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Pathophysiology > Shock & MODS > Flashcards

Shock & MODS Flashcards

1
Q

What is Shock?

A

Major loss of fluid volume and/or vasodilation

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2
Q

What happens as a result of shock?

A

Inadequate perfusion of organs/tissues

Inadequate oxygen/nutrients for cellular metabolism

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3
Q

Aerobic Metabolism (Citric Acid Cycle)

A

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

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4
Q

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

A

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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5
Q

Anaerobic Metabolism

A

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

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6
Q

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

A

Anaerobic Metabolism

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7
Q

Compensatory responses to shock

A

Sympathetic Nervous System - Receptor Functions
Renin System
Epinephrine
Norepinephrine

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8
Q

Sympathetic Nervous System Receptors

A

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

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9
Q

Epinephrine

A

Increase HR and contractile force = increased cardiac output

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10
Q

Norepinephrine

A

Constricts Blood vessels = Increased BP

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11
Q

Signs of Early Shock

A

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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12
Q

Signs of Progressive Shock

A

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

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13
Q

Shock Categories

A

Hypovolemic
Cardiogenic
Obstructive
Distributive

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14
Q

Hypovolemic Shock Causes

A

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

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15
Q

Cardiogenic Shock Causes

A

Acute MI
Acute Valve Abnormality
Refractory Dysrhythmias
Heart Surgery

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16
Q

Obstructive Shock Definition

A

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

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17
Q

Obstructive Shock Causes

A

Inadequate blood filling into the heart
Pneumothorax
Pulmonary Embolism
Dissecting Aneurysm

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18
Q

Distributive shock is

A

Related to vasomotor tone

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19
Q

Distributive Shock Causes

A

Profound vasodilation
Lack of vasomotor tone
Inflammatory Mediators
Spinal Cord Injuries

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20
Q

Hypovolemic Shock Definition

A

Inadequate circulating blood volume

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21
Q

Indicators of Hypovolemic Shock

A

Decreased Central Venous Pressure

Urinary output increased

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22
Q

Treatment for Hypovolemic Shock

A

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

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23
Q

Blood Products

A 
Whole blood
Packed RBCs
Clotting Factors
Plasma
Platelets
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24
Q

When is whole blood used?

A

Dire emergencies

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25
Q

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

A

Packed RBCs; typically used for transfusion

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26
Q

What is the function of colloids?

A

Increase serum colloid osmotic pressure

Draws fluid into blood vessels

27
Q

Types of colloids

A

Albumin
Dextran
Hetastarch

28
Q

Crystalloids

A

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

29
Q

Normal Saline

A

0.9% Sodium Chloride; Isotonic

Most compatible with plasma sodium concentration

30
Q

Advantage to Using Normal Saline

A

Allows for rapid volume expansion

31
Q

Disadvantages for Normal Saline

A

Large volumes contribute to acidosis

Chloride ions attract Hydrogen Ions and lower pH

32
Q

What is Cardiogenic Shock

A

Severe Heart Failure

33
Q

Cardiogenic Shock - Etiologies

A 
MI = most common
Severe contractile dysfunction
Cardiomyopathy
Papillary muscle dysfunction
Congenital heart defects
34
Q

How does cardiomyopathy lead to cardiogenic shock?

A

Heart becomes enlarged and the heart muscle is very thin.

Pumping force is lost

35
Q

Cardiogenic Shock - Treatment

A

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

36
Q

Distributive Shock

A

Anaphylactic
Neurogenic
Septic

37
Q

Anaphylactic Shock cause

A

Hypersensitivity Type 1 reaction

Allergen-Antibody response

38
Q

Neurogenic Shock

A

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

39
Q

Neurogenic Shock

Causes

A

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

40
Q

What is sepsis?

A

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

41
Q

Goals of the Surviving Sepsis Campaign

A
  1. Reduce mortality. 2. Build awareness
  2. Develop guidelines of care. 4. Educate Healthcare professionals
  3. Performance Improvement Program. 6. Improve Diagnosis.
  4. Increase use of appropriate treatment. 8. Improve post-ICU treatment
42
Q

Normal Immune Response

Sepsis

A

altered w/ sepsis

Unpredictable

43
Q

Abnormal Immune Response

Sepsis

A 
Clotting Activated
Healthy Tissue Attacked
Blood flow disrupted
Cellular oxygenation decreased
Excessive reaction to invader
Cell Death and Organ Failure
44
Q

Septic Shock

Definition

A

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

45
Q

Clinical criteria for septic shock

A

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

46
Q

Mortality rate for septic shock

A

30-50%

47
Q

What is most often the cause of septic shock?

A

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

48
Q

Who is most susceptible to septic shock?

A

The very young and the very old

49
Q

Treatment for Septic Shock

A

Antibiotics
IV Fluids
Colloids

50
Q

Obstructive Shock

Definition

A

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

51
Q

Obstructive Shock

Causes

A

Pulmonary Embolism - most often
Pneumothorax
Cardiac Tamponade
Cardiac tumor

52
Q

Clinical Manifestation

Obstructive Shock

A

Right Sided Heart Failure

53
Q

Manifestations of Right Sided Heart Failure

A

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

54
Q

Shock Complications

A 
ALI 
ARF
ARDS
DIC
MODS
55
Q

ALI

A

Acute Lung Injury

56
Q

ARDS

A

Acute Respiratory Distress Syndrome

57
Q

DIC

A

Disseminated Intravascular Coagulation

58
Q

ARF

A

Acute Renal Failure

59
Q

MODS

A

Multiple Organ Dysfunction Syndrome

60
Q

MODS

Definition

A

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

61
Q

Mortality rate for MODS. WHY??

A

70-80%

More organs involved = higher mortality

62
Q

Risk Factors for MODS

A 
Very Young/Old
Immunosuppressed
Chronic Illness
Cancer.   Malnutrition
Severe Trauma
63
Q

How long does it take someone to succumb to MODS?

A

W/in 28 Days

Some can die within 24 hours

Pathophysiology (5 decks)

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