SHOCKS !!

Question 1

Shock Patho

Answer 1

poor tissue perfusion -> aerobic -> anaerobic metabolism **(muscle break down, lactic acid bulid up, > 3mmol) ** -> organ dysfunction d/t decrease cap blood flow

Question 2

Perfusion Triangle

Answer 2

Heart: Pump dysfucntion (treat: ionotrope)
Blood Volume: Content function (treat: give volume)
Blood Vessels: Container problem (treat: epi)

Question 3

Stages of Shock

Answer 3

1) Stage I: Initiation
* decrease CO, vitals not affected yet

2) Stage II: Compensatory
* symptoms more apparent
* shock may still be reversible
* vitals change: increase HR, decrease BP
* neural compensation ( blood shunting to vital organs)
* endocrine compensation (glycocorticoids increase BG, RAAS, ADH)
* chemical compensation: increase resp

3) Stage III: Progressive Stage
* Failed compensatory mechanism
* anaerobic metabolism
* lactic acidosis
* incease vascular permeability -> intravascular hypovolemia -> tissue edema
* cellular death

4) Stage IV: Refractory
* pt will not respond to interventions
* MODS
* ARDS: alveolia w/ fluids
* circulating volume not in vascular space ( ineffective tissue perfusion)

Question 4

SIRS

Answer 4

systemic inflammatory response syndrome
widespread inflammation from:
* infection (sepsis)
* injury
* ischemaia
* shock
* pancreatitis

inflammatory cascade acts abnom
* systemic response: increased permeability of endothelial wall -> fluid shifting -> intravascular volume -> hypolvemia
* clotting factors overact-> micro clots -> clotting factors runs out -> DIC (bleed !)

Question 5

DIC

Answer 5

clotting cascade activation -> micro clotting -> depletion of clottinf factors -> massive hemorrhage

Question 6

MODS

Answer 6

multiple organ dysfunction syndrome
* decrease BP, increase HR, lactate > 6
* symptoms dependent on organs affected
* prevent @ all costs !