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3 CLASP & Transition Block > Physiology of Shock > Flashcards

Physiology of Shock Flashcards

1
Q

what is shock?

A

inadequate organ perfusion leading to inadequate oxygen delivery to tissues and eventually organ failure

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2
Q

where is the problem in shock?

A

problem with the heart, blood vessels or the flow of blood

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3
Q

name the types of shock

A 
anaphylactic (distributive)
cardiogenic
septic
hypovolaemic
neurogenic
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4
Q

what is distributive shock?

A 
umbrella term for:
septic
anaphylactic
neurogenic
- sufficient fluid but in the wrong place
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5
Q

what should you give to restore coagulation factors?

A

calcium

FSP

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6
Q

CO = _ x _

A

HR x SV

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7
Q

MAP = _ x _

A

CO x TPR

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8
Q

what is stroke volume?

A

volume of blood pumped from the left ventricle per heartbeat

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9
Q

what is TPR?

A

resistance offered by the systemic vascular circulation

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10
Q

state the oxygen delivery equation

A

CO x arterial oxygen content (CaO2)

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11
Q

CO is increased in what type of shock?

A

septic

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12
Q

how can oxygen delivery to tissues be improved in shock?

A

give a blood transfusion

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13
Q

describe BP and HR in anaphylactic shock

A

BP reduced profoundly

tachycardia

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14
Q

main pathological process in anaphylactic shock

A

mast cell degranulation causes release of inflammatory mediators

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15
Q

what type of shock is the only one to cause bradycardia?

A

neurogenic

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16
Q

what causes bronchoconstriction in anaphylaxis

A

leukotrienes

prostaglandins

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17
Q

Tx anaphylactic shock

A
  1. adrenaline
  2. IV fluids
  3. chloramphenamine
  4. hydrocortisone
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18
Q

why do you need to give IV fluids in anaphylaxis

A

capillaries are vasodilated and leaky so you need alot of fluid to perfuse it to where you want to go

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19
Q

describe BP and HR in cardiogenic shock

A

low BP

tachycardia

20
Q

CO is increased initially increased and then reduces in what type of shock?

A

septic

21
Q

skin is swollen and oedematous in what type of shock?

A

cardiogenic!

22
Q

what does the skin look like in neurogenic shock?

A

vasodilated below lesion

23
Q

what does skin look like in anaphylactic shock?

A

urticarial rash

24
Q

when does BP reduce in hypovolaemia?

A

maintained by compensation then reduces in a late stage

25
Q

Tx hypovolaemia

A

fluids
blood replacement
stop bleeding

26
Q

Tx cardiogenic shock

A

careful fluid management
inotropes eg dobutamine
vasopressor drugs

27
Q

Tx septic shock

A

sepsis 6 eg fluids

vasopressors if fluid unresponsive

28
Q

give an example of a vasopressor

A

adrenaline

29
Q

give an example of an inotrope

A

dobutamine

30
Q

Tx neurogenic shock

A

vasopressors

31
Q

describe the progression of the skin in septic shock

A

patient will be flushed and warm and then cool and pale

32
Q

septic shock tends to be caused by gram _ve bacteria

A

positive

33
Q

what is septic shock

A

dysregulated immune response to infection eg when BP drops below 90/30% drop in systolic

34
Q

why is lactate measured in sepsis

A

it is an anaerobic metabolism product because theyre not getting enough oxygen perfusion

35
Q

why is urine output measured in sepsis

A

it is a measure of organ function; if the kidney isnt perfused/oxygenated it wont produce urine

36
Q

most common bacteria to cause sudden death in young adults

A

GABHS

37
Q

cause of leaky capillaries and decreased BP in septic shock?

A

dysfunctional endothelial barrier as a result of bacteria adhering to it

38
Q

main cause of cardiogenic shock

A

failure of the heart

39
Q

cause of neurogenic shock?

A

loss of sympathetic outflow in thoracic spine leading to lack of feedback

40
Q

why do patients with septic shock need so many fluids?

A

capillaries have become extremely leaky

41
Q

skin appearance in hypovolaemic shock?

A

cool

pale

42
Q

how can you improve oxygen delivery in septic shock? name 1st and 2nd line options

A
  1. IV fluids

2. vasopressins

43
Q

if someone is confused and they are septic, what are they thinking of and why?

A

septic shock

poor perfusion to the brain

44
Q

describe qSOFA

A

systolic BP <100mmHg
altered mental status
RR >22

45
Q

why is heart rate low in neurogenic shock?

A

sympathetic outflow taken out by an injury so parasympathetics take over by slowing the heart down and vasodilating BVs

46
Q

name the 2 shockable rhythms

A

VF

pulseless VT

47
Q

name the 8 reversible causes of shock

A 
4 Hs 4 Ts
hypoxia
hypovolaemia
hypothermia
hyperkalaemia + other metabolic
cardiac Tamponade
tension pneumo
thrombus
toxins

3 CLASP & Transition Block (20 decks)

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