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Clinical Medicine Master > Shock (MR) > Flashcards

Shock (MR) Flashcards

1
Q

Define shock?

A

Circulatory system failure to supply O2 and nutrients to meet metabolic and cellular demand

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2
Q

Equation for BP?

A

BP = CO * SVR (systemic vascular resistance)

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3
Q

Equation for CO?

A

CO = HR * SV

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4
Q

What does Stroke Volume depend upon?

A

Preload Afterload Contractility

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5
Q

Equation for Delivery of O2 (DO2)?

A

CO * CaO2 (Arterial O2 Content)

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6
Q

Equation for CaO2?

A

CaO2 = [Hb]1.34SaO2 + (PaO2 * 0.003)

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7
Q

What does SaO2 mean?

A

Arterial O2 Saturation

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8
Q

TQ!!! What are the Abnormalitites in Perfusion Parameters (6)? When is shock likely?

A

Mentation CRT MM Color Extremity Temp Pulse Quality An abnormality in ANY of them!

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9
Q

Why does mentatin represent perfusion?

A

Brain O2 dependent perfusion

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10
Q

Why do Mucous Membranes represent perfusion?

A

White/pale = Vasocontriction & Anemia Red – Vasodialation Venous pooling

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11
Q

Why does CRT represent perfusion? What Lengthens CRT? Shortens?

A

Time to refill capillaries after digital pressure Vasoconstriction Vasodialation

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12
Q

How does pulse quality represent perfusion?

A

Shows fullness or body of pulse

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13
Q

How does ↓ Extremity Temperature represent pulse?

A

Vasoconstriction

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14
Q

How does HR represent perfusion?

A

HR will ↑ to ↑ CO

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15
Q

What are the 3 parts of the Circulatory System?

A

Pump Fluid Tubes

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16
Q

What are the tube types?

A

Low Pressure High Pressure

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17
Q

Low pressure tubes?

A

Systemic Capillaries -> Right Heart -> pulmonary circ -> left atrium

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18
Q

High Pressure tubes?

A

Left ventricle to capillaries

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19
Q

When patient comes in and you are assessing for shock, what will you check?

A

A = Airway B = Breathing C = Circulation D = Disability E = External

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20
Q

How will you check Airway?

A

Determine Patency

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21
Q

What will you check for Breathing?

A

RR, Posture, Effort, Character, Breath Sounds

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22
Q

How will you assess circulation?

A

MM color CRT Pulse Cardiac Auscultation

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23
Q

What is CRT < 1 sec? What else can you assess to find this condition? What causes it?

A

Hyperdynamic Pulse Anemia or Sepsis

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24
Q

How will you assess pulse?

A

1 per Heart Beat Strength

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25
Q

Things to asses upon auscultation?

A

Rate Rhythm Murmurs

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26
Q

What should be assesed for disability?

A

Level of consciousness Ambulation Sensation

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27
Q

What to assess Externally?

A

Fractures Open Wounds Augulations/Deformities Crepitus Hernias Hemorrhage Swelling/Bruising

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28
Q

What type of event is shock?

A

Cellular - Inadequate cellular energy production

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29
Q

3 Main types of Shock?

A

How many types can a patient have at once Hypovolemia - The Fluid Cardiogenic - The Pump Distributive - The Tubes ≥ 1

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30
Q

Events leading to shock?

A

↓ effective circulating VOLUME Reduced O2 Carrying Capacity ↓ Pump Efficiency Changes in Vascular Tone & Responsiveness

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31
Q

How do the tissues initially deal with ↓ O2 delivery (DO2)?

A

They pull more blood from circulation for O2

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32
Q

What is critical point?

A

A critical ↓ in DO2 (Delivery of O2 to tissues) where Shock ensues.

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33
Q

When O2 isnt available what happens?

A

Anaerobic metabolism -> Lactic Acidosis

34
Q

What are high leels of Lactic Acidosis correlated with?

A

Reduced survival

35
Q

What is Lactic Acidosis created by? What is produced?

A

Anaerobic glycolysis Lactate & H+

36
Q

Where does Lactate accumulate? What does this Reduce?

A

INTRAcellularly EXTRAcellulat HCO3-

37
Q

What conditiondoe lactic acidosis contribute to?

A

Metabolic Acidosis

38
Q

Stages of Shock?

A

Compensated Uncompensated Terminal/Reversible

39
Q

Describe compensated shock?

A

Blood Flow: Normal -> ↑ Possibly Maldistributed Vital Organ Function= Maintained

40
Q

Describe Uncompensated Shock?

A

Micro-vascular perfusion compromised Significant reduction in circulating volume

41
Q

Describe Terminal/Irreversible shock?

A

Inadequate perfusion to bvital organs Irreparable damage Incompatible with life

42
Q

What is hypovolemic shock?

A

↓ Effective Circulating Volume (ECV)

43
Q

What is ECV?

A

Volume of Arterial Blood perfusing Tissues

44
Q

Severely reduced tissue perfusion leads to?

A

Cellular hypoxia and eventually death

45
Q

Causes of hypovolemic shock?

