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Shock Flashcards

1
Q

What is shock?

A

Inadequate oxygen to meet metabolic/tissue demands

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2
Q

Does shock mean hypotension?

A

No it can be normal, increased, or decreased

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3
Q

What shock is from an inadequate blood volume or oxygen carrying capacity?

A

Hypovolemic Shock

Hemorrhagic Shock

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4
Q

What shock is from inappropriate distribution of blood volume and flow?

A

Distributive Shock

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5
Q

What shock is from impaired cardiac contractility

A

Cardiogenic Shock

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6
Q

What shock is from obstructed blood flow?

A

Obstructive Shock

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7
Q

Main function of the cardiopulmonary system

A

deliver O2 to body tissues and remove metabolic by products of cellular metabolism (CO2)

When O2 is inadequate to meet tissue demand
Cells use anaerobic metabolism - to produce energy

= LACTIC ACID

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8
Q

Oxygen delivery to the tissues is dependent on…

A

Arterial O2 content (oxygen bound to hemoglobin plus dissolved O2)

Cardiac output (volume of blood pumped each minute)

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9
Q

Arteries vs veins

A

Arteries carry O2

Veins carry blood back through the vena cava to be reoxygenated

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10
Q

O2 may be normal despite hypoxemia due to what compensation

A

CO increasing

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11
Q

When hypoxemia is chronic what does hemoglobin concentration due

A

increases - polycythemia

Therefore increasing the O2 carrying capacity of the blood

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12
Q

CO =

A

SV X HR

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13
Q

CO
SV
HR

A

CO - (the volume of blood pumped by the heart in each minute)
SV - The amount of blood pumped by the left V with each contraction
HR - Number of times the ventricles contract per minute

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14
Q

Infants are more dependent on CO or HR?

A

very small SV - dependent on HR

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15
Q

Preload

A

Volume of blood present in the ventricle before contraction

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16
Q

Contractility

A

Strength of contractin

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17
Q

Afterload

A

Resistance against which the ventricle is ejecting

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18
Q

Inadequate preload is the most common cause of

A

hypovolemic shock

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19
Q

Inadequate contractility is the most common cause of

A

Cardiogenic Shock

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20
Q

Increased afterload can cause

A

cardiogenic shock

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21
Q

what is pulse pressrue

A

the distance between systolic and diastolic pressure

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22
Q

If SVR is low (as in sepsis) what happens to the pulse pressure

A

diastolic pressure decreases and pulse pressure widens

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23
Q

Compensated shock.

