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CR2 > Circulatory Shock > Flashcards

Circulatory Shock Flashcards

1
Q

Clinical shock

A

Acute circulatory failure with inadequate or inappropriately distributed tissue perfusion resulting in cellular hypoxia and end organ damage

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2
Q

What are the main mediators of vasodilation

A

Nitric oxide
Prostacyclin

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3
Q

How does vasodilation regulate blood flow

A

Enhances blood flow to certain areas
Decr systemic vascular resistance

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4
Q

What hormones cause vasoconstriction

A

Noradrenaline - a2
Angiotensin
Vasopressin

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5
Q

Is vasoconstriction controlled by the sympathetic or parasympathetic nervous system

A

Sympathetic

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6
Q

Which receptors does noradrenaline work on to cause vasoconstriction

A

Alpha 2

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7
Q

What are the 3 causes of shock

A

Decr cardiac output
Reduced systemic vascular resistance
Incr afterload

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8
Q

How is shock a vicious cycle

A

Inadequate blood flow -> heart and circ system failure -> further cardiac output decr -> worsening shock and perfusion

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9
Q

Why is shock very difficult to reverse once initiated

A

Involves lots of positive feedback mechanisms

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10
Q

How does hypoxia cause cell death

A

Cells switch to anaerobic metabolism -> lactic acid made -> cell function ceases + swells -> ICF membrane permeability -> electrolytes + fluids enter + leave -> Na/K+ pump impaired -> cells swell -> mitochondria damage -> cell death

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11
Q

4 stages of shock

A

Initial
Compensatory
Progressive
Refractory

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12
Q

Which stage of shock is irreversible

A

Refractory

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13
Q

What causes a patient to go from compensatory to progressive stage shock

A

Body can’t compensate anymore

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14
Q

Features of initial stage shock

A

Body switches to anaerobic metabolism
Incr lactic acid
Subtle clinical sign changes

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15
Q

Features of compensatory stage shock

A

Sympathetic stimulation
Incr catecholamine release
Incr cardiac contractility
Vasoconstriction
Aldosterone release
Decr urine output
Incr heart rate
Incr glucose level

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16
Q

Features of progressive stage shock

A

Electrolyte imbalance
Metabolic acidosis
Respiratory acidosis
Peripheral oedema
Irregular tachyarrhythmia
Hypotension
Pallor
Cool clammy skin
Altered level of consciousness

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17
Q

Features of refractory stage shock

A

Irreversible cellular and end organ damage
Impending death

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18
Q

4 types of shock

A

Obstructive
Distributive
Cardiogenic
Hypovolaemic

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19
Q

Obstructive shock

A

Physical obstruction to vessels entering or leaving heart reduces flow to heart, decreasing preload and cardiac output

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20
Q

What causes obstructive shock

A

Physical obstruction to large vessels entering or leaving heart

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21
Q

What type of shock can a pulmonary embolism cause

A

Obstructive

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22
Q

What type of shock can a tension haemothorax cause

A

Obstructive

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23
Q

How does a pulmonary embolism cause shock

A

Clot blocks artery in lungs increasing heart afterload

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24
Q

How does tension haemothorax cause shock

A

Obstructs venous return to heart impairing left ventricular filling

25
Q

What type of shock does cardiac tamponade cause

A

Obstructive

26
Q

How does cardiac tamponade cause shock

A

Increases intra pericardial pressure, restricting cardiac filling and decr cardiac output

27
Q

Distributive shock

A

Excessive vasodilation impairs blood flow distribution

28
Q

Characteristic signs of distributive shock

A

Drop in peripheral vascular resistance
Hypotension

29
Q

What type of shock is septic shock a form of

A

Distributive

30
Q

Septic shock

A

Life threatening organ dysfunction due to dysregulated host response to infection

31
Q

Signs of septic shock

A

Altered mental status
Systolic BP <100mmHg
RR >22 breaths/min
Signs of infection

32
Q

How does septic shock cause hypotension

A

Bacteria in blood release chemicals causing uncontrolled hypotension

33
Q

What type of shock is anaphylactic shock a form of

A

Distributive

34
Q

What causes anaphylactic shock

A

Pathological allergy response

35
Q

How does anaphylactic shock cause uncontrolled hypotension

A

Exposure to antigen -> IgE mediates mast cell degranulation -> histamines released -> vasodilation + capillary leaking -> decr peripheral vascular resistance -> hypotension

36
Q

Neurogenic shock

A

Sudden loss of vasomotor tone throughout body due to loss of sympathetic input

37
Q

What causes neurogenic shock

A

Loss of sympathetic input leaving unopposed parasympathetic activity

38
Q

Cardiogenic shock

A

Failure of heart to pump blood due to ventricular dysfunction

39
Q

What is the most common cause of Cardiogenic shock

A

Acute myocardial infarction

40
Q

What type of shock can acute myocardial infarction cause

A

Cardiogenic

41
Q

Hypovolaemic shock

A

Reduced circulating volume causes reduced venous return and preload

42
Q

Hypovolaemia causes

A

Haemorrhage
GI losses
Surgery
Burns

43
Q

How can GI system issues cause hypovolaemia

A

Diarrhoea and vomiting cause dehydration

44
Q

How can surgery lead to hypovolaemia

A

Internal structures exposed to air and heat

45
Q

What types of shock can burns lead to

A

Distributive and hypovolaemic

46
Q

How can burns lead to hypovolaemia

A

Fluid shift into Extravascular space due to inflam response
Loss of fluid due to loss of skin barrier

47
Q

Why is bleeding into the skull not likely to cause Hypovolaemic shock

A

Patient would die from coning before Anouilh blood was lost to go into shock

48
Q

Haemorrhage signs and symptoms (inc internal)

A

Confusion
Anxiety
Clammy skin
Cold
Low BP
Hugh heart rate
Slow capillary refill
Greyish pallor
Bruising
Bleeding
Melaena

49
Q

What happens to arterial pressure and cardiac output during haemorrhage

A

Decr

50
Q

How many classes of Haemorrhagic shock are there

A

4

51
Q

How much blood loss is needed for class 4 Haemorrhagic shock

A

2 lites

52
Q

How much blood loss is class 1 Haemorrhagic shock

A

<750 ml

53
Q

How much blood loss for class 2 Haemorrhagic shock

A

750ml - 1.5 litres

54
Q

How much blood loss for class 3 Haemorrhagic shock

A

1.5 - 2 litres

55
Q

Acute compensatory mechanisms for Haemorrhagic shock

A

Constriction of small arterioles
Constriction of veins and venous reservoirs
Increased heart rate and contractility
Noradrenaline and adrenaline from adrenal medulla

56
Q

How is Haemorrhagic shock detected by body

A

Decreased arterial pressure detected by baroreceptors

57
Q

Long term compensatory mechanisms for Haemorrhagic shock

A

RAAS system activation
Vasopressin release
Albumin and other plasma protein synthesis stimulation in liver
Incr fluid absorption from GI tract
Incr erythropoietin release

58
Q

How is shock treated

A

A - E
Treat underlying cause
Supportive management

CR2 (33 decks)

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