Shock

Question 0

Laplace Law

Answer 0

1. The thicker the wall and greater the wall tension and smaller the radius the greater the contraction

Question 1

Frank-Sterling Law

Answer 1

1. The greater the stretch from preload blood volume, the stronger the contraction.

Question 2

Factors Affecting Blood Flow

Answer 2

1. Poiseuille Law (Viscosity of Fluid)
2. Pressure
3. Resistance

Question 3

Shock

-Underlying Problem

Answer 3

1. Inadequate tissue perfusion

2. Leads to microcirculatory failure and ultimately organ failure

Question 4

Types of Shock

Answer 4

1. Hypovolemic - Volume
2. Cardiogenic - Pump
3. Distributive - Plumbing

Question 5

Hypovolemic Shock

-External

Answer 5

1. GI losses
2. Loss of limb
3. Vessel disruption
4. Diabetes Insipidus
5. DKA
6. Burns & Trauma

Question 6

Hypovolemic Shock

-Internal

Answer 6

1. Dissecting Aorta
2. Retroperitoneal bleed
3. Hemothorax
4. Splenic rupture
5. Third spacing

Question 7

Cardiogenic Shock

Pump Failure

Answer 7

1. > 40% muscle mass loss from? (80% of pts)
   - If Pt loses ventricle muscle, it is much more serious
2. Papillary muscle rupture
3. Cardiac Tamponade
4. Tachyarrhythmias & Bradyarrhythmias
5. Drugs

Question 8

Distributive Shock

Answer 8

1. Anaphylactic
2. Neurogenic
3. Septic

Question 9

Distributive Shock

-Anaphylactic Shock

Answer 9

1. Systemic allergic reaction
   - Drugs
   - Food
   - Insect bites or stings
   - Chemicals

Question 10

Distributive Shock

-Neurogenic Shock

Answer 10

1. Damage or dysfunction of the SNS
   - Spinal cord injury
   - Head injury
   - Anesthesia

Question 11

Distributive Shock

-Septic Shock

Answer 11

1. Release of inflammatory mediators that result in massive vasodilation
   - E Coli **

Question 12

Cells in Shock

-What happens?

Answer 12

1. Anaerobic metabolism only
2. Decrease in ATP (2 moles vs 36 moles)
3. Increase in lactic acid
4. Failure of sodium-potassium pump
5. Endothelial cells swell, decreasing blood flow
6. Fluid leaks from vessels to tissue (third spacing)
7. Cell autolyses w/ release of vasoactive metabolites & phagocytic enzymes

Question 13

Stages Of Shock

Answer 13

1. Compensatory (initial)
2. Decompensated (Progressive)
3. Refractory (Irreversible)

Question 14

Compensated Shock

-What happens?

Answer 14

1. Catecholamines released
2. Systemic venous constriction
3. Systemic artery constriction

Question 15

Compensatory Shock

-Clinical Presentation

Answer 15

1. Anxiety, Fear, Restless & beginning to be confused
2. Thirst
3. Tachycardia & Tachypnea
4. Cool, clammy skin
5. Decreased Bowel sounds but present

Question 16

Decompensated Shock

-What Happens?

Answer 16

1. Blood flow to vital organs reduced
2. Decreased O2 delivery and/or uptake
3. Cerebral & myocardial ischemia
4. Increased lactic acid
5. Ischemia of tissues

Question 17

Decompensated Shock

-Clinical Presentation

Answer 17

1. Hypotension w/ tachycardia
2. Dyspnea
3. Agitation, lethargy, coma
4. Cardiac Rhythm changes

Question 18

Refractory Shock

-What happens

Answer 18

1. Profound hypotension
   - Refractory to therapy
2. Leaky, porous capillaries
3. Passive dilation of arteries and veins
4. Decreased venous return and cardiac output

Question 19

MODS

Answer 19

Multiple Organ Dysfunction Syndrome

1. Progressive dysfunction of 2 or more organ systems resulting from an uncontrolled inflammatory response to severe illness or injury
2. 4 or more organs = 100% mortality

Question 20

Most Common Cause of MODS

Answer 20

1. Sepsis and septic shock are the most common cause of MODS

2. MODS is the most common cause of death in ICU patients