Test 2: lecture 35 shock Flashcards
what is shock
Deficient cellular energy production as a result of either:
* Insufficient blood flow and oxygen delivery to meet the needs of the tissue
* Insufficient uptake and utilization of oxygen by the tissue
low oxygen delivery to a cell, means less glucose. cell will start to use — for energy
anerobic → increased lactate production
lack of glucose will do what to Na/K pump
glucose needed to make ATP
no glucose= no ATP = pump doesn’t work = increased Na in the cell
water will flood into cell and cause swelling and death
4 forms of shock
hypovolemic shock
cadiogenic
hypoxic
distributive (vasodilatory) shock
cardiogenic shock is failure of —
the pump
normal/increased blood volume but not reaching the tissues
what can cause cardiogenic shock
DCM
HCM
valve disease
CHF
arrhythmias
pericardial effusion with tamponade
distributive shock is failure of the —
pipes
massive vasodilation
what can cause distributive shock
- SIRS-systemic inflammatory response syndrome
- Sepsis
- Anaphylaxis
- Heat Stroke
- Drug induced
hypovolemic shock is failure of the —
fluid
decreased effective circulartion volume
what can cause hypovolemic shock
- vomiting
- Severe diarrhea
- Severe polyuria
- Hemorrhage- trauma
- 3rd Spacing
hypoxic shock is failure of
blood oxygenation, oxygen carriage, or
oxygen uptake
pump okay and blood volume normal- but not oxygenating
what can cause hypoxic shock
- Pulmonary disease
- Hypoventilation
- Severe anemia
- Dyshemoglobinemia
- Mitochondrial dysfunction
how to measure oxygen delivery
initial response of decreased effective circulating volume will cause
increased HR and contractility and vasoconstriction
within minutes: catecholamines are secreted from adrenals
prolonged decreased circulating volume will do what to kindeys
decreased renal perfusion→ RAAS activation
hypovolemic shock clinical signs
high HR and respiratory rate
Dull mentation
peripheral vasoconstriction
* Pale mucous membranes
* CRT > 2 seconds
* Decreased peripheral pulse quality
* Cool extremities
* Decreased rectal temperature
clinical signs of distributive shock in dogs
initially (hyperdynamic phase)
increased HR, respiratory rate
Dull mentation
temp normal or increased
Peripheral vasodilation
* Hyperemic (bright pink or red mucous membranes)
* Fast CRT
* Bounding pulse quality
late(decompensated phase) will look like hypovolemic shock
clinical signs of distributive shock in cats
rare to see hyperdynamic phase
low HR
cold
poor or absent pulses
clinical signs of cardiogenic shock
Most often will have evidence of CHF
* tachycardia
* +/- Murmur or gallop heart sound (esp cats)
* Tachypnea, dyspnea +/- pulmonary crackles
Arrhythmia
Syncope
Muffled heart sounds with pericardial effusion
shock index
heart rate divided by systolic blood pressure
SI >1 can identify early shock
what happens to glucose, urine and WBC during shock
hyperglycemia → fight or flight (can be low BG if septic)
increased WBC
decreased urine output (low perfusion of kidney, RAAS, AKI)
stages of shock
Compensated Shock – ↑ HR, vasoconstruction. ↑ lactate. Blood pressure can stay within the normal range.
Decompensated Shock: ↓BP. compensatory responses fail
Terminal shock: irreversible injury, death is coming
