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Human Diseases Yr2 > Shock, including sepsis > Flashcards

Shock, including sepsis Flashcards

1
Q

What is shock?

A

An abnormal circulatory state in which TISSUE BLOOD FLOW IS REDUCED. This causes to CELLULAR HYPOXIA.

Reduced cellular oxygen > anaerobic metabolism > lactic acidosis (enzymes don’t function)

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2
Q

What does shock cause? (1)

A

Loss of perfusion to end organs

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3
Q

Cardiac output =

A

CO = HR x SV

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4
Q

Blood pressure =

A

BP = CO x SVR

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5
Q

Oxygen delivered =

A

Oxygen delivered = CO x O2 content of blood

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6
Q

What are the different types of shock?

A
  1. HAEMORRHAGIC
    a. hypovolaemia - loss of circulating blood vol.
  2. NON-HAEMORRHAGIC
    a. Cardiogenic
    b. Septic
    c. Anaphylactic
    d. Neurogenic (spinal)
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7
Q

What factors do you need for end organ perfusion? (3)

A

Airways + Breathing + Circulation = end organ perfusion

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8
Q

How do you improve circulation? (4)

A
  1. INOTROPES - improve myocardial performance, maintain perfusion pressure, blood flow to organs.
  2. VASOPRESSORS - increase SVR, maintain arterial pressure.
  3. IV fluids
  4. Bloods
    (5. medicines)
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9
Q

What are the aims of management of shock? (4)

A
  1. Resolve lactic acidosis
  2. Prevent tissue ischaemia
  3. Optimise cardiac output
  4. Maintain BP
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10
Q

What is haemorrhagic shock?

A

Loss of fluid from intravascular space. Plasma vol

  1. Reduced venous return
  2. Reduced cardiac output
  3. Baroreceptor response
  4. Increased SVR
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11
Q

What happens when blood is lost? (3)

A
  1. RAAS is activated
  2. Catecholamine release
  3. Vasopressin release
  4. Vasoconstriction, increased vol, cardiac stimulation

Vasoconstrict small vessels to incr volume returning to heart to stimulate CO.

–> restore end organs perfusion

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12
Q

What are other causes of hypovolaemia: loss of extracellular fluid/plasma proteins

A

> Bleeding from trauma
GI losses (diarrhoeal, inflammatory bowel disease e.g. Crohns)
Burns
Diabetic ketoacidosis

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13
Q

How do you treat haemorrhagic shock?

A

Replace blood with blood and repair any injury.

Shock management: support physiology

1) airway
2) breathing
3) circulation

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14
Q

What is cardiogenic shock?

A

pump failure due to myocardial damage or inhibited contraction.

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15
Q

What causes myocardial damage? (4)

A

MI (coronary artery blocked)

Cardiomyopathy (heart muscle disease affects function)

Myocarditis (inflammation of heart muscle wall)

Trauma (stab)

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16
Q

What causes inhibited contraction (which can cause cardiogenic shock)? (3)

A

Local anaesthetics (effect contractility)
Anti-arrhythmic drugs
B-blockers.

17
Q

What is cardiac tamponade?

A

When fluid collects btw inner lining of pericardium and outer surface of heart.

External pressure on heart wall muscle

  • myocarditis
  • trauma
  • rupture heart muscles
18
Q

How do you manage cardiogenic shock?

A

Improve myocardial O2 delivery.
preload, contractility, afterload.

If STEMI - stenting of coronary artery to open it up to allow blood flow to heart.
If cardiac tamponade - remove fluid from pericardium with needle.

19
Q

What is septic shock?

A

It is a systemic response to infection where pathogenic organisms have released toxins.

20
Q

What releases endotoxins and how?

A

Gram negative bacterial from cell wall.

21
Q

What releases exotoxins and how?

A

Gram positive bacteria when they are lysed.

22
Q

How does endo/exotoxin release cause altered end organ perfusion?

A 
Endo/exotoxin release
>
Cytokines released (interleukins, TNF)
> 
Cytokines release metabolites and free radicals
>
Blood vessels become leaky as plasma proteins are not able to retain fluid
>
Hypotension, low BP
>
Reduced delivery of blood to end organs
> 
Increased blood lactate
> 
Altered end organ perfusion
23
Q

What does altered end organ perfusion cause?

A

low urine output
altered CNS functio
clotting disorders
metabolic disorders

24
Q

What does the cytokine cascade cause?

A

increased vascular permeability, cardiac dysfunction, bone marrow dysfunction (clotting problems), thermoregulation.

25
Q

What does SIRS stand for?

A

systemic inflammatory response syndrome

26
Q

How do you manage septic shock? (3)

A

Support physiology (airways, breathing, circulation).
Appropriate antibiotic.
Eliminate source - remove puss.

27
Q

Describe the process of anaphylactic shock. (5)

A
  1. Exposure to allergen
  2. Mast cells
  3. Histamine
  4. Complement cascade
  5. Systemic effects
28
Q

How does anaphylactic shock present?

A

Swollen tongue, swollen lips, rash, wheezing.

29
Q

How do you manage anaphylactic shock?

A

ADRENALINE (0.5ml of 1 in a 1000 adrenaline IM)
- this will counter inflammatory vasodilation

Oxygen

Fluids

Corticosteroids - hydrocortisone

Antihistamines

B2 agonist - salbutamol

30
Q

What is neurogenic shock?

A

Loss of normal sympathetic activity

31
Q

What causes neurogenic shock? (3)

A

Trauma - damage spinal cord
Drugs
Tumour - compress cord

32
Q

Explain neurogenic shock.

A

Vasomotor paralysis below level of injury. (smooth muscle cells in vasculature, SNS control arterioles).
Decreased peripheral vascular resistance.
Blood pools in capillary beds.
Reduced venous return, CO and BO.

33
Q

Myocardial infarction may lead to which type of shock?

A

Cardiogenic shock

34
Q

What medication is given as a first line treatment for anaphylactic shock?

A

0.5ml of 1 in a 1000 adrenaline IM

Human Diseases Yr2 (20 decks)

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