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YEAR 3 SUDDEN DEATH > Shock > Flashcards

Shock Flashcards

(92 cards)

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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
what can happen if a large fluid challenge is given to someone with HF and hypovolaemic shock
EDV increases to maintain SV - results in pulmonary congestion
26
who should get a smaller fluid challenge
HF
27
what is cardiogenic shock
inability of the heart to act as an effective pump to meet circulatory demands
28
what causes cardiogenic shock
``` most commonly a complication of an MI acute valve dysfunction - acute mitral valve prolapse myocarditis cardiomyopathy myocardial contusion ```
29
even a small MI may affect the ______ ____ leading to valve dysfunction
papillary muscle
30
in cardiogenic shock you cannot increase the ___
CO
31
what are some clinical signs of cardiogenic shock
poor forward flow - lethargic, hypotension/shock, syncope | back pressure - pulmonary oedema, elevated JVP, hepatic congestion
32
what is positive inotropy
increase in force of contraction for any given preload
33
how is positive inotropy achieved physiologically
increased sympathetic output
34
how can positive inotropy be acheived pharmacologically
dobutamine adrenaline dopamine dopexamine
35
what is dobutamine
B1 agonist
36
what is dopexamine
synthetic dopamine analogue
37
how does an intra-aortic balloon pump work
provides counterpulsion
38
an intra-aortic balloon pump is ____ during ventricular diastole
inflated
39
intra-aortic balloon pump is ___ during ventricular systole
deflated
40
intra-aortic balloon pump is inflated during ventricular diastole to
increase diastolic pressure and increase coronary perfusion
41
intra-aortic balloon pump is deflated during systole to
decrease systolic pressure so force that heart has to contract against is lower
42
adrenaline is a _____ and increases ___ and therefore __
vasopressor TPR BP
43
dobutamine increases _____ and so ___
force of contractility | SV
44
what is obstructive shock
physical obstruction to filling of heart (obstruction to heart of great vessels) leading to reduced preload and cardiac output
45
what are some causes of obstructive shock
PE | cardiac tamponade
46
obstructive shock mainly affects cardiac ____ rather than ___
filling rather than ejection
47
how is a PE treated
anticoagulation +/- thrombolysis
48
how is cardiac tamponade treated
pericardiocentesis
49
how is tension pneumothorax treated
decompression and chest drainage
50
how is obstructive shock diagnosed
echo
51
what would be seen on ECHO of PE
right side of heart not contracting well - dilated and hypokinetic RV McConnells sign Bowing of interventricular septum
52
what is Mcconnells sign
hyperkinetic RV apex
53
what is pericardial effusion/tamponade
fluid accumulation in pericardial sac which compresses each of the chambers impairing cardiac filling an contraction
54
what is a tension pneumothorax
air trapped in pleural cavity under positive pressure - creates a one way valve effect that subjects lung to increasing pressure
55
tension pneumothorax prevents patient getting __
venous return - impairs cardiac filling and distribution
56
tension pneumothorax leads to
collapsed lung
57
what is the problem in distributive shock
circuit is too big - problem is with distribution of fluid rather than volume
58
what are 2 other names for distributive shock
vasodilatory | warm
59
what are 3 causes of distributive shock
septic shock anaphylactic shock neurogenic shock
60
what is distributive shock
significant reduction in SVR beyond compensatory limits of increased CO
61
what is the BP like in distributive shock
low
62
what is the skin like in cardiogenic shock
warm and flushed
63
what is the skin like in distributive shock
initially warm then cold
64
how does septic shock occur
bacteria releasing toxins causes capillary dysfunction - WBCs encounter pathogen leading to inflammation, vasodilation and leeky vessels --> hypotension
65
what is the treatment for septic shock
SEPSIS 6
66
what is sepsis 6
``` give 3 take 3 BUFALO Bloods urine output fluids antibiotics lactate oxygen ```
67
what if given early in septic shock improves perfusion and reduces excessive fluid volumes
vasopressors
68
what can detect hypoperfusion before hypotension occurs
rising lactate levels
69
what is seen on the skin of anaphylactic shock
hives itching flushing
70
what occurs in anaphylactic shock
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
what is the treatment of anaphylactic shock
adrenaline
72
how does adrenaline fix anaphylactic shock
vasoconstricts stabilises mast cells also causes bronchodilation
73
what level is diagnostic of anaphylactic shock
serum mast cell tryptase level
74
what is neurogenic shock
loss of thoracic sympathetic outflow following spinal injury
75
loss of sympathetic outflow leads to what
unopposed vasodilation and bradycardia from parasympathetic stimulation --> hypotension
76
is neurogenic shock the same as spinal shock
no
77
what is spinal shock
loss of spinal reflexes despite cord being intact
78
is there compensatory tachycardia in neurogenic shock
no - unopposed vagal tone
79
how is neurogenic shock treated
dopamine alongside vasopressors e.g. adrenaline
80
what is hypotension
below 90/60 | or 25-30% fall from baseline
81
what is MAP equation
[ 2(DBP) + SBP ] / 3
82
what is hypotension
below 90/60 | or 25-30% fall from baseline
83
what is MAP equation
[ 2(DBP) + SBP ] / 3
84
hypovolaemic shock class I is blood loss of up to
750 ml (15%)
85
hypovolaemic shock class II is blood loss of
750 - 1500 (15-30%)
86
hypovolaemic shock class III is blood loss of
1500 - 2000 (30-40%)
87
hypovolaemic shock class IV is blood loss of
> 2000 (>40%)
88
hypovolaemic shock class (?) is when BP starts to fall
III
89
hypovolaemic shock class I has pulse of
< 100
90
hypovolaemic shock class II has pulse of
100 - 120
91
hypovolaemic shock class III has pulse of
120 - 140
92
hypovolaemic shock class IV has pulse of
> 140

YEAR 3 SUDDEN DEATH (7 decks)

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