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CRRAB I Final > Shock - Abrams > Flashcards

Shock - Abrams Flashcards

1
Q

What do we NOT do if someone goes into shock?

A

Put their feet up

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2
Q

What is shock?

A
  • Hypoperfusion of vital organs (brain, heart, kidney, lungs, gut)
  • It is NOT low bp, can be hypertensive or normal bp
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3
Q

Are you in shock if you are alert and sharp?

A

NO

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4
Q

What does lack of oxygen in shock lead to?

A

Anaerobic metabolism

  • Lactic acid production is a marker of severity of oxygen supply/demand imbalance.
  • By following the lactic acid you can track the course of the illness/treatment effectiveness
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5
Q

What don’t you need for shock?

A

CORTISOL!

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6
Q

What are the typical signs of shock that result form loss of cellular integrity?

A
  1. Hyperkalemia (high K+)
  2. Hyponatremia (low Na+)
  3. Metabolic acidosis (too much H+)
  4. Hyperglycemia (excess glucose)
  5. Lactic acidosis
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7
Q

What is systemic tissue perfusion a balancing act between?

A

Cardiac Output and Systemic Vascular resistance

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8
Q

What is the continuum of shock?

A

Shock is a broad term which encompasses a progression from SIRS (systemic inflammatory response syndrome) to MODS (multi-organ dysfunction syndrome)

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9
Q

What is SIRS?

A

Systemic inflammatory response syndrome

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10
Q

What is MODS?

A

Multi-organ dysfunction syndrome

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11
Q

What happens when MODS starts?

A

This is when the dec. organ perfusion begins

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12
Q

What is required for SIRS?

A

Atleast two of:

  • Temp (less than 36C, higher than 38C)
  • Pulse (tachycardic)
  • Respirations (>20 - tachypnea)
  • PaCO2 (12,000 or 10% bands
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13
Q

What can you think of SIRS as?

A

Septic like disorder in the absence of infection!!

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14
Q

Either sepsis or SIRS can progress to…

A

MODS (multi-organ dysfunction syndrome)

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15
Q

What are the classical findings in shock?

A

-Hypotension (systolic

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16
Q

How should you monitor a patient with shock?

A

-Level of alternates
-Urine output
(also lactic acid, CXR, bp, O2 saturation, Hgb (Hct))

17
Q

What is the Shock Index (SI)?

A
  • Heart rate divided by systolic pressure
  • The index is inversely related to effective left ventricular stroke work
  • A normal index = 0.5-0.7
  • Index at or above 1 has increased mortality
  • An elevated IS is more useful than a normal one to extrapolate morbidity/mortality
18
Q

What is the capillary wedge pressure?

A
  • Swan Ganz catheter reflects the left ventricular pressure but the use of these catheters has been associated with INCREASED MORTALITY
  • DON’T USE ANYMORE!!
19
Q

What are the four major categories of shock>

A
  1. Cardiogenic (heart fails)
  2. Hypovolemic (lack of fluid)
  3. Extracardiac (outflow obstruction)
  4. Dissociative (increased area for blood to disperse to) - outlier
20
Q

What happens in cariogenic shock?

A

-Causes decreased CO due to pathology of heart

21
Q

What pathologies are associated with cariogenic shock?

A
  • Acute MI (>40% myocardial damage)
  • Arrhythmia (too fast or slow)
  • Out-flow obstruction
  • -AS (Aortic Stenosis)
  • -Hypertrophic cardiomyopathy (used to be called IHSS)
  • Mitral regurgitation, VSD (ventricular septal defect)
22
Q

What happens in Distributive/Dissociative Shock?

A
  • Initially CO is increased, then it falls.

- Dec. Systemic Vascular Resistance or maldistribution

23
Q

What pathologies are associated with distributive/dissociative shock?

A
  • Septic shock
  • -Gram - bacteria release endotoxins
  • -Gram + bacteria release exotoxins
  • Spinal cord injury
  • Anaphylaxis
  • Cyanide
  • Carbon monoxide
24
Q

What happens in Extracardiac shock?

A

Outflow obstruction!!

-Causes decreased cardiac output due to external pathology

25
Q

What pathology is associated with extra cardiac shock?

A
  • Pulmonary emboli
  • Pericardial tamponade (fluid bulid-up around the heart within the pericardium)
  • Constrictive pericarditis
  • Pulmonary hypertension
  • Cor pulmonale
26
Q

What happens in hypovolemic shock?

A

Lack of fluid!!

-Causes decreased CO due to decreased preload

27
Q

What pathologies are associated with hypovolemic shock?

A
  • Diarrhea, vomiting, diuretics, sweating
  • Hemorrhage
  • Burns
  • 3rd spacing: ascites (fluid collection in abdomen)
28
Q

What is the PRIMARY principle of shock treatment?

A

Volume replacement!! (Normal saline (20-30 ml/kg), blood)

29
Q

What agents can you use for shock?

A

Vasopressor agents! (inc. vasoconstriction and inc. MAP)
(NE, EPI, DA, dobutamine)
-No difference in efficacy or safety of first two!!

30
Q

Do you use hypothermia in post cardiac arrest patients?

A

not usually

31
Q

What else can you use to treat shock?

A

Antibiotics, surgery, thrombolytics, anticoagulants

32
Q

What about insulin?

A

Evidence is mixed at best for use of insulin in shock or the routine use of adrenal replacement steroids.

CRRAB I Final (21 decks)

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