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New cardio > Shock - Full summary > Flashcards

Shock - Full summary Flashcards

1
Q

What is meant by shock?

A

An abnormality of the circulatory system, resulting in inadequate tissue perfusion and oxygenation

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2
Q

How can shock cause cellular failure?

A

Inadequate tissue perfusion can lead to anaerobic metabolism, which results in accumulation of metabolic waste, resulting in cellular failure

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3
Q

What 2 factors does adequate tissue perfusion depend on?

A

Adequate Mean arterial pressure (MAP)
Adequate Cardiac Output (CO)

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4
Q

What are the 4 main classes of shock?

A

Hypovolaemic shock
Cardiogenic shock
Obstructive shock
Distributive shock

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5
Q

What is hypovolaemic shock?

A

Shock caused by a loss of blood volume

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6
Q

What are the 2 types of hypovolaemic shock?

A

Haemorrhagic shock
Non-Haemorrhagic shock

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7
Q

What causes haemorrhagic shock?

A

This is a decrease in blood volume caused by direct loss of blood, either by trauma, surgery or GI haemorrhage

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8
Q

What causes non-hemorrhagic shock?

A

This is shock caused by a loss of fluid in the body by processes such as vomiting, diarrhoea or excessive sweating

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9
Q

Describe the pathophysiology of hypovolaemic shock

A

Loss of blood volume
Decreased venous return
Decreased end diastolic volume
Decreased stroke volume (Frank-Starling)
Decreased cardiac output and MAP
Inadequate tissue perfusion

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10
Q

Up until what percentage of blood loss can compensatory mechanisms maintain blood pressure?

A

30%

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11
Q

How do compensatory mechanisms increase blood pressure?

A

Decrease in blood volume causes a decrease in blood pressure
Baroreceptors detect this and stimulate an increase in SVR and heart rate

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12
Q

What are some common symptoms of hypovolaemic shock?

A

Cold peripheries
Tachycardia
Small volume pulse

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13
Q

What is meant by Class I haemorrhagic shock?

A

≤15% blood loss (750mL) and normal BP

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14
Q

What is meant by class II haemorrhagic shock?

A

15-30% blood loss (750-1500mL) and normal BP

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15
Q

What is meant by class III haemorrhagic shock?

A

30-40% blood loss (1500-2000mL) and low BP

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16
Q

What is meant by class IV haemorrhagic shock?

A

> 40% blood loss (2000mL) and low BP

17
Q

What is meant by cardiogenic shock?

A

This is shock caused by sudden, severe impairment of heart function, meaning it is unable to pump sufficient blood to perfuse the brain

18
Q

What is an example a condition that can lead to cariogenic shock?

A

Myocardial infarction

19
Q

Describe the pathophysiology of cardiogenic shock

A

Decreased cardiac contractility
Decreased stroke volume
Decreased CO and MAP
Inadequate tissue perfusion

20
Q

What medication is indicated in cardiogenic shock?

A

Adrenaline or dopamine injection
(Inotropes)

21
Q

What treatment is contraindicated in cariogenic shock?

A

IV fluids

22
Q

What is meant by obstructive shock?

A

This is shock due to physical obstruction of circulation, either in or out of the heart

23
Q

What are some conditions that can cause obstructive shock?

A

Cardiac tamponade
Tension pneumothorax
Pulmonary embolism
Severe aortic stenosis

24
Q

Describe the pathophysiology of obstructive shock in tension pneumothorax

A

Increased intra-thoracic pressure
Decreased venous return
Decreased end diastolic volume
Decreased stroke volume
Decreased CO and MAP
Inadequate tissue perfusion

25
Q

What is meant by distributive shock?

A

Shock caused by excessive vasodilation and abnormal distribution of shock

26
Q

What are the 2 types of distributive shock?

A

Vasoactive
Neurogenic

27
Q

What is an example of a cause of neurogenic shock?

A

Spinal cord injury

28
Q

What are some examples of vasoactive shock?

A

Septic shock
Anaphylactic shock

29
Q

Describe the pathophysiology of neuroactive shock in spinal cord injury?

A

Loss of sympathetic tone to heart and vessels
Massive vasodilation and decreased heart rate
Decreased CO and MAP
Inadequate tissue perfusion

30
Q

Describe the pathophysiology of vasoactive shock

A

Release of vasoactive mediators
Massive vasodilation and capillary permeability
Decreased venous return and SVR
Decrease in CO and MAP
Inadequate tissue perfusion

31
Q

What is the 1st line treatment option in anaphylactic shock?

A

Adrenaline

32
Q

What is the 1st line treatment in septic shock?

A

Vasopressors (e.g. epinephrine, ADH)

33
Q

How should all cases of shock be managed first?

A

ABCDE
High flow oxygen
Fluid replacement (Not in cardiogenic)

New cardio (28 decks)

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