Shock/stabilization Flashcards
Compensatory shock
Body is compensating - most things go up to help the body maintain perfusion to vital organs
RAAS activation
Decompensatory shock
Body is not able to maintain vital organs function and things are beginning to fail
5 causes of hypoxemia
V-FiSHeD
V/Q mismatch
Fi02 decreased
Shunt
Hypoventilation
Diffusion Impairment
Virchows triad
ESP
Endothelial damage (preexisting)
Stasis of blood flow
Hypercoagulopathy
What is the process used to create ATP?
Oxidative phosphorylation of adenosine diphosphate
Hypoxia vs hypoxemia
Hypoxia - inadequate oxygen delivery to meet tissue metabolic demand
Hypoxemia - PaO2 < 80mmHg
Hypoxemic hypoxia
Inadequate oxygen delivery results from inadequate oxygen carrying capacity of blood
Hypemic Hypoxia
Anemia - decreased circulating hemoglobin reducing CaO2 = decreased DO2
Methemoglobinemia, CO toxicity
Stagnant hypoxia
circulatory hypoxia - decreased CO, decreased DO2
Circulatory shock, cardiac arrest
Histotoxic hypoxia
Adequate delivery of O2 to tissues but cells unable to use/extract them
Cyanide poisoning, mitochondrial dysfunction
Metabolic hypoxia
Increased cellular consumption of CO2, not enough to go around
Hypoglycemia, sepsis
Hypovolemia Shock
Decreased intravascular volume caused by fluid loss, blood loss or third spacing
Decreased preload –> decreased CO
Obstructive Shock
Physical obstruction in circulatory system –> decreased preload
Distributive shock
Adequate volume - cells unable to use oxygen (vasodilation)
Cardiogenic shock
Heart pump failure, inability to eject blood
Decreased contractility, increased afterload, increased preload
What to hypertonic crystalloids do?
Quickly restore intravascular volume –> rapid shifts
Water follows Na
Why have synthetic colloids fallen out of favor?
Renal injury
Coagulation concerns
Cost
Circulating blood volume
Dogs 90mL/kg
Cats 60mL/kg
Dopamine
catecholamine – oliguric renal failure
Beta 1 –> improve CO, BP
Higher doses = alpha 1 –> vasoconstricting effect
Dopaminergic –> beta 1 –> alpha 1
Dobutamine
Beta 1 –> improve contractility and CO
Some beta 2 - vasodilation
Increased CO has no effect on BP
Norepinephrine
Mixed - distributive shock, increased vasoconstriction, improves CO, decreased HR
Phenylephrine
Alpha 1, increase BP, bradycardia
Vasopressin or ADH
Vasoconstriction –> refractory hypotension
Epinephrine
Mixed alpha 1 and beta 1
Improve CO and contractility
Increased doses –> alpha 1 = Increased BP by vasoconstriction
Nasal Canula flow rates
50-150mL/kg/min
Intratracheal oxygen rate
No more than 0.5mL/min
BIG 4
BG
Lactate
PCV/TS
BUN
4 locations of POCUS (abdomen)
Splenorenal
Diaphragmatic - hepatic
Hepatorenal
Cystocolic
Normal CVP
0-5 cmH20
Where is lactate metabolized?
Liver, kidney, myocardium
Type A lactate
Caused by hypoxia, anaerobic metabolism, hypoperfusion, anemia, CO toxicity
Exercise, seizures, tremors
Type B lactate
B1 - systemic diseases
B2 - drugs/toxins
B3 - congenital diseases
