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YEAR 3 SUDDEN DEATH > Shock > Flashcards

Shock Flashcards

1
Q

what is shock

A

inadequate perfusion of the vital organs to sustain normal organ function

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2
Q

what is hypovolaemic shock

A

insufficient circulating volume

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3
Q

insufficient circulating volume in hypovolaemic shock leads to reduced _____ and __

A

preload and CO

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4
Q

what are some causes of hypovolaemic shock

A 
haemorrhage
dehydration
loss of interstitial fluid
excessive vomiting 
burns
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5
Q

shock from burns is a combination of what kinds of shock

A

hypovolaemic and distributive

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6
Q

what is the BP like in hypovolaemic shock

A

initially normal due to compensation then suddenly drops when body can no longer compensate

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7
Q

what is the patients skin like in hypovolaemic shock

A

pale and cool

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8
Q

what are 4 compensatory mechanisms is hypovolaemic shock

A

baroreceptor reflex
sympathetic mediated neurohormonal response
capillary absorption of interstitial fluid
HPA response

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9
Q

how does the baroreceptor response work in hypovolaemic shock

A

stretch sensitive receptors in the carotid and aortic arch sinus detect decreased stretch and so they fire less - decreased afferent input to the medullary cardiovascular centres leading to inhibition of parasympathetic and enhanced sympathetic output

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10
Q

what cranial nerve is the afferent from the carotid sinus

A

CN IX

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11
Q

what cranial nerve is the afferent from the aortic arch

A

CN X

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12
Q

increased sympathetic output increases ___ and ____

A

chronotropy and inotropy

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13
Q

name 4 vasoconstrictors that are released in response to increased sympathetic output

A

adrenaline
angiotensin
noradrenaline
vasopressin

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14
Q

how does lactic acid build up in hypovolaemic shock

A

vasoconstrictors redirect fluid from peripheral secondary organs leading to lactic acidosis

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15
Q

the lactic acidosis drives what

A

chemoreceptors to enhance response

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16
Q

what causes the decompensation towards the end of hypovolaemic shock

A

circulating vasodilators also increases

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17
Q

why do capillaries absorb interstitial fluid

A

reduced capillary hydrostatic pressure so net inward filtration

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18
Q

what is the Hypothalamus-pituitary-adrenal response to hypovolaemic shock

A

intrarenal baroreceptors mediate renin release from the JGA - resulting angiotensin II enhances vasoconstriction and ADH release so enhanced renal reabsorption of Na and water

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19
Q

CO = ?

A

HR x SV

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20
Q

in order to increase CO what can you do

A

increase HR or SV or both

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21
Q

who isnt able to increase SV

A

young children

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22
Q

what does the frank starling relationship say about SV

A

greater EDV results in greater SV within physiological limits

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23
Q

inotropy results in increased contractility making the FS curve shift ____

A

upwards

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24
Q

a failing heart has decreased contractility so the FS curve is shifted

A

downwards

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25
Q

what can happen if a large fluid challenge is given to someone with HF and hypovolaemic shock

A

EDV increases to maintain SV - results in pulmonary congestion

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26
Q

who should get a smaller fluid challenge

A

HF

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27
Q

what is cardiogenic shock

A

inability of the heart to act as an effective pump to meet circulatory demands

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28
Q

what causes cardiogenic shock

A 
most commonly a complication of an MI
acute valve dysfunction - acute mitral valve prolapse
myocarditis
cardiomyopathy
myocardial contusion
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29
Q

even a small MI may affect the ______ ____ leading to valve dysfunction

A

papillary muscle

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30
Q

in cardiogenic shock you cannot increase the ___

A

CO

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31
Q

what are some clinical signs of cardiogenic shock

A

poor forward flow - lethargic, hypotension/shock, syncope

back pressure - pulmonary oedema, elevated JVP, hepatic congestion

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32
Q

what is positive inotropy

A

increase in force of contraction for any given preload

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33
Q

how is positive inotropy achieved physiologically

A

increased sympathetic output

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34
Q

how can positive inotropy be acheived pharmacologically

A

dobutamine
adrenaline
dopamine
dopexamine

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35
Q

what is dobutamine

A

B1 agonist

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36
Q

what is dopexamine

A

synthetic dopamine analogue

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37
Q

how does an intra-aortic balloon pump work

A

provides counterpulsion

38
Q

an intra-aortic balloon pump is ____ during ventricular diastole

A

inflated

39
Q

intra-aortic balloon pump is ___ during ventricular systole

A

deflated

40
Q

intra-aortic balloon pump is inflated during ventricular diastole to

A

increase diastolic pressure and increase coronary perfusion

41
Q

intra-aortic balloon pump is deflated during systole to

A

decrease systolic pressure so force that heart has to contract against is lower

42
Q

adrenaline is a _____ and increases ___ and therefore __

A

vasopressor
TPR
BP

43
Q

dobutamine increases _____ and so ___

A

force of contractility

SV

44
Q

what is obstructive shock

A

physical obstruction to filling of heart (obstruction to heart of great vessels) leading to reduced preload and cardiac output

