chapter 24 ( circulatory shock and its treatment)

Question 1

define circulatory shock

Answer 1

inadequte blood flow through the body to the extent tissue is damaged because ot too little oxygen and nutrient delivery

Question 2

Circulatory shock can be caused by reduced cardiac output. Name 1 way cardiac output is reduced

Answer 2

any cardiac abnormality that decreases the ability of the heart to pump blood. ( myocardial infartion, arrhythmias, valve disfunction)

Question 3

name 1 other way cardiac output is reduced

Answer 3

anything that reduces venous return ( diminished blood volume, decreased vascular tone)

Question 4

what % of people who develop cardiogenic shock die?

Answer 4

70 %

Question 5

circulatory shock that occurs without diminished cardiac shock

Answer 5

1. excessive metabolic rate
2. abnormal tissue perfustion patterns, so that most cardiac output is going to vessels that dont supply local tissue ( that needs it)

Question 6

1st stage of circulatory shock

Answer 6

nonprogressive stage-( compensated stage) normal circulatory compensatory mechanisms eventually cause full recovery without outside help

Question 7

2nd stage of circulatory shock

Answer 7

progressive stage- in which without therapy , the shock becomes steadily worse until death

Question 8

3rd stage of circulatory shock

Answer 8

irreversable stage- shock has progressed to such an extent that all forms of therapy dont work to save the persons life.

Question 9

hemorrhagic shock

Answer 9

caused by hypovolemia ( means diminished blood). Filling pressure of circulation decreases which decreases the cardiac output

Question 10

sympathetic reglex compensations in shock

Answer 10

1. The arterioles constrict in systemic circulation causing an increase in total peripheral resistance
2. veins and venous reservoires constrict to help maintain adequate venous return
3. heart rate increases ( sometimes from the 72 beats/min normal to 160 beats/min)

Question 11

what is the value of the sympathetic nervous reflexes?

Answer 11

without them only 15-20 % of blood can be lost for 30 min before death. With them 30-40% can be lost until death

Question 12

name the ways someone can come out of the non-progressive shock stage

Answer 12

Baroreceptor reflex, CNS ischemic response, Reverse stress-relaxation of circulatory system, increased secretion of renin by the kidneys and formation of angiotensis 2, increased secretion by the posterior pituitary gland of vasopressin, increased secretion by the adrenal medullae of epinephrine and norepinephrine, compensatory mechanisms that return the blood volume back toward normal

Question 13

Whats happening in deteriation during shock

Answer 13

active transport of sodium and potassium is diminished, mitochondria activity goes down, lysosomes begin to open, cellular metabolism of nutrients like glucose become depressed

Question 14

during shock the body will turn to acidosis. Why is this a problem?

Answer 14

cells use the anaerobic process of glycolysis which creates alot of lactic acid

Question 15

what happens to energy compound during irreversible shock?

Answer 15

they greatly diminish. This is the most significant for the development of the final state of irreversable shock

Question 16

name some causes of hypovolemic shock caused by plasma loss

Answer 16

excessive sweating, diarrhea/vomiting, excess fluid loss from kidneys, inadequate intake of fluid and electrolytes, destruction of adrenal corices with loss of aldosterone secretion.

Question 17

describe neurogenic shock

Answer 17

instead of having blood loss, the vascular capacity increases( more flexible) and the blood volume is not enought to fill the circulatory system adequayely.

Question 18

what does neurogenic shock do to the vessels

Answer 18

Loss of vascular tone throughout the body especially in the veins

Question 19

What causes neurogenic shock?

Answer 19

deep general anesthesia, Spinal anesthesia, Brain damage

Question 20

Whats anaphylactic shock and histamine shock

Answer 20

allergic condition in which the cardiac output and arterial pressure often decreases drastically. The release of histamine from basophils causes this

Question 21

what 3 things does histamine do?

Answer 21

1.increased vascular capacity which causes decrease in venous return
2. dilation of arterioles which decreases arterial pressure
3. increased capillary permeability with rapid loss of fluid and protein into the tissue spaces.
( the net effect of all these causes reduction in venous return)

Question 22

Septic shock

Answer 22

blood poisening, bacteria in blood ( most common cause of shock-related death in the modern hospitals)

Question 23

Common causes of septic shock

Answer 23

1. peritonitis caused by infection from the uterus and fallopian tubes
2. peritonitis from rupture of GI system
3. body infection from spread of skin i nfection such as streptococcal or staphylococcal infection
4. gangrenous infection
5. infection that spread into the blood from the kidney or urinary tract

Question 24

treatment of shock , blood and plasma transfusion is best for what kind of shock?

Answer 24

shock caused by hemorrhage

Question 25

treatment of shock, dextran solution as a plasma substitue

Answer 25

this is used as a plasma substitue. The substance has large molecular sizes to exert colloid osmotic pressure.

Question 26

treatment of shock with sympathomimetic drugs

Answer 26

sympothomimetic drugs are drugs that mimic sympathetic stimulation. Examples of these are norepinephrine and epinephrine

Question 27

which kinds of shock have sympathomimetic drugs been proven usefull?

Answer 27

neurogenic shock and anaphylactic shock

Question 28

why are sympathomimetic drugs usefull in neurogenic shock?

Answer 28

because the sympathetic nervous system is severely depressed. The drug picks up the slack the nervous system needs

Question 29

why are sympathomimetic drugs usefull in anaphylactic shock?

Answer 29

anaphylactic shock has excess histamine which dilates the vessels and capillaries. The drugs have vasoconstrictor effects with control the effect of histamine

Question 30

whats another way to help someone in shock? Especially neurogenic and hemorrhagic shock?

Answer 30

place their head 12 inches below their feet

Question 31

Treatment with glucocorticoids for shock

Answer 31

1. They actually increase the heart strength in late stages of shock
2. stabilize lysosomes in the cells thus preventing deteriation.
3. they “ might” aid in metabolism of glucose by severly damaged cells.

Question 32

Is oxygen therapy very usefull?

Answer 32

it can be but usually the problem is delivering nutrients and oxygen. Not bonding the oxygen

Question 33

what is circulatory arrest?

Answer 33

complete stop of blood flow.

Question 34

in general what time frame for most individuals causes some brain damage while in circulatory arrest?

Answer 34

5-8 minutes