Test 2: lecture 35 shock

Question 1

what is shock

Answer 1

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

Question 2

low oxygen delivery to a cell, means less glucose. cell will start to use — for energy

Answer 2

anerobic → increased lactate production

Question 3

lack of glucose will do what to Na/K pump

Answer 3

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

Question 4

4 forms of shock

Answer 4

hypovolemic shock
cadiogenic
hypoxic
distributive (vasodilatory) shock

Question 5

cardiogenic shock is failure of —

Answer 5

the pump

normal/increased blood volume but not reaching the tissues

Question 6

what can cause cardiogenic shock

Answer 6

DCM
HCM
valve disease
CHF
arrhythmias
pericardial effusion with tamponade

Question 7

distributive shock is failure of the —

Answer 7

pipes

massive vasodilation

Question 8

what can cause distributive shock

Answer 8

• SIRS-systemic inflammatory response syndrome
• Sepsis
• Anaphylaxis
• Heat Stroke
• Drug induced

Question 9

hypovolemic shock is failure of the —

Answer 9

fluid

decreased effective circulartion volume

Question 10

what can cause hypovolemic shock

Answer 10

• vomiting
• Severe diarrhea
• Severe polyuria
• Hemorrhage- trauma
• 3rd Spacing

Question 11

hypoxic shock is failure of

Answer 11

blood oxygenation, oxygen carriage, or
oxygen uptake

pump okay and blood volume normal- but not oxygenating

Question 12

what can cause hypoxic shock

Answer 12

• Pulmonary disease
• Hypoventilation
• Severe anemia
• Dyshemoglobinemia
• Mitochondrial dysfunction

Question 13

how to measure oxygen delivery

Answer 13

Question 14

initial response of decreased effective circulating volume will cause

Answer 14

increased HR and contractility and vasoconstriction

within minutes: catecholamines are secreted from adrenals

Question 15

prolonged decreased circulating volume will do what to kindeys

Answer 15

decreased renal perfusion→ RAAS activation

Question 16

hypovolemic shock clinical signs

Answer 16

high HR and respiratory rate
Dull mentation
peripheral vasoconstriction
* Pale mucous membranes
* CRT > 2 seconds
* Decreased peripheral pulse quality
* Cool extremities
* Decreased rectal temperature

Question 17

clinical signs of distributive shock in dogs

Answer 17

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

Question 18

clinical signs of distributive shock in cats

Answer 18

rare to see hyperdynamic phase

low HR
cold
poor or absent pulses

Question 19

clinical signs of cardiogenic shock

Answer 19

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

Question 20

shock index

Answer 20

heart rate divided by systolic blood pressure

SI >1 can identify early shock

Question 21

what happens to glucose, urine and WBC during shock

Answer 21

hyperglycemia → fight or flight (can be low BG if septic)

increased WBC

decreased urine output (low perfusion of kidney, RAAS, AKI)

Question 22

stages of shock

Answer 22

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