can SV be manipulated by

Answer 13

vasoconstriction

Question 14

what occurs when you initially go into shock

Answer 14

• get cold
• blood starts SHUNTING UP (no longer in extremities)
• vasoconstriction pushes blood to liver, heart, and lungs (eventually only heart)

Question 15

what factors influence MAP

Answer 15

1) total blood volume
2) cardiac output
3) size of vascular bed

Question 16

what is the C.O formula

Answer 16

SV x HR

Question 17

what is normal C.O

Answer 17

4-6 L

Question 18

describe afterload

Answer 18

systolic

force heart has to push to get blood out (push of blood from left ventricle to aorta)

Question 19

describe preload

Answer 19

diastolic
left ventricle and diastolic volume, how much blood left after heart pushes out blood
-never pushes all out (leftover blood)

Question 20

describe ejection fraction

Answer 20

the % you push out
normal is 65-75%
if heart is working well you push this amount of blood out of the heart

Question 21

pt with CHF or MI will have a decreased

Answer 21

ejection fraction

no/bad C.O. (may be as low as 20%)

Question 22

describe size of vascular bed

Answer 22

where does the blood have to go

in septic shock, dilation of vessels is not enough blood flow

Question 23

what are the 4 types of shock

Answer 23

• hypovolemic
• cardiogenic
• distributive
• obstructive

Question 24

describe hypovolemic shock

Answer 24

• total body fluid is decreased
• lost blood or fluid (cannot maintain C.O.)
• hemorrhage and dehydration
• easy to fix, give more fluid or blood

Question 25

describe cardiogenic shock

Answer 25

- pump failure, fluid volume is okay - no strength to push blood out - r/t HF (heart not working) - cannot pump well

Question 26

describe obstructive shock

Answer 26

- cardiac function is decreased by non cardiac functions - fluid NOT affected - clot - pulmonary HTN, tamponade, pneumothorax, pericarditits

Question 27

describe distributive shock

Answer 27

- fluid shifted from central vascular space - body fluid is normal or elevated - neural or chemical

Question 28

what is chemical distributive shock

Answer 28

- septic shock - loss of vascular tone - lose things to fight infection

Question 29

what causes shock

Answer 29

-decrease in MAP d/t decrease in C.O, decrease in blood volume or expansion of vascular bed

Question 30

drop of MAP is detected by what

Answer 30

baroreceptors in the aortic arch and carotid sinus that cause shock process

Question 31

pt in shock appears

Answer 31

- cold d/t shunting blood (put legs up, elevate) - gut GI doesnt work - liver doesnt work (no outward sign) - kidneys stop working (outward sign is decreased renal output ie/ less than 30 mL/hr) - head/brain stop working - heart and lungs stop working

Question 32

chemical process of shock

Answer 32

- baroreceptors send infor to brian, starts to shunt blood to vital areas - leads to an increase in lactic acid, protein destroying enzymes and oxygen radicals

Question 33

how soon does shock need to be reversed before it progresses

Answer 33

in 1 or 2 hrs or may be irreversible and can lead to MODS

Question 34

what is MODS

Answer 34

multiple organ dysfunction system | d/t lack of oxygen

Question 35

what do the baroreceptors do

Answer 35

sit on glomerulus and trigger conservation of blood flow, no output oxygen free radicals attack the heart