Test #2 Shock - Josh Flashcards
Shock:
what is the def on shock
- inadequate O2 delivery to meet metabolic demands
- Results in global tissue hypoperfusion and Metabolic acidosis
Shock:
Shock can occur with a normal ____ _____ and _______ can occur without shock
blood pressure
hypotension
Shock:
Inadequate systemic O2 delivery activates ____ responses to maintain systemic O2 delivery
Autonomic
Inadequate systemic O2 delivery activates Autonomic responses to maintain systemic O2 delivery. the ____, ___, and ____ blood flow is preserved; other regional beds are constricted
heart
kidney
brain
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
- Hormone
- Inflammatory
Shock: SNS
the SNS releases catecholamines. what are they?
- NE
- Epinephnine
- dopamine
- cortisol
Shock:
the SNS’s release of the catecholamines NE, epi, Dopamine, and cortisol cause what?
- vasoconstriction
- increase HR
- Increase CO
Shock: SNS
besides the release of catecholamines what else does the SNS activate during shock
Renin-angiotension axis
Shock: SNS
what does the renin angiotensin axis do?
- Water and Sodium conservation
- Vasoconstriction
- Increase in blood volume
- Increase in Blood pressure
Shock: Cellular response
what is the cellualr response to decreased systemic O2 delivery?
- 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
Shock:
what is the boddies intrinsic goal?
- maintain cerebral and cardiac perfusion
Shock:
how does the body accomplish it’s goal of maintaining cerebral and cardiac perfusion?
- Vasoconstriction of splenic, musculoskeletal, and renal blood flow
Shock:
ischemic cells produce what
- lactate
- free radicles
- Inflammatory factors
Shock:
the ischemic cells that produce lactate, free radicles, and inflammatory factors, result in __ ___ ___ that overcomes the bodies compensatory mechanisms
systemic metabolic acidosis
Global Tissue Hypoxia
is the _______ inflammation and disruption and inability of ____ delivery to meet demand. it results in ____, _____, and ______
- endothelial
- O2
- lactic acidosis
- Cardiovascular insufficiency
- Increased demands
Organ System Response: CNS
what does teh CNS trigger?
- neuroendocrine response
Organ System Response: CNS
the neuroendocrine response causes changes in the uptake of what in the brain?
glucose
Organ System Response: CNS
what happens to the reflexes and cortical activity?
depressed
Organ System Response: Kidney and Adrenal Glands
the kidneys maintain GFR how?
- selective vasoconstriction and concentration of blood flow in the medulla and deep cortical area
Organ System Response: Kidney and Adrenal Glands
how is renal failure caused in Shock?
- prolonged hypotension
- decreased cellular energy
- inability to concentrate urine
- patchy cell death
- tubular necrosis
- Renal failure
Organ System Response:
____ fxn is well preserved until the late stages
Cardiac
Organ System Response: Heart
Lactate, free radicals, and other humoral factors act as ____ ____ and in a bleeding pt, may produce cardiac dysfuntion
Negative inotrope
Organ System Response: Heart
the trauma pt w/ cardiac dz or direct cardiac trauma is at great risk for what?
decompenstion
Organ System Response: Heart
why is the cardiac pt prone to decompensation?
- Fixed stroke volume (inhibits the bodies ability to increase blood flow in response to hypovolemia and anemia)
- tachycardia is the only option
Organ System Response:
what organ is a filter for the inflammatory by-products of the ischemic body?
Lungs
Organ System Response: Lungs
immune complexes and cellular factors accumulate in the pulmonary _____
Capillaries
Organ System Response: Lungs
what is te patho of ARDS in the Shock pt?
- Neutophil and platelet aggregation
- Increased Permeability of cappillary
- Destruction of lung architecture
- ARDS
Organ System Response:
what is one of the earliest organs affected by hypoperfusion
gut
Organ System Response: Gut
may be the prime trigger of _____
MOSF
Organ System Response: Gut
the intense vasoconstriction occurs early and frquently leads to a _________ phenoomenon
no-reflow
Organ System Response: Gut
how can the Gut cause ARDS?
- intestinal cell death
- Breakdown of barrier function of gut
- increased translocation of bacteria to liver and lung
- potentiates ARDS
Organ System Response: Liver
is a complex organ of microvasculation; and holds the potential for ______ injury during recovery from shock
repurfusion
Organ System Response:
what organ is not metabolically active during shock; and tolerates inchemia well?
Skeletal Muscle
MODS:
is the progression of physiologic effects as shock ensues (Cardiac depression, resp distress, renal failure, DIC) and results in ?
End organ failure
Shock:
what are the S/S of shock
- pallor
- Diaphoresis
- hypotension
- Tachycardia
- prolonged cap refill
- Diminished UOP
- NARROWED PULSE PRESSURE
Shock:
what should you ask about in the physical?
- recent illness
- Fever
- CP
- SOB
- Abd pain
- Comorbidities
- Meds
- Toxins
- Recent hospitalizationa
- Baseline mental status
Shock:
what will you want to examine on the physical examination
- 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
Shock:
is the pt in shock? whata are 6 Signs that all indicate shock
- Looks Ill
- AMS
- Skin cool and mottled or hot and flushed
- weak or absent pulses
- SBP < 110
- Tachycardia
Shock:
if you can palpate a pulse here what is the SBP at least
- Carotids
- Radial
- Femoral
- posterior tibial
- 60
- 70
- 80
- 90
Shock:
what are the 6 types of shock?
- Hypovolemic
- Septic
- Cardiogenic
- Anaphylactic
- neurogenic
- Obstructive
