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Surgery and anesthesia 3 > shock and sepsis in the surgical patient > Flashcards

shock and sepsis in the surgical patient Flashcards

1
Q

shock

A

decline in vital organ function as a result of maldistribution of blood flow such that delivery of oxygen and nutrients to tissues is inadequate

state of inadequate tissue oxygenation

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2
Q

main causes of shock

A

hypovolemic

distributive

cardiogenic

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3
Q

hypovolemic shock

A

hemorrhage due to trauma, neoplasia, coagulopathy, RBC destruction, surgergy

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4
Q

classification of hypovolemic shock

A

mild: 10 to 15% blood loss
moderate: 30 to 35% blood loss, systolic BP 70 to 80
severe: 35 to 40% blood loss, systolic BP 50 to 70
profound: 40 to 50% blood loss, systolic BP <50

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5
Q

causes of hypovolemic shock

A

severe vomiting/diarrhea

hemorrhagic gastroenteritis

pancreatitis

burns

ascites

peritonitis

both diabetes

adrenocortical insufficiency

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6
Q

cardiogenic shock

A

failure of pump function of heart

myopathic, intracardiac or pericardial causes

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7
Q

reasons for myopathic cardiogenic shock

A

cardiomyopathy

myocardial infarction

myocardial contusion

myocarditis

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8
Q

reasons for intracardiac cardiogenic shock

A

ruptured chordae tendineae

acute aortic regurgitation

aortic stenosis

hypertrophy

arrhythmias

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9
Q

reasons for pericardial cardiogenic shock

A

neoplasia

idiopathic

coagulopathy

trauma

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10
Q

intraoperative cardiogenic shock flow chart

A
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11
Q

distributive shock causes

A

traumatic

anaphylactic

septic

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12
Q

how does trauma cause distributiv shock?

A

tissue damage leads to inflammatory response

tissue factors, endothelins, epinephrine

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13
Q

how does anaphylasis causes distributive shock?

A

histamine

bradykinin

serotonin

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14
Q

how does sepsis cause distributive shock?

A

bacterial toxins cause the release nitric oxide, tumor necrosis factor, eiconasoids

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15
Q

initial response of body to those 3 kinds of shock

A
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16
Q

what is the shock organ of a dog? What happens?

A

GI tract

shunt blood away from mesentery

decreased GI integrity

ulceration

melena

ileus

danger of bacterial translocation

17
Q

what is the shock organ in a cat? what happens?

A

the lung

pulmonary edema

pleural effusion

acute respiratory distress syndrome

respiratory failure

18
Q

stages of shock

A

compensatory

early decompensatory

late decompensatory

19
Q

compensatory stage of shock

A

decreased venous return

decreased cardiac output

release of catecholamines

release of aldosterone, ADH

activation of renin-angiotension system

all of the above leads to increased HR, contractility and cardiac output

20
Q

clinical signs of compensatory stage

A

tachycardic

tachypnic

BP may be normal

hyperdynamic stage

varies in length dependinng on insult

may not be seen clinically

21
Q

early decompensatory stage

A

significantly decreased cardiac output

increased! sympathetic response

shunting of blood to brain and heart

all the above lead to:

decreased oxygen delivery

anaerobic glycolysis

cellular swelling

cell death

22
Q

clinical signs of early decompensatory stage

A

tachycardia (or bradycardia in cats)

hypothermia

pale MM

prolonged CRT

cold limbs and skin

muscle weakness

decreased level of consciousness

oliguria

23
Q

why do cats become bradycardic during the early compensatory stage of shock?

A

increased parasympathetic response

increased myocardial depressant factor

24
Q

late decompensatory stage

A

prolonged tissue hypoxia

circulatory collapse

insufficienct cerebral and cardiac blood flow

leads to organ failure and cardiopulmonary arrest

25
Q

clinical signs of late decompensatory stage

A

refractory hypotension

absent pulses

damaged myocardium causes decreased cardiac output

pale or cyanotic MM

absert CRT

severe hypothermia

anuric renal failure

pulmonary edema

petechia, hemorrhage

GI sloughing

26
Q

goals for therapy for shock

A

restore tissue perfusion and oxygen delivery

ensure adequate respiration

control hemorrhage

expand circulating blood volume

ABCs

27
Q

ABCs of therapy for shock

A

Airway: patent airway, oxygen

Breathing: diuretics, bronchodilators, thoracocentesis, chest tube, intubation, ventilation, pain management

circulation: IV crystalloids, colloids, blood products, vasopressor agents, anti-arrhythmics

28
Q

fluid support for shock

A

Crystalloids: isotonics, hypertonic, hypotonic

colloids: hetastarch, pentastarch, vetstarch, human/canine albumin

blood products: Packed RBCs, fresh frozen plasma, fresh whole blood

29
Q

sepsis

A

systemic response to infection with bacteria, viral or protozoal organisms

30
Q

septic shock

A

sepsis with hypotension despite adequate fluid resuscitation

31
Q

pathophysiology of sepsis

A

LPS and peptidoglycans stimulate inflammatory target cells (mononuclear cells, PMN, vascular endothelial cells, plts

32
Q

what happens in sepsis after mediators are released?

A

vasodilationo

increased vascular permeability

initiation of complement cascade

further recruitment of neutrophils and macrophages

activation of coagulation

33
Q

consequences of vasodilation in sepsis

A

hypotension

decreased organ and tissue perfusion

ischemia-organ damage

venodilation: decreased preload

myocardial depression

34
Q

consequences of activating coagulation during sepsis

A

Disseminated intravascular coagulation-thrombocytopenia, hypofibrinogenemia, elevates FSP, PT, PTT and D-dimers

bleeding tendencies

microthrombosis of small vessels

organs ischemia and hypoperfusion

35
Q

clinical signs of sepsis

A

dereased mentation

weak

collapsing

abdominal pain

dyspnea/tachypnea

tachycardia

fever/hypothermmia

poor pulses

injected mucous membranes

36
Q

diagnosis of sepsis

A

good PE

mentation, hydration, perfusion indices

heart murmur, arrhythmia

respiratory effort, lung sounds

abdominal palpation-pain, mass, fluid wave, foreign body, intestinal sounds

evidence of skin lesions

swollen/painful/warm joints

37
Q

diagnostics of sepsis

A

CBC, Chem23, UA

coagulation profile, blood gas analysis

cultures!

rads, u/s

abdominocentesis, thoracocentesis, arthrocentesis

fluid analysis

38
Q

treatment of sepsis

A

surgical correction

fluid balance

BP

treat underlying disease

treat DIC: fresh frozen plasma, +/- heparin

oxygen therapy

pain meds

nutrition

monitor!

39
Q

prognosis of sepsis

A

depends on underlying disease process and status of cardiovascular system

mortality rate 25-60%

Surgery and anesthesia 3 (10 decks)

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