Shock Trauma Flashcards
Shock state:
↑ CVP (Right ♡ preload pressure)
↑JVP (distended R neck vein)
NO RESPIRATORY DISTRESS
Cardiac Tamponade
Shock state:
↑ CVP (Right ♡ preload pressure)
RESPIRATORY DISTRESS
Decreased breath sounds
hyper-resonant on percussion
Tension Pneumothorax
If Pericardial Tamponade is suspected what imaging is used to confirm?
U/S
aka ECHOcardiograph
Hypovolemic shock:
Loss of intravascular fluid volume →
↓ CVP, ↓ PCWP & ↓ Stroke Volume →
resulting in _ CO →
compensatory ↑ SVR & ↑ HR
↓ CO
Hypovolemic shock:
Loss of intravascular fluid volume →
_ CVP, _ PCWP & _ Stroke Volume →
resulting in ↓ CO →
compensatory ↑ SVR & ↑ HR
↓ CVP (R ♡ Preload)
↓ PCWP (L ♡ Preload)
↓ Stroke Volume
Hypovolemic shock:
Loss of intravascular fluid volume →
↓ CVP, ↓ PCWP & ↓ Stroke Volume →
resulting in ↓ CO →
_ SVR & _ HR
compensatory
↑ SVR
↑ HR
Underlying event causes ♡ dysfunction → \_\_ cardiac contractility → ↓ CO, \_\_ Stoke Volume, ↓ BP → ↑ catecholamine release → ↑ SVR & ↑ ♡ O2 demand → ↑ RAAS causes Na+/water retention & ↑ SVR → shunts blood to brain & vital organs → resulting in insufficient perfusion of peripheral organs
↓ Cardiac Contractility
↓ Stroke Volume
Underlying event causes ♡ dysfunction → ↓ cardiac contractility → _ CO, ↓ Stoke Volume, _ BP → ↑ catecholamine release → ↑ SVR & ↑ ♡ O2 demand → ↑ RAAS causes Na+/water retention & ↑ SVR → shunts blood to brain & vital organs → resulting in insufficient perfusion of peripheral organs
↓ CO
↓ BP
Cardiogenic shock:
Underlying event causes ♡ dysfunction → ↓ cardiac contractility → ↓ CO, ↓ Stoke Volume, ↓ BP → ↑ \_\_\_ release → ↑ SVR & ↑ ♡ O2 demand → ↑ \_\_\_ causes Na+/water retention & ↑ SVR → shunts blood to brain & vital organs → resulting in hypoperfusion of peripheral organs
↑ catecholamines
↑ renin-angiotensin-aldosterone system
Underlying event causes ♡ dysfunction → ↓ cardiac contractility → ↓ CO, ↓ Stoke Volume, ↓ BP → ↑ catecholamine release → ↑ SVR & ↑ ♡ O2 demand → ↑ RAAS causes Na+/water retention & ↑ SVR → shunting of \_\_\_\_\_\_ → resulting in insufficient perfusion of peripheral organs
shunting of blood to the brain and vital organs
Cardiogenic Shock Underlying event causes ♡ dysfunction → ↓ cardiac contractility → ↓ CO, ↓ Stoke Volume, ↓ BP → ↑ catecholamine release → _ SVR & ↑ ♡ O2 demand → ↑ RAAS causes Na+/water retention & _ SVR → shunts blood to brain & vital organs → resulting in \_\_\_
↑ SVR (Vasoconstriction)
hypoperfusion of peripheral organs (ischemia)
Obstructive shock
obstruction of the ___ or ___ →
inability of the heart to circulate blood →
↓ CO →
compensatory ↑ SVR
heart or its great vessels
Elevation and equalization of pressures in all the cardiac chambers is seen in ___
cardiac tamponade
unlike all other causes of obstructive shock
Obstructive shock (TPX, Tamponade)
obstruction of the heart or its great vessels →
inability of the heart to circulate blood →
_ CO →
compensatory ↑ SVR
↓ CO
Obstructive shock
obstruction of the heart or its great vessels →
inability of the heart to circulate blood →
↓ CO →
compensatory ↑ __
↑ SVR
systemic vasocontriction
Septic shock
Dysregulated ______ →
capillary leakage and systemic vasodilation →
acute organ dysfunction
host immune response to infection
Septic shock
Dysregulated host immune response to infection →
capillary leakage & __ SVR → __ CO →
acute organ dysfunction
↓ SVR (systemic vasodilation)
↑ CO
Neurogenic shock
Damage of ___ pathways →
loss of sympathetic vascular tone →
unopposed vagal tone →
↓ SVR (peripheral vasodilation) →
pooling of peripheral blood
autonomic
Neurogenic shock
Damage of autonomic pathways → loss of \_\_\_\_ → unopposed vagal tone → ↓ SVR (peripheral vasodilation) → pooling of peripheral blood
↓ sympathetic vascular tone
Neurogenic shock
Damage of autonomic pathways →
loss of sympathetic vascular tone →
unopposed ___ →
↓ SVR (peripheral vasodilation) →
pooling of peripheral blood
vagal tone
{Parasympathetic tone}
Neurogenic shock
Damage of autonomic pathways → loss of sympathetic vascular tone → unopposed vagal tone (PSNS) → _ SVR & _ Cardiac Index/Output → pooling of peripheral blood
↓ SVR (peripheral vasodilation)
↓ CO/CI
Anaphylactic shock
immunologic anaphylaxis (HSR Type _; Ig_ mediated) degranulation of mast cells → massive histamine release → ↓ SVR (systemic vasodilation) and ↑ capillary leakage
type I
IgE
Causes of obstructive shock
↓ ___ filling → cardiac tamponade
↓ ____ return → TPX
↑ Ventricular ____ → massive PR or Aortic Dissection
↓ Diastolic filling
↓ Venous return
↑ Ventricular afterload
Anaphylactic shock
immunologic anaphylaxis (type I HSR; IgE-mediated) or nonimmunologic anaphylaxis (not IgE-mediated) →
degranulation of ___ cells →
massive release of ____ →
_ SVR and ↑ capillary leakage
mast
histamine
↓ SVR (systemic vasodilation)
List 3 types of Distributive shock
Septic shock
Anaphylactic shock
Neurogenic shock
cause of Septic shock
Infection/ bacteremia
especially gram-negative bacteria
Causes of Anaphylactic shock
– Food allergies (e.g. peanuts)
–
–
Drug reactions (e.g. sulfa drugs) Insect stings or bites (e.g. bee stings)
causes of Neurogenic shock (2)
Spinal cord injury
Traumatic brain injury/Cerebral hemorrhage
↑ Lactate indicated global ____
hypoperfusion/ ischemia
One imaging study to consider for hypovolemic shock
FAST exam (to assess for intraperitoneal hemorrhage)
3 Studies to consider for cardiogenic shock
EKG
Echo
cardiac markers (Troponin)
Imaging studies to consider for obstructive shock
3
ECHO aka U/S ( r/o Cardiac Tamponade)
CXR ( r/o TPX)
CTA (pulm) or V/Q scan ( r/p PE & aortic dissection)
Causes of obstructive shock
↓ Diastolic filling → ____
↓ Venous return → ____
↑ Ventricular afterload → ____ or ____
Cardiac tamponade
Tension pneumothorax
Massive pulmonary embolism (PE)
or
Aortic dissection
