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Principles 4 > Test #2 Shock - Josh > Flashcards

Test #2 Shock - Josh Flashcards

1
Q

Shock:

what is the def on shock

A
  • inadequate O2 delivery to meet metabolic demands
  • Results in global tissue hypoperfusion and Metabolic acidosis
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2
Q

Shock:

Shock can occur with a normal ____ _____ and _______ can occur without shock

A

blood pressure

hypotension

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3
Q

Shock:

Inadequate systemic O2 delivery activates ____ responses to maintain systemic O2 delivery

A

Autonomic

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4
Q

Inadequate systemic O2 delivery activates Autonomic responses to maintain systemic O2 delivery. the ____, ___, and ____ blood flow is preserved; other regional beds are constricted

A

heart

kidney

brain

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5
Q

Inadequate systemic O2 delivery activates Autonomic responses to maintain systemic O2 delivery. the Heart, kidney, and brains blood flow is preserved; other regional beds are constricted. pain , hemorrhage, cortical perception of traumatic injury cause the release of _____ and ____ mediators

A
  • Hormone
  • Inflammatory
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6
Q

Shock: SNS

the SNS releases catecholamines. what are they?

A
  • NE
  • Epinephnine
  • dopamine
  • cortisol
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7
Q

Shock:

the SNS’s release of the catecholamines NE, epi, Dopamine, and cortisol cause what?

A
  • vasoconstriction
  • increase HR
  • Increase CO
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8
Q

Shock: SNS

besides the release of catecholamines what else does the SNS activate during shock

A

Renin-angiotension axis

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9
Q

Shock: SNS

what does the renin angiotensin axis do?

A
  • Water and Sodium conservation
  • Vasoconstriction
  • Increase in blood volume
  • Increase in Blood pressure
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10
Q

Shock: Cellular response

what is the cellualr response to decreased systemic O2 delivery?

A
  • ATP depletion -> ion pump dysfunction
  • Hydrolysis of cellular membranes and cellualr death
  • Individual cells take up interstitial fluid
  • Fuurther depletion of IVF
  • cellualr edema occludes adjacent capllaries; no re-flow phenomenon prevents reveral of ischemia even restoration of adeuate macrocirculation
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11
Q

Shock:

what is the boddies intrinsic goal?

A
  • maintain cerebral and cardiac perfusion
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12
Q

Shock:

how does the body accomplish it’s goal of maintaining cerebral and cardiac perfusion?

A
  • Vasoconstriction of splenic, musculoskeletal, and renal blood flow
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13
Q

Shock:

ischemic cells produce what

A
  • lactate
  • free radicles
  • Inflammatory factors
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14
Q

Shock:

the ischemic cells that produce lactate, free radicles, and inflammatory factors, result in __ ___ ___ that overcomes the bodies compensatory mechanisms

A

systemic metabolic acidosis

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15
Q

Global Tissue Hypoxia

is the _______ inflammation and disruption and inability of ____ delivery to meet demand. it results in ____, _____, and ______

A
  • endothelial
  • O2
  • lactic acidosis
  • Cardiovascular insufficiency
  • Increased demands
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16
Q

Organ System Response: CNS

what does teh CNS trigger?

A
  • neuroendocrine response
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17
Q

Organ System Response: CNS

the neuroendocrine response causes changes in the uptake of what in the brain?

A

glucose

18
Q

Organ System Response: CNS

what happens to the reflexes and cortical activity?

A

depressed

19
Q

Organ System Response: Kidney and Adrenal Glands

the kidneys maintain GFR how?

A
  • selective vasoconstriction and concentration of blood flow in the medulla and deep cortical area
20
Q

Organ System Response: Kidney and Adrenal Glands

how is renal failure caused in Shock?

A
  • prolonged hypotension
  • decreased cellular energy
  • inability to concentrate urine
  • patchy cell death
  • tubular necrosis
  • Renal failure
21
Q

Organ System Response:

____ fxn is well preserved until the late stages

A

Cardiac

22
Q

Organ System Response: Heart

Lactate, free radicals, and other humoral factors act as ____ ____ and in a bleeding pt, may produce cardiac dysfuntion

A

Negative inotrope

23
Q

Organ System Response: Heart

the trauma pt w/ cardiac dz or direct cardiac trauma is at great risk for what?

A

decompenstion

24
Q

Organ System Response: Heart

why is the cardiac pt prone to decompensation?

A
  • Fixed stroke volume (inhibits the bodies ability to increase blood flow in response to hypovolemia and anemia)
  • tachycardia is the only option
25
Q

Organ System Response:

what organ is a filter for the inflammatory by-products of the ischemic body?

A

Lungs

26
Q

Organ System Response: Lungs

immune complexes and cellular factors accumulate in the pulmonary _____

A

Capillaries

27
Q

Organ System Response: Lungs

what is te patho of ARDS in the Shock pt?

A
  • Neutophil and platelet aggregation
  • Increased Permeability of cappillary
  • Destruction of lung architecture
  • ARDS
28
Q

Organ System Response:

what is one of the earliest organs affected by hypoperfusion

A

gut

29
Q

Organ System Response: Gut

may be the prime trigger of _____

A

MOSF

30
Q

Organ System Response: Gut

the intense vasoconstriction occurs early and frquently leads to a _________ phenoomenon

A

no-reflow

31
Q

Organ System Response: Gut

how can the Gut cause ARDS?

A
  • intestinal cell death
  • Breakdown of barrier function of gut
  • increased translocation of bacteria to liver and lung
  • potentiates ARDS
32
Q

Organ System Response: Liver

is a complex organ of microvasculation; and holds the potential for ______ injury during recovery from shock

A

repurfusion

33
Q

Organ System Response:

what organ is not metabolically active during shock; and tolerates inchemia well?

A

Skeletal Muscle

34
Q

MODS:

is the progression of physiologic effects as shock ensues (Cardiac depression, resp distress, renal failure, DIC) and results in ?

A

End organ failure

35
Q

Shock:

what are the S/S of shock

A
  • pallor
  • Diaphoresis
  • hypotension
  • Tachycardia
  • prolonged cap refill
  • Diminished UOP
  • NARROWED PULSE PRESSURE
36
Q

Shock:

what should you ask about in the physical?

A
  • recent illness
  • Fever
  • CP
  • SOB
  • Abd pain
  • Comorbidities
  • Meds
  • Toxins
  • Recent hospitalizationa
  • Baseline mental status
37
Q

Shock:

what will you want to examine on the physical examination

A
  • CNS - Mental changes
  • VS
  • Skin-color temp, rash sores
  • CV-JVD
  • Resp- lung sounds, RR, O2 sat,.
  • Gi- abd pain, rigidity, Guarding,rebound
  • Renal- urine output
38
Q

Shock:

is the pt in shock? whata are 6 Signs that all indicate shock

A
  • Looks Ill
  • AMS
  • Skin cool and mottled or hot and flushed
  • weak or absent pulses
  • SBP < 110
  • Tachycardia
39
Q

Shock:

if you can palpate a pulse here what is the SBP at least

  • Carotids
  • Radial
  • Femoral
  • posterior tibial
A
  • 60
  • 70
  • 80
  • 90
40
Q

Shock:

what are the 6 types of shock?

A
  • Hypovolemic
  • Septic
  • Cardiogenic
  • Anaphylactic
  • neurogenic
  • Obstructive
41
Q
A

Principles 4 (20 decks)

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