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850 > Shock Patho > Flashcards

Shock Patho Flashcards

1
Q

Shock

A
  • Many mechanisms each with their own treatment
  • All hypo-perfusion to tissues => anaerobic metab
  • Hemodynamic Instability: SBP < 90, MAP < 65
  • Signs of poor tissue perfusion/anaerobic metabolism: elevated lactate > 4
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2
Q

Shock leads to

A
  • Impaired Cellular metabolism: burn ATP more than remake, increased Na+ in cell pulls water from extracellular, decreased circulatory volumes
  • Impaired glucose utilization: increased cortisol, GH, and catecholamines, skeletal/cardiac muscle wasting, hyperglycemia/insulin resistance
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3
Q

BP/CO/CVP

A
  • BP = CO * SVR
  • CO = SV * HR (L/min)
  • CVP: pressure of bleed returning to heart (preload) through venous system
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4
Q

MAP

A

1/3SBP + 2/3DBP

  • Average of SP and DP in arterial system
  • Surrogate marker of tissue perfusion
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5
Q

SVR

A
  • 80*(MAP-CVP)/CO

- Total resistance of circulatory system (heart must overcome)

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6
Q

Cardiogenic

A
  • “Problems with pump”
  • Decompensated HF, MI, PAH, massive PE, dysrhythmias, etc.
  • Compensatory INCREASE in SVR further reduces CO
  • Treatment: make it pump! (already failing heart has poor outcome)
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7
Q

Cardiogenic Treatment

A
  • Inotrope
  • Vasopressor
  • Cautious diuresis
  • Correct underlying cause
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8
Q

Hypovolemic Shock

A
  • “Hole in the bucket”

- Hemorrhage (whole blood), burn (plasma), emesis, diarrhea, DM (interstitial fluid)

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9
Q

Hypovolemic Shock Treatment

A
  • Plug the whole and fill the bucket
  • Hemorrhage => whole blood (PRBC + Platelets + fresh frozen plasma)
  • Other volume loss: crystalloid or colloid
  • Vasopressors to temposize
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10
Q

Neurogenic Shock

A
  • “Profound vasodilation and lack of compensatory tachycardia”
  • Too much parasympathetic => bradycardia
  • Too little sympathetic of vascular muscle => decreased SVR
  • Usually spinal cord injury (high T-spine or C-spine)
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11
Q

Neurogenic Shock Treatment

A
  • Fluids
  • Vasopressors (increase vascular tone)
  • Inotropes (bradycardia)
  • Stabilize spine if injured
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12
Q

Anaphylactic Shock

A
  • Distributive shock
  • Allergic: immune response (IgE mediated)
  • Vasodilation (decreased SVR) and vascular permeability (tissue edema/hypovolemia)
  • Extra-vascular smooth muscle constriction (bronchoconstriction and laryngospasm)
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13
Q

Anaphylactic Shock Treatment

A
  • Remove antigen/anti-vemon
  • Glucocorticoids/antihistamine => blunt inflammatory response
  • Fluid resuscitation => correct hypovolemia
  • EPI => vasoconstriction and vasodilation
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14
Q

Septic Shock

A
  • Distributive Shock
  • Bacteremia => endo/ecotoxin, lipopolysaccharides gram negative, peptidoglycan, lipoteichoic acid gram positive
  • Extremely complex host response designed to eliminate invasive organism: dysregulation and overactive immune response lead to host morbidity/mortality
  • *Once positive feedback loops are established, extremely difficult to restore homeostatic function**
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15
Q

Septic Shock Treatment

A
  • Remove/suppress infection
  • Drain abscess, remove infected heart valve, debridement/amputation
  • Antimicrobials
  • Supportive care: fluid resuscitation, vasopressors, renal replacement therapy, mechanical ventilation
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16
Q

MODS

A
  • Multi-organ dysfunction syndrome
  • Results from sustained shock
  • Triggers: severe trauma, major surgery, burns, shock, pancreatitis, AKI, ARDS
17
Q

Cardiogenic Diagnostic Criteria

A
  • Sustained hypotension (SBP < 90)

- Reduced Cl (<2.2) in presence of elevated PCWP (>18)

18
Q

Cardiogenic Shock + STEMI Patient Treatments

A
  • Revascularization PCI or CABG if due to pump failure
  • Fibrinolytic therapy for those unstable for PCI/CABG
  • Intra-aortic balloon pump for unstable after pharmacologic therapy
  • Alternative LV assist devices for circulatory support in refractory cardiogenic shock
19
Q

Progression of Sepsis

A

SIRS => Sepsis (infection)=> Severe Sepsis REDUNDANT (w/ organ dysfunction/tissue hypoperfusion)=> Septic Shock (hypotension or elevated lactate persisting after fluids)

20
Q

SIRS Criteria

A

-Multifactorial: ischemia, infection, pancreatitis, trauma, burns

Criteria

  • Temp >38.3 or <36
  • HR >90
  • RR > 20 or mechanical ventilation
  • WBC >12000 or <4000 OR > 10% immature forms
21
Q

qSOFA

A
  • Quicker way to identify sepsis

- Must have 2 of the following: RR >=22, altered mentation, SBP =<100

22
Q

Sepsis

A
  • Life threatening organ dysfunction caused by deregulate host response
  • SOFA >=2
  • Scored by respiration, platelets, bilirubin, MAP/pressors, Coma scale, creatinine/urine output
  • In-hospital mortality >10%
23
Q

Hour-1 Bundle

A
  • Sepsis Patient Care
  • Measure lactate and repeat if elevated (>2)
  • Blood cultures and broad spectrum antibiotics
  • Fluids for hypotension or lactate >4
  • Vasopressors for MAP >= 65
24
Q

Septic Shock

A
  • Subset of sepsis
  • Circulatory, cellular, and metabolic abnormalities are associated with greater risk of mortality
  • Vasopressor needed to maintain MAP of 65 and serum lactate >2 in absence of hypovolemia (already fluid corrected)
  • 40% in-hospital mortality risk

850 (23 decks)

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