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HEMATOLOGY > SHOCK > Flashcards

SHOCK Flashcards

1
Q

What is shock?

A
  • cellular and tissue hypoxia due to either reduced oxygen delivery
  • increased oxygen consumption, inadequate oxygen utilisation,
  • a combination of these processes..
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2
Q

Normal tissue perfusion depends on ….

A
  1. norrmal cardiac fxn
  2. capacity of vascular bed
  3. Circulating Blood volume
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3
Q

How may hypovolemic shock occur?

A
  • acute hemorrhage
  • severe dehydration (BURNS)
  • volume depletion > reduced SVR
  • reduced pre-load > reduced CO
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4
Q

What occurs in cardiogenic shock ?

A
  • pump failure
  • —Iary ischemia INDUCED MI
  • —–OTHER causes: cardiomyopatheis/ valvular probles and dysrthmias
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5
Q

What occurs with obstructive shock)

A
  • mechanical obstruc. to nomra CO
  • d.t obstruction to CO (P.E/ air embolism)
  • —-restriction of cardiac fillin (PNEUMOTHORAX/ tamponade)
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6
Q

Name examples of distributive shock.

A
  • aka HOT hsokc

- –spetic/ anaphylaxis/ acute LIVER failure/ spinal cord injuries

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7
Q

Why may distributive shock occur?

A

Due to disruption of normal vascular autoregulation, and profound vasodilatation.

Poor perfusion – despite increased cardiac output

Regional perfusion differences

Alteration of oxygen extraction

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8
Q

Most common type of shock?

A
  • Distributive shock (Sepsis)
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9
Q

Is an inflammatory response seen with shock?

A
  • activation of complement cascade
  • cytokine release (Ili-/ TNF-a)
  • platelet activatingn factors
  • adhesion molecules
  • endothelial derived mediators
  • imbalance between antioxidants and oxidants
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10
Q

What hemodynamic changes are seen with shock?

A
  • maldistribution of blood flow
  • DIC
  • reperfusion injuries
  • inappropriate activation of coaglation syst.
  • microcirculatory abnormalities– AV shunting.
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11
Q

What is seen with myocardial dysfxn?

A
  • reversible biventricular SYSTOLIC and diastolic dysfxn —-d.t beta-R downreg. and cytokines circulation
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12
Q

WHat clinical fts are seen with shock?

A
  • MI sx (clammy/ pale)
  • raised JVp/ pulsus paradoxus
  • pyrexia/ vasodilation/ rapid cap. refill/ hypotension
  • profound casodilatation/ erythema/ aedema/
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13
Q

What to monitor clinically with shock?

A 
Urine output 
Neurological 
Biochemical (acidosis/ lactate levels) 
P.e : pale/ cold skin/ CRT -prolonged 
PRESSURE -- cuff/ central venous pr./ pulmonary art. pre./ pulmonary capillary WEDGE pressure
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14
Q

How to manage CO?

A
  • THERMODILUTION with a PA catheter
  • pulse contour analysis
  • doppler usg
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15
Q

How to manage SHOCK?

A

prompt dx/ rx is critical

  • ABC
  • estblishing reliable, WIDE bore IV access and resuscitate
  • –identify and TREAT underlying cause
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16
Q

What is the minimal acceptable BP?

A
  • how much ever, as long as the pt is awake

- —-70-80 systolic !

17
Q

Why are shocked pts MORE susceptible to pulmonary edema with regards to fluids ?

A

microvascular dysfxn

18
Q

What is fluid challenge?

A
  • rapid administration of fluid (with assessment of response)
  • —-300-500ml over 10 mins
  • – have a target in mind
19
Q

What are the choices for fluids, in a fluid challnege?

A
  1. Crystalloids (saline) –SAFE/cheap; BUT RAPIDLY lost ot extravascular spaces
  2. Colloids–cheap….BUT MAY CAUSE ANAPHYLAXIS
  3. Blood - oxygen carrying capacity (stays in circulation) —-scarce/ multiple risks
20
Q

Why are fluids given to a pt?

A
  • to incr. pre-load
  • rapid fluid replacement
    0 balance RAPID volume replacement and risk of fluid iverload
21
Q

What are the goals when managing oxygen saturation?

A
  • falling lactate levels

- SvO2 ; to estimate balance between supply and demand

22
Q

What is given if fluid resuscitation fails?

A

drugs rx

  • ADRENALINE
  • Noradrenaline (1st choice)
  • VASOPRESSIN
  • dopamine— causes MORE deaths in sepsis
  • dopexamine
23
Q

If drugs fails, what is dones next for fluid resuscitations?

A
  • MECHANICAL support
  • balloon pumps
  • L-VADs
  • R-vads
  • –in severe cases: VA-ECMO
24
Q

How to manage hypovolemic shock?

A
  • asses bleeding (estimate volume loss/ speed on ongoign loss)
  • –source
  • temporisation (tourniquet’s)
  • damage limitata resuscitation
  • damage limitation surgeyr
25
Q

What are the risks of resuscitation?

A
  • volume delivered
  • extr-vascular overload
  • s/c edema obvious
  • “WET” LUNGS (ARDS/ bowel edema)
26
Q

Whatshoudl be done once shock is resolved?

A

removed extra fluid !

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HEMATOLOGY (20 decks)

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