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CLASP - sudden death > Physiology of shock > Flashcards

Physiology of shock Flashcards

1
Q

define shock

A

condition of inadequate perfusion to sustain normal organ function

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2
Q

what are the different types of shock

A 
hypovolaemic 
cardiogenic 
obstructive 
distributive 
cytotoxic
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3
Q

what is hypovolaemic shock

A

loss of circulating volume

insufficient circulating volume to fill circuit

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4
Q

give examples of hypovolaemic shock

A

blood loss

fluid loss

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5
Q

what are causes of cardiogenic shock

A

heart failure eg MI, papillary muscle rupture, acute valve dysfunction, myocarditis, cardiomyopathy
post surgery

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6
Q

causes of obstructive shock

A

tension pneumothorax
cardiac tamponade
PE

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7
Q

what happens in distributive shock

A

circuit becomes too big, fluid is insufficient to fill circuit

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8
Q

what types of distributive shock are there

A

septic
anaphylactic
neurogenic

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9
Q

what happens in cytotoxic shock

A

uncoupling of tissue oxygen delivery and mitochondrial uptake

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10
Q

causes of cytotoxic shock

A

CO or cyanide poisoning

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11
Q

what are compensatory mechanisms for hypovolaemic shock

A

baroreceptor reflex
sympathetic neurohormonal response
capillary absorption of interstitial fluid
hypothalamo-pituitary-adrenal response

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12
Q

what are methods of increasing cardiac output

A

increase HR, SV or both

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13
Q

increased baroreceptor firing increases/decreases sympathetic activity and increases/decreases parasympathetic activity

A

^BR firing results in
decreased sympathetic activity
increased parasympathetic activity

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14
Q

what happens to baroreceptors in hypovolaemic shock

A

decreased BP results in decreased baroreceptor firing

this results in increased sympathetic activity and decreased parasympathetic activity to try and increase BP

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15
Q

what is the hypothalamo-pituitary-adrenal response in hypovolaemic shock

A

enhances renal system to hold on to Na and water

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16
Q

what is the Frank Starling mechanism

A

ability of the heart to change its contractility + stroke volume depending on venous return

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17
Q

in which direction does decreased inotropy change the Frank Starling curve

A

shifts down and to the right

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18
Q

in which direction does the Frank Starling curve shift with increased inotropy

A

up and to the left

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19
Q

you should give lots of fluid in a failing heart, true or false

A

false, leads to congestion

give lower fluid challenge

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20
Q

fluids are prescribed, true or false

A

true

according to weight in kg

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21
Q

indications for IV fluids

A

cannot be taken orally
vomiting, diarrhoea
hypovolaemic shock eg haemorrhage

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22
Q

list findings suggestive of hypovolaemia

A 
tachycardic 
hypotensive
tachypnoeic 
reduced oxygen saturations 
bilateral crackles on auscultation 
prolonged CRT
absent JVP
23
Q

do you still need fluid challenge when you are normovolaemic

A

no

24
Q

what is cardiogenic shock

A

inability of heart to meet circulatory demands

25
Q

what are consequences of cardiogenic shock

A

poor forward flow –> hypotension, fatigue, syncope

back pressure –> pulmonary oedema, ^JVP, hepatic congestion

26
Q

how can you treat cardiogenic shock, what is their function

A

inotropic drugs increase contractility of the heart

27
Q

examples of inotropic drugs and their mechanism of action

A

B agonists - dobutamine, adrenaline

dopamine agonists - dopamine, dopexamine

28
Q

what kind of a device is an intra-aortic balloon pump

A

counterpulsation device
inflates in diastole
deflates in systole

29
Q

what happens when you increase diastole

A

increase coronary artery filling - perfuse the heart

30
Q

what happens when you decrease systole

A

decrease the force which the heart has to pump against

31
Q

pathology of obstructive shock

A

something in the great vessels or obstruction in venous filling of the heart

32
Q

inspiration decreases/increases venous return

A

increases venous return

33
Q

what is the mechanism behind distributive shock

A

inappropriate vasodilatation

BP is usually normal but circuit is too big then BP drops

34
Q

management of septic shock

A

sepsis 6 bundle and vasopressors in 1 hour

35
Q

what is the cause of anaphylactic shock

A

mast cells release histaminergic vasodilators in response to allergen

36
Q

in anaphylactic shock, there is uncontrolled widespread vasoconstriction/dilatation

A

vasodilatation

37
Q

why is adrenaline preferred over noradrenaline in treatment of anaphylactic shock

A

adrenaline is a vasoconstrictor AND a mast cell stabiliser

38
Q

what can be measured to confirm anaphylaxis

A

serum mast cell tryptase levels

39
Q

what is neurogenic shock

A

loss of sympathetic outflow following spinal injury

40
Q

there is constant sympathetic/parasympathetic tone exerted on blood vessels

A

natural vasodilatation (passive process), therefore there is sympathetic tone (active process) exerted on blood vessels

41
Q

what is the difference between neurogenic and spinal shock

A

neurogenic shock = loss of sympathetic tone

spinal shock = loss of spinal reflexes even though spinal cord at that level is intact

42
Q

hypo/hypertension occurs as a result of neurogenic shock and why

A

hypotension because there is no sympathetic tone

43
Q

in neurogenic shock there is brady/tachycardia

A

BRADYcardia

44
Q

in hypovolaemic shock there is brady/tachycardia

A

TACHYcardia

45
Q

what can cause cardiac arrest in neurogenic shock

A

suction in ET tube or PR exam

- stimulates vagus nerve with no sympathetic to compensate

46
Q

what are the 4Hs and 4Ts or reversible causes of cardiac arrest

A 
Hypoxia 
Hypovolaemia 
Hypothermia 
Hypo/Hyperkalaemia 
Tension pneumothorax
Tamponade
Toxins 
Thrombosis
47
Q

what is the basis of CPR

A

cyclical changes in intrathoracic pressure to alternatively push and suck blood out of the chest

48
Q

if you were to shock someone with a defibrillator, should they have a pulse

A

NO

49
Q

what are the shockable rhythms

A

VF

Pulseless VT

50
Q

what are the non-shockable rhythms

A

PEA

asystole

51
Q

in PEA, there is a rhythm that could be associated with a pulse, true or false

A

true

52
Q

generally, which arrhythmia does hypovolaemia cause

A

PEA

53
Q

asystole has a good/bad prognosis

A

BAD

low chance of resuscitation

CLASP - sudden death (8 decks)

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