A

Maintain a systolic pressure

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24
Q

Compensated shock clinical symptoms

A 
tachycardia (vasoconstriction)
decreased UO  (Retaining water)
delayed cap refill (send blood to peripheral)
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25
Pulses in compensated shock
Narrow pulse pressure (increase in diastolic)
26
In most types of shock what is hypotension
a late finding
27
what is hypotension in septic shock?
When SVR is decreased due to the mediators of sepsis - hypotension will be an early sign (brisk cap refill, full pulses)
28
Hypotensive forumla
70 + (Age in years X 2)
29
How long can it take compensated shock to turn into hypotensive shock
Possibly hours
30
Hypotensive Shock to Cardiac arrest?
Possibly mintues
31
Hypovolemic shock etiology
Gastroenteritis, burns, hemorrhage, inadequate fluid intake, body fluid loss, osmotic diuresis
32
Cardiogenic shock etiology
CHD, myocarditis, cardimyopathy, arrhythmia
33
Distributive shock etiology DIS (3)
Sepsis Anaphylaxis Spinal cord injury
34
Obstructive
tension pneumo, cardiac tamponade, PE, constriction of the ductus arteriosus in infants with ductal-dependent CH lesions (coarctation, hypoplastic left ventricle)
35
Hypovolemic shock is typically a depletion of both
intravascular and extravascular fluid volume
36
What type of fluid boluses are required for hypovolemic shock
Fluid boluses that exceed the volume of the intravascular deficit due to extravascular deficit as well
37
What respiratory compensation is used in hypovolemic shock
typically tachypnea - creates respiratory alkalosis - blowing off CO2 Partially compensating for metabolic acidosis (lactic acidosis) that accompanies shock
38
Hypovolemic shock is characterized by a
decrease preload leading to reduced SV and low CO
39
Hypovolemic shock main compensatory mechanisms
Tachycardia Inc SVR Increased cardiac contractility
40
Relative hypovolemia
Arterial/Venous vasodilation Increased capillary permeability Plasma Loss into the interstitum = Third spacing
41
A clinical finding that separetes hypovolemic shock from other shocks
Narrow pulse pressure Adequate or hypotensive systolic pressure Increased diastolic resistance - increased both to try and compensate
42
Distributive shock includes
Septic Anaphylactic Neurogenic (spinal injury)
43
Distributive shock is characterized by
dec SVR leading to maldistribution of blood volume and flow
44
In septic and distributive shock there is decreased..
cell permeability .. leading to loss of volume from the intravascular space - decreased preload
45
In neurogenic shock there is decreased..
sympathetic tone, leading to vasodilation and lack of compensatory mechansims
46
Distributive shock characteristics
1. Volume depletion due to capillary leak 2. Rlease of inflammatory / vasoactive substances 3. Inadequate perfusion of the splanchnic (gut and kidney) 4. Inc blood flow to peripheral tissue beds 5. Accumulation of lactic acid 6. Low SVR
47
The inflamatory cascade response to sepsis
1. Infectious organism activates the immune system (neutrophils, monocytes, macrophages) 2. These cells stimulate release of inflammatory mediators (cytokines) 3. Cytokines produce vasodilation and damage to the lining of the bv causing increased cap permeability 4. Cytokines activate the coagulation cascade (microvascular thrombosis or DIC) 5. Specific inflammatory mediators can impair cardiac contractility and cause dysfunction
48
What makes sepsis so hard to treat?
The variability of perfusion throughout the body
49
What is septic shock caused by
Infectious organism that cause the small blood vessels to dilate and to leak fluid into the tissues
50
What glands have insufficiency in septic shock (explain)
adrenal glands - prone to microvascular thrombosis
51
Neurogenic shock results from what level
T6 and above
52
What are the compensatory mechanisms of neurogenic shock
None due to the sympathetic system being interupted
53
What separates hypovolemia from cardiogenic shock
Hypovolemia is quiet tachypnea | While cardiogenic is retractions, grunting, use of accessory muscles - pulmonary edema
54
Fluid refill in cardiogenic shock for peds
5-10 ml/kg boluses over 10 to 20 minutes
55
Simple pneumo
air leak that enters the pleural space but stops spontaneously
56
Specific findings in tension pneumo
Tracheal deviation Hyperresonance on the affected side Hyperexpansion on the affected side
57
PE is
a total or partial obstruction of the pulmonary artery or its branches by a clot, air, amniotic fluid, catheter fragment
58
What is glucose used for
vital for proper cardiac and brain function | Hypoglycemia can lead to seizures and brain injury
59
What is calcium used for
Cardiac function and vasomotor tone
60
How does sodium bicarb work in acidosis
Sodium bicarb combines with hydrogen ions = carbon dioxide and water CO2 is then eliminated through alveolar ventilation
61
Fluid resuscitation rate
20ml/kg over 5 to 20 mins
62
Inotropes work by
Increase cardiac contractility | Increase HR
63
Inotropes drugs
Dopamine Epi Dobutamine
64
Phosphodiesterase ihibitors work by
Decrease SVR Improve coronary artery blood flow Improve contractility
65
Phosphodiesterase examples
Milrinone
66
Vasodilator examples
Nitro
67
Vasopressor examples NEVD
Epi (>0.3 mcg/kg a minute) Norephinephrine Dopamine (>10mcg/kg a minute) Vasopressin
68
What fluid is usually used for shock
isotonic crystalloids will expand intravascular volume | Blood is usually only used for hemorrhage
69
Other fluid rates for hypotensive and septic shock
60 ml/kg or 200m/kg
70
DKA osmolality
Significantly dehydrated - hyperglycemia
71
What happens with rapid fluid fix in DKA
Cerebral edema
72
Fluid resuscitation in DKA
10 to 20 ml/kg over 1 to 2 hours
73
Posoning fluid resuc (CCB - B blockers)
5-10ml/kg bolus over 10-20 mins
74
Dextrose dosage for symptomatic child
D25W : 2-4ml/kg | D10W: 5-10ml/kg
75
Hemorrhagic sock resuscitation
3ml of isotonic crystalloid for every 1ml of blood loss

PALS (9 decks)

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