Shock & MODS Flashcards by Kate Burton

What is Shock?

Major loss of fluid volume and/or vasodilation

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What happens as a result of shock?

Inadequate perfusion of organs/tissues

Inadequate oxygen/nutrients for cellular metabolism

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Aerobic Metabolism (Citric Acid Cycle)

Occurs in the Mitochondria
Pyruvate enters mitochondria -> Citric Acid Cycle Begins
Yields ATP, H2O and CO2

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What happens when there is not adequate oxygen to perform the citric acid cycle? What is the significance?

Pyruvate does not pass through the citric acid cycle
Instead, it is changed into lactic acid
BIG MARKER THAT OXYGENATION IS INADEQUATE

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Anaerobic Metabolism

AKA Glycolytic Pathway
Occurs in the cytoplasm
Glucose is metabolized into ATP and Pyruvate

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Which state of metabolism would a patient in shock be more likely to be in?

Anaerobic Metabolism

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Compensatory responses to shock

Sympathetic Nervous System - Receptor Functions
Renin System
Epinephrine
Norepinephrine

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Sympathetic Nervous System Receptors

Alpha = vasoconstriction
Beta 1 = Increased HR and contractile force
Beta 2 = Vasodilation of skeletal muscles & Relaxation of bronchioles

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Epinephrine

Increase HR and contractile force = increased cardiac output

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Norepinephrine

Constricts Blood vessels = Increased BP

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Signs of Early Shock

Tachycardia
Narrow Pulse Pressure; Increased RR and Depth;
Decreased urine output; increased Urine specific gravity
Cool, Clammy skin; Altered Mental Status; Dilated Pupils

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Signs of Progressive Shock

Narrow Pulse Pressure; Tachycardia; Hypotension;
Oliguria; Tachypnea;
Metabolic & Respiratory Acidosis w/ Hypoxemia;
Decreased Level of Consciousness

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Shock Categories

Hypovolemic
Cardiogenic
Obstructive
Distributive

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Hypovolemic Shock Causes

Loss of Blood
Loss of Plasma
Loss of Extracellular Fluid - GI fluid, wounds, burns

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Cardiogenic Shock Causes

Acute MI
Acute Valve Abnormality
Refractory Dysrhythmias
Heart Surgery

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Obstructive Shock Definition

Something that obstructs blood flow w/in cardio-pulmonary circuit

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Obstructive Shock Causes

Inadequate blood filling into the heart
Pneumothorax
Pulmonary Embolism
Dissecting Aneurysm

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Distributive shock is

Related to vasomotor tone

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Distributive Shock Causes

Profound vasodilation
Lack of vasomotor tone
Inflammatory Mediators
Spinal Cord Injuries

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Hypovolemic Shock Definition

Inadequate circulating blood volume

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Indicators of Hypovolemic Shock

Decreased Central Venous Pressure

Urinary output increased

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Treatment for Hypovolemic Shock

Stop Bleeding
Replace fluids aggressively
Vasoconstriction Drug therapy (last choice)

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Blood Products

Whole blood
Packed RBCs
Clotting Factors
Plasma
Platelets

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When is whole blood used?

Dire emergencies

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What is the typical blood product used and when is it most used for?

Packed RBCs; typically used for transfusion

What is the function of colloids?

Increase serum colloid osmotic pressure | Draws fluid into blood vessels

Types of colloids

Albumin Dextran Hetastarch

Crystalloids

Contain Electrolytes Extracellular Isotonic solutions preferred More effective to increase blood volume BUT large quantities needed

Normal Saline

0.9% Sodium Chloride; Isotonic | Most compatible with plasma sodium concentration

Advantage to Using Normal Saline

Allows for rapid volume expansion

Disadvantages for Normal Saline

Large volumes contribute to acidosis | Chloride ions attract Hydrogen Ions and lower pH

What is Cardiogenic Shock

Severe Heart Failure

Cardiogenic Shock - Etiologies

``` MI = most common Severe contractile dysfunction Cardiomyopathy Papillary muscle dysfunction Congenital heart defects ```

How does cardiomyopathy lead to cardiogenic shock?

Heart becomes enlarged and the heart muscle is very thin. | Pumping force is lost

Cardiogenic Shock - Treatment

Very challenging to treat as heart damage is often irreversible Prevention is key: Limit size of acute MI Quick myocardial reperfusion

Distributive Shock

Anaphylactic Neurogenic Septic

Anaphylactic Shock cause

Hypersensitivity Type 1 reaction | Allergen-Antibody response

Neurogenic Shock

Disruption of nerve impulses from the spinal cord to the blood vessels Blood vessels then lose vascular tone and will not constrict

Neurogenic Shock | Causes

Depression of medulla vasomotor center Disruption of spinal SNS Fibers High Spinal Anesthesia Drug overdose

What is sepsis?

Life threatening organ dysfunction caused by a dysregulated host response to infection

Goals of the Surviving Sepsis Campaign

1. Reduce mortality. 2. Build awareness 3. Develop guidelines of care. 4. Educate Healthcare professionals 5. Performance Improvement Program. 6. Improve Diagnosis. 7. Increase use of appropriate treatment. 8. Improve post-ICU treatment

Normal Immune Response | Sepsis

altered w/ sepsis | Unpredictable

Abnormal Immune Response | Sepsis

``` Clotting Activated Healthy Tissue Attacked Blood flow disrupted Cellular oxygenation decreased Excessive reaction to invader Cell Death and Organ Failure ```

Septic Shock | Definition

Underlying circulatory, cellular and metabolic abnormalities are associated with greater risk of mortality than sepsis alone

Clinical criteria for septic shock

Hypotension requiring the use of vasopressors to make MAP >= 65 mmHg and having a serum lactate >2mmol/L persisting despite adequate fluid resuscitation.

Mortality rate for septic shock

30-50%

What is most often the cause of septic shock?

Gram negative bacteria (releases endotoxins and cytokines which promotes vasodilation)

Who is most susceptible to septic shock?

The very young and the very old

Treatment for Septic Shock

Antibiotics IV Fluids Colloids

Obstructive Shock | Definition

Obstruction of blood flow in the heart, lungs and/or great vessels

Obstructive Shock | Causes

Pulmonary Embolism - most often Pneumothorax Cardiac Tamponade Cardiac tumor

Clinical Manifestation | Obstructive Shock

Right Sided Heart Failure

Manifestations of Right Sided Heart Failure

Decreased Pumping of the Right Ventricle Increased right atrial pressure Jugular venous distention

Shock Complications

``` ALI ARF ARDS DIC MODS ```

ALI

Acute Lung Injury

ARDS

Acute Respiratory Distress Syndrome

DIC

Disseminated Intravascular Coagulation

ARF

Acute Renal Failure

MODS

Multiple Organ Dysfunction Syndrome

MODS | Definition

Presence of altered organ function such that homeostasis cannot be maintained without intervention

Mortality rate for MODS. WHY??

70-80% | More organs involved = higher mortality

Risk Factors for MODS

``` Very Young/Old Immunosuppressed Chronic Illness Cancer. Malnutrition Severe Trauma ```

How long does it take someone to succumb to MODS?

W/in 28 Days | Some can die within 24 hours