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CLASP Sudden Death > Shock > Flashcards

Shock Flashcards

1
Q

What is the definition of ‘shock’?

A

A condition of inadequate perfusion to sustain normal organ function

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2
Q

Name the 5 main classes of shock?

A 
Hypovolaemic
Cardiogenic
Obstructive
Distributive
Cytotoxic
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3
Q

Hypovolaemic is solely due to loss of blood. true/false?

A

FALSE

It can also be a loss of interstitial fluid or pure water

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4
Q

Which hypovolaemic compensation mechanism involves:
inhibition of the vagus nerve and enhancement of sympathetics via nerve signals that originate from stretch receptors in the carotids and aortic arch?

A

Baroreceptor reflex

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5
Q

Describe the sympathetic mediated neurohormonal response to hypovolaemia

A

Sympathetic chronotropy and inotropy
Release of vasoconstrictors (adrenaline, NA, angiotensin, vasopressin etc.)
Redirection of fluids from peripherals and secondary organs
Lactic acidosis causing enhanced chemoreceptor response
When decompensating- increased vasodilators

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6
Q

What does capillary absorption of interstitial fluid do when in a hypovolaemic state?

A

Reduces capillary hydrostatic pressure

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7
Q

Describe the hypothalamic-pituitary-adrenal response to hypovolaemia?

A

Intrarenal baroreceptors=> renin release from juxtaglomerular apparatus
Angiotensin II enhances vasoconstriction and ADH secretion
=> enhanced renal reabsorption of Na and H20

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8
Q

What are the three basic ways to increase cardiac output?

A

Increase HR
increase SV (inotropy)
Increase both

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9
Q

Young people struggle to control HR. true/false?

A

FALSE

they often struggle to control stroke volume!

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10
Q

What happens to the Frank-Starling curve when inotropes are physiologically released/given?

A

Curve shifts up

= increased contractility

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11
Q

What happens to FS curve when contractility is decreased?

A

Shifts down

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12
Q

Describe some compensations made in HF, and what the consequences are?

A

Failing heart= decreased contractility
End diastolic volume increases to maintain stroke volume.
end result in pulmonary congestion

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13
Q

Patients with heart failure often respond poorly to fluid challenges, true/false?

A

true.

lower challenges are given and it is impossible to get a full response due to decreased contractility of the heart

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14
Q

What must you remember when prescribing fluids?

A

They are a drug.
Appropriate dose
Appropriate fluid and electrolyte components for that patient
Remember the difference between resuscitation and maintenance!

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15
Q

What is the main principle behind cardiogenic shock?

A

Heart pump failing to meet circulation demands.

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16
Q

name some causes of cardiogenic shock?

A 
Acute MI
Acute mitral prolapse
Myocarditis
Cardiomyopathy
Myocardial Contusion (traumatic bruising)
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17
Q

What would be the resulting symptoms/signs resulting from failure to pump blood forward?

A

hypotension/shock
fatigue
syncope

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18
Q

What would be some symptoms/signs resulting from cardiac back pressure?

A

Pulmonary oedema (struggle to breath lying down, SOB)
sacral oedema
ankle oedema

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19
Q

What does positive inotropy mean?

A

an increase in the force of cardiac contraction for any preload

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20
Q

what has a positive inotropic effect physiologically?

A

the sympathetic nervous system

21
Q

what exogenous drug can induce a positive inotropic effect?

A

B-Adrenoceptors: Dobutamine, adrenaline

Dopaninergic: dopamine, dopexamine

22
Q

describe what inotropes and fluids do to the Frank-Starling Curve?

A

Inotropes=> UP

Fluids=> RIGHT

23
Q

What device can be used to:

  • provide counter pulsation
  • assist inflation during ventricular diastole and deflation during ventricular systole?
A

Intra-aortic balloon pump

24
Q

What is the main factor behind obstructive shock?

A

Something is obstructing the filling of the heart

25
Q

Name some causes of obstructive shock

A

Pulmonary embolus
cardiac tamponade
tension pneumothorax

26
Q

How would a PE be diagnosed on echo?

A

Hypokinetic right ventricle

Bowing of septum into Left side (due to higher pressure in right side)

27
Q

PE treatment

A

anticoagulation +/- throbolysis

28
Q

How would tamponade be diagnosed on echo?

A

fluid accumulation in pericardium

compression of each chamber with decreased filling

29
Q

What does a tension pneumothorax look like on CXR?

A

blacked out lung space

30
Q

How does a tension pneumothorax cause reduced venous return?

A

intrathoracic pressure is higher than venous pressure

- compression of vessels= obstruction of blood flow

31
Q

describe distributive shock in a basic way

A

dilated circuit, normal blood volume

32
Q

what is the initial compensation for distributive shock?

A

increased CO, however this will start to fall as venous return falls

33
Q

what are the subtypes of distributive shock?

A

Septic shock
Anaphylactic shock
Neurogenic shock

34
Q

Describe the cause septic shock

A

Bacterial toxin release causing capillary dysfunction

35
Q

Describe the treatment for septic shock

A

Sepsis 6 + vasopressors

vasopressors improve perfusion and minimise excessive fluid volumes)

36
Q

Describe the cause of anaphylactic shock

A

mast cell release of histiminergic vasodilators

37
Q

describe anaphylactic shock treatment

A

adrenaline (vasopressor AND mast cell stabiliser)

38
Q

What test can confirm anaphylactic origin?

A

serum mast cell tryptase

39
Q

describe the cause of neurogenic shock

A

loss of sympathetic tone after a spinal injury causing inappropriate bradycardia as CNX is unopposed

40
Q

what is the treatment for neurogenic shock?

A

dopamine and vasopressors

41
Q

what interventions may exacerbate neurogenic shock?

A 
PR exam (vagal stimulation)
ET tube suction (vagal stimulation)
42
Q

what should always make you think neurogenic shock?

A

hypotensive with BRADYCARDIA

43
Q

what are the 4Hs (reversible cardiac arrest)

A

Hypovolaemia
hypothermia
hypoxia
hypo/hyperkaaemia

44
Q

What are the 4Ts (reversible cardiac arrest)

A

Tamponade
thromboembolism
toxins
tension pneumothorax

45
Q

what does CPR do physiologically?

A

cyclical changes in intrathoracic pressure that alternatively pushes blood out of and sucks it back into chest

46
Q

what cardiac rhythm would you most likely see in arrest caused by hypovolaemia?

A

Pulseless electrical activity

47
Q

What cardiac rhythm would most likely be seen in arrest caused by severe hypoxia?

A

asystole

48
Q

what cardiac rhythm would most likely be seen in arrest caused by acute MI, toxins and electrolyte abnormalities?

A

VF and VT

CLASP Sudden Death (8 decks)

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