A

Hemorrhage - Whole blood or plasma ↓ in Na+ Excessive losses - dxa/vomit

46
Q

Dehydration represents loss of fluid from what space?

A

Interstitial

47
Q

What does Extracellular space is represented by?

A

interstitial and intravascular

48
Q

How does body initially react to hypovolemia? How does it compensate?

A

↓ CO 2º to ↓ Venous Return Compensation: ↑ Sympathetic Tone - Vasoconstriction - 1º compensation ↑ Cardiac Contractability Tachycardia to ↑ CO – initially Microvasculature alteration - fluid from interstitium ↓ Renal Perfusion RAAS Activation - Na+ & H2O retention

49
Q

Clinically what will hypovolemic shock patients look like?

A

Mildly depressed Normal -> slightly ↓ Pulse Quality Normotension Normothermia Sluggish - CRT 2 - 2.5 sec Pale MM color

50
Q

Can patient in shock have normla BP?

A

YES!!!

51
Q

What will Late shock patient look like clinically?

A

Severe Depression Poor Pulse Quality Hypotension Hypothermia CRT > 3 sec MM Pale

52
Q

What does MODS mean?

A

Multiple Organ Dysfunction Syndrome

53
Q

TQ!!! How are Cats different in Hypovolemic Shock?

A

Bradycardia! Dull Mentation Hypothermia

54
Q

Shock organs for Cats?

A

Liver*** & Lungs

55
Q

Shock organ for Dogs?

A

GIT

56
Q

Dx of Hypovolemic Shock?

A

PCV/TS Lactate Blood Gas Analysis BUN/CRE SpO2 - Saturation O2 NIBP - non-invasive BP LATER - Radiographs, full CBC, Chem, UA

57
Q

Distributive Shock (Vasodilatory): Loss of systemic vascular resistance is a problem with which part of the circulatory system? What is happening?

A

TUBES Maldistribution of Blood Flow

58
Q

Why does Distributive shock occur?

A

Sepsis Vascular obstruction Anaphylaxis - MOST COMMON

59
Q

What are the two phases of Distributive Shock?

A

Hyperdynamic - tachycardic, febrile, bounding pulses Hypodynamic

60
Q

Hyperdynamic phase of Distributive look like?

A

Tachycardia to ↑ CO Febrile Bounding Pulses Rapid CRT < 1 sec Hyperemic Mucus Membranes - CYTOKINES

61
Q

What is the cause of Peripheral vasodialation with Distributive Shock?

A

Nitric Oxide

62
Q

When does Hypodynamic phase of Distributive shock occur? CX?

A

after Hyperdynamic phase Compensation is failing Still Tachycardic – CYTOKINES Prolonged CRT Pale/Icteric MM Hypothermia

63
Q

What will occur once in hypodynamic phase?

A

Organ damage or failure

64
Q

Cardiogenic Shock: why?

A

PUMP failure CHF Arrhythmias Cardiac tamponade Drugs -> Myocardial Depression

65
Q

What types of drugs lead to myocardial depression?

A

Anesthetics Beta-Blockers Ca2+ Channel Blockers

66
Q

Is there a volume issure with cardiogenic shock?

A

NO

67
Q

What is failure of forward flow? What can cause this?

A

Systolic Failure Ventricular Tachycardia What type of failure is Restrictive Filling? Condition that can cause this? Diastolic Failure Hypertrophic Cardiomyopathy

68
Q

Presentation in cardiogenic shock? Clues it is cardiogenic?

A

Low mentation Pale MM Weak Pulses Tachycardic Slow CRT Crackles, tachypnea, dyspnea, murmur, arrhythmia, abd distention, fluid thrill

69
Q

What tells you if you are treating shock appropriately?

A

Profusion parameters!

70
Q

Terminal Shock: What occurs?

A

↓ Coronary Blood FLow - myocardial damage ↓ CNS Blood Flow – Vasoconstriction Cytokine Release - cell damage/death

71
Q

What are the expected changes in vascular tone: Hypovolemic Shock?

A

Constriction

72
Q

What are the expected changes in vascular tone: Distributive Shock?

A

Dialation

73
Q

What are the expected changes in vascular tone: Cardiogenic Shock?

A

Constriction

74
Q

What are the expected changes in Cardiac Output: Hypovolemic Shock?

A

↑ with Vasoconstriction then ↓ with continued loss

75
Q

What are the expected changes in Cardiac Output: Distributive Shock?

A

↓

76
Q

What are the expected changes in Cardiac Output: Cardiogenic Shock

A

↓

77
Q

What are the expected changes in Systemin Vascular Resistance: Hypovolemic Shock?

A

↑

78
Q

What are the expected changes in SVR: Cardiogenic Shock?

A

↑

79
Q

What are the expected changes in SVR: Distributive Shock?

A

↓

80
Q

What are the expected changes in mechanism of organ damage: Hypovolemic Shock?

A

ischemia Inflammatory Mediators

81
Q

What are the expected changes in mechanism of organ damage: Cardiogenic Shock?

A

Ischemia

Clinical Medicine Master (17 decks)

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