Svensson Lec 2

Question 1

State the three key elements of shock.

Answer 1

Shock is a life threatening condition of circulatory failure that results in inadequate oxygenation of body tissues

Question 2

Identify the component of gram negative bacteria that mediates septic shock.

Answer 2

endotoxin

Question 3

Define edema.

Answer 3

Accumulation of fluid in interstitial space of body tissues

Question 4

Describe the role of adrenomedullin in modulating vascular function.

Answer 4

In intravascular space enhances the endothelial barrier, reducing movement of solutes out of vascular space. When it does this ADM enters the interstitial space and mediates the relaxation in vascular smooth muscle, resulting in lower BP (vasodilation)

Question 5

State the primary drivers of the movement of fluid into and out of vascular space.

Answer 5

1. Hydrostatic pressure
   –> Drives fluid out of vascular space
2. colloid osmotic pressure
   –> Draws fluid back into vascular space

Question 6

what are common clinical causes of edema.

Answer 6

1. Increased capillary permeability
2. Increased capillary hydrostatic pressure
3. Decreased capillary oncotic pressure
4. Lymphatic obstruction (lymphedema)

Question 7

what is transudate

Answer 7

protein poor

Question 8

what is exudate

Answer 8

protein rich

Question 9

describe the mechanism of Increased capillary permeability

Answer 9

• Local causes: cellulitis
• Systemic causes: sepsis, hypersensitivity reactions

Question 10

describe the mechanism of Increased capillary hydrostatic pressure

Answer 10

• Local causes: compartment syndrome, chronic venous insufficiency
• Systemic causes: heart failure, renal failure, pregnancy

Question 11

describe the mechanism of Decreased capillary oncotic pressure

Answer 11

• Systemic causes: protein deficient states (nephrotic syndrome cirrhosis)

Question 12

describe the mechanism of Lymphatic obstruction (lymphedema)

Answer 12

• Local causes: tumor, trauma, infection (filariasis)

Question 13

Name the 4 main types of shock and their most common causes.

Answer 13

1. distributive
2. hypovolemic
3. cardiogenic
4. obstructive

Question 14

what are the causes of distributive shock

Answer 14

• Sepsis
• Anaphylaxis
• Neurogenic

Question 15

what are the causes of hypovolemic shock

Answer 15

• Hemorrhage
• Severe burns
• Severe vomiting, diarrhea

Question 16

what are the causes of cardiogenic shock

Answer 16

• Myocardial infarction
• Ventricular arrhythmia
• Cardiomyopathy
• Valvular disease

Question 17

what are the causes of obstructive shock

Answer 17

• Cardiac tamponade
• Pulmonary embolism
• Pneumothorax

Question 18

describe distributive shock

Answer 18

• Normal/high output SvO2
  1. Symptoms:
• hypovolemia and hypotension that leads to vasodilation in the release of inflammatory response
  2. Echocardiographic signs
• Normal cardiac chambers and preserved contractility

Question 19

describe hypovolemic shock

Answer 19

• Low SvO2 and low venous pressure
  1. Symptoms:
• leads to loss of plasma or blood volume
  2. Echocardiographic signs
• Small cardiac chambers and normal or high contractility
  –> Triad with hypothermia → coagulopathy → acidosis

Question 20

describe cardiogenic shock

Answer 20

• Low SvO2 and high venous pressure
  1. Symptoms:
• deals with cardiogenic shock and everything related to your heart
  2. Echocardiographic signs
• Large ventricles and poor contractility

Question 21

describe obstructive shock

Answer 21

• Low SvO2 and high venous pressure
  1. Symptoms:
• obstructive shock is characterized by a blockage in blood flow caused by (causeson other slide)
  2. Echocardiographic signs
• Depends on the cause