45
Q

what are some causes of obstructive shock

A

PE

cardiac tamponade

46
Q

obstructive shock mainly affects cardiac ____ rather than ___

A

filling rather than ejection

47
Q

how is a PE treated

A

anticoagulation +/- thrombolysis

48
Q

how is cardiac tamponade treated

A

pericardiocentesis

49
Q

how is tension pneumothorax treated

A

decompression and chest drainage

50
Q

how is obstructive shock diagnosed

A

echo

51
Q

what would be seen on ECHO of PE

A

right side of heart not contracting well - dilated and hypokinetic RV
McConnells sign
Bowing of interventricular septum

52
Q

what is Mcconnells sign

A

hyperkinetic RV apex

53
Q

what is pericardial effusion/tamponade

A

fluid accumulation in pericardial sac which compresses each of the chambers impairing cardiac filling an contraction

54
Q

what is a tension pneumothorax

A

air trapped in pleural cavity under positive pressure - creates a one way valve effect that subjects lung to increasing pressure

55
Q

tension pneumothorax prevents patient getting __

A

venous return - impairs cardiac filling and distribution

56
Q

tension pneumothorax leads to

A

collapsed lung

57
Q

what is the problem in distributive shock

A

circuit is too big - problem is with distribution of fluid rather than volume

58
Q

what are 2 other names for distributive shock

A

vasodilatory

warm

59
Q

what are 3 causes of distributive shock

A

septic shock
anaphylactic shock
neurogenic shock

60
Q

what is distributive shock

A

significant reduction in SVR beyond compensatory limits of increased CO

61
Q

what is the BP like in distributive shock

A

low

62
Q

what is the skin like in cardiogenic shock

A

warm and flushed

63
Q

what is the skin like in distributive shock

A

initially warm then cold

64
Q

how does septic shock occur

A

bacteria releasing toxins causes capillary dysfunction - WBCs encounter pathogen leading to inflammation, vasodilation and leeky vessels –> hypotension

65
Q

what is the treatment for septic shock

A

SEPSIS 6

66
Q

what is sepsis 6

A 
give 3 take 3 
BUFALO
Bloods
urine output 
fluids
antibiotics
lactate
oxygen
67
Q

what if given early in septic shock improves perfusion and reduces excessive fluid volumes

A

vasopressors

68
Q

what can detect hypoperfusion before hypotension occurs

A

rising lactate levels

69
Q

what is seen on the skin of anaphylactic shock

A

hives
itching
flushing

70
Q

what occurs in anaphylactic shock

A

allergens enter blood stream and bind to b cells which produce IgE
IgE binds to mast cells causing degranulation
histamine is released causing widespread vasodilation —> hypotension
cytokines also released by mast cells recruit WBCs causing widespread inflammation

71
Q

what is the treatment of anaphylactic shock

A

adrenaline

72
Q

how does adrenaline fix anaphylactic shock

A

vasoconstricts
stabilises mast cells
also causes bronchodilation

73
Q

what level is diagnostic of anaphylactic shock

A

serum mast cell tryptase level

74
Q

what is neurogenic shock

A

loss of thoracic sympathetic outflow following spinal injury

75
Q

loss of sympathetic outflow leads to what

A

unopposed vasodilation and bradycardia from parasympathetic stimulation –> hypotension

76
Q

is neurogenic shock the same as spinal shock

A

no

77
Q

what is spinal shock

A

loss of spinal reflexes despite cord being intact

78
Q

is there compensatory tachycardia in neurogenic shock

A

no - unopposed vagal tone

79
Q

how is neurogenic shock treated

A

dopamine alongside vasopressors e.g. adrenaline

80
Q

what is hypotension

A

below 90/60

or 25-30% fall from baseline

81
Q

what is MAP equation

A

[ 2(DBP) + SBP ] / 3

82
Q

what is hypotension

A

below 90/60

or 25-30% fall from baseline

83
Q

what is MAP equation

A

[ 2(DBP) + SBP ] / 3

84
Q

hypovolaemic shock class I is blood loss of up to

A

750 ml (15%)

85
Q

hypovolaemic shock class II is blood loss of

A

750 - 1500 (15-30%)

86
Q

hypovolaemic shock class III is blood loss of

A

1500 - 2000 (30-40%)

87
Q

hypovolaemic shock class IV is blood loss of

A

> 2000 (>40%)

88
Q

hypovolaemic shock class (?) is when BP starts to fall

A

III

89
Q

hypovolaemic shock class I has pulse of

A

< 100

90
Q

hypovolaemic shock class II has pulse of

A

100 - 120

91
Q

hypovolaemic shock class III has pulse of

A

120 - 140

92
Q

hypovolaemic shock class IV has pulse of

A

> 140

YEAR 3 SUDDEN DEATH (7 decks)

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