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Phase 2A - Cardiovascular > Conditions - Shock > Flashcards

Conditions - Shock Flashcards

1
Q

What are the 4 different types of shock?

A

Hypovolaemia - haemorrhagic, septic, neurogenic and anaphylactic. And then cardiogenic

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2
Q

What is shock?

A

Inability of the heart to adequately perfuse tissues

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3
Q

What is hypovolemia?

A

volume depletion or volume contraction, is a state of Decreased intravascular volume. This may be due to either a loss of both salt and water or a decrease in blood volume. Hypovolemia refers to the loss of extracellular fluid and should not be confused with dehydration

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4
Q

What is the clinical presentation of haemorrhagic shock? Give 3 symptoms and 3 signs

A

Symptoms: anxiety, blue fingers/lips, shallow breathing, sweating, dizziness, confusion Signs: Low bp, low urine output, weak pulse, high HR

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5
Q

What is the pathophysiology of haemorrhagic shock?

A

Lower blood volume, lower stroke volume, lower cardiac output and reduced perfusion

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6
Q

What is the aetiology of haemorrhagic shock?

A

Bleeding/burns

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7
Q

What diagnostic tests are done for haemorrhagic shock?

A

Bloods - electrolytes Ultrasound - to visualise internal organs

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8
Q

What is the treatment for haemorrhagic shock?

A

Stop the bleeding Give oxygen (to increase perfusion) Patients require IV early on Supply fluids

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9
Q

What are the complications of haemorrhagic shock?

A

Death Organ failure Gangrene Heart attack

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10
Q

Is haemorrhagic shock a medical emergency?

A

Yes

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11
Q

What are the clinical presentations of septic shock? Give 3 symptoms and signs

A

Symptoms: dizziness, confusion, tachypnoea Signs: low bp, diarrhoea, cold clammy skin and fever

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12
Q

What is the pathophysiology of septic shock?

A

Bacterial infection can damage blood vessels. Causing the blood vessels to leak into the surrounding tissues

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13
Q

What is the aetiology of septic shock?

A

Sepsis

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14
Q

What diagnostic tests are done for septic shock?

A

FBC and U&E. On FBC - leukocytosis (increase in the number of white cells in the blood) and low platelets. U&E - raised urea and creatinine (suggests poor kidney function)

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15
Q

What would you find in a FBC of septic shock?

A

Leukocytosis and low platelets

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16
Q

What would you find in U&E of septic shock

A

Raised urea and creatinine (suggesting poor kidney function)

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17
Q

What is the treatment of septic shock?

A

Oxygen therapy, vasopressors, take cultures, IV fluids, supply fluids, antibiotics

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18
Q

What is the mechanism of action of vasopressors ?

A

Vasopressors increase vasoconstriction, which leads to increased systemic vascular resistance (SVR)

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19
Q

What are the complications of septic shock?

A

Recurrence, cardiomyopathy and AKI

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20
Q

Is septic shock a medical emergency?

A

Yes

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21
Q

What is neurogenic shock?

A

Sympathetic innervation of the blood vessels is lost due to CNS damage. Sympathetic tone loss leads to blood pooling at the extremities

22
Q

What is the clinical presentation of neurogenic shock? Give 2 symptoms and 2 signs

A

Symptoms:Warm flushed skin, priapism Signs: instantaneous hypotension and bradycardia

23
Q

What is the pathophysiology of neurogenic shock?

A

Trauma causes a sudden loss of background sympathetic stimulation to blood vessels, sudden vasodilation and drop in blood pressure

24
Q

What is the aetiology of neurogenic shock?

A

Damage to the CNS spinal cord above T6

25
Q

What are the diagnostic tests for neurogenic shock?

A

Physical examination. FBC and U&E. CT scan to assess condition

26
Q

What is the treatment of neurogenic shock?

A

Inotropic (dopamine) - modifying the force or speed of contraction of muscles. Vasopressin Vasopressors

27
Q

What is anaphylactic shock?

A

Type 1 IgE mediated hypersensitivity reaction

28
Q

What is a hypersensitivity reaction?

A

A condition in which the normally protective immune system has a harmful effect on the body

29
Q

What is a type 1 hypersensitivity reaction?

A

IgE mediated reaction Immediate and includes anaphylactic shock Degranulation of cells Release of histamine and other mediates Hypovolemia, hypoxia Erythema Oedema Pruritus Eosinophilia

30
Q

What is a type 2 hypersensitivity reaction?

A

Type II cytotoxic - autoimmune IgM and IgG bind to antigens on cells in the body mistaken as foreign COmplement activation Cellular lysis or phagocytosis - opsonisation and complement mediated lysis antibody-dependent cell mediated cytotoxicity

31
Q

What is a type 3 hypersensitivity reaction

A

Immune complex reactions and include many glomerulonephritides and vasculitides. Antigen binds to IgG to form an immune complex = antigen-antibody complex Immune complexes are deposited in tissue, especially blood vessels → initiation of complement cascade → release of lysosomal enzymes from neutrophils → cell death → inflammation → vasculitis

32
Q

What is a type 4 hypersensitivity reaction?

A

Delayed and cell-mediated.T cell-mediated reaction Sensitization: antigen penetrates the skin → uptake by Langerhans cell → migration to lymph nodes and formation of sensitized T lymphocytes Eruption: repeated contact with antigen → secretion of lymphokines and cytokines (e.g., IFNγ, TNF α) by presensitized T lymphocytes → macrophage activation and inflammatory reaction in the tissue

33
Q

What is the clinical presentation of anaphylactic shock? Give 3 symptoms and 3 signs

A

Symptoms: itching, sweating, diarrhoea, vomiting and hives (urticaria) Signs: erythema, oedema, wheeze, cyanosis, tachycardia and hypotension

34
Q

What is the pathophysiology of anaphylactic shock?

A

Release of histamine and other agents - leading to capillary leak, wheeze, cyanosis, oedema and hives (urticaria)

35
Q

What is the aetiology of anaphylactic shock?

A

Type 1 hypersensitivity reaction. IgE mediated . Preformed IgE antibodies coating mast cells and basophils are crosslinked by contact with free antigen Cell degranulation and release of histamine and other inflammatory mediators

36
Q

What is the treatment of anaphylactic shock?

A

Adrenaline Chlorphenamine (antihistamine) and hydrocortisone (corticosteroid) If wheeze treat for asthma

37
Q

What is the action of adrenaline in the treatment of anaphylactic shock?

A

alpha-adrenergic receptors, adrenaline lessens the vasodilation and increased vascular permeability that occurs during an anaphylactic reaction that can lead to loss of intravascular fluid volume and hypotension. Through its action on beta-adrenergic receptors, adrenaline causes bronchial smooth muscle relaxation that helps alleviate bronchospasm, wheezing, and dyspnoea that may occur during anaphylaxis.10 Beta-adrenergic action also works on the heart to enhance coronary blood flow and increase cardiac output to increase blood pressure.6

38
Q

What are the complications of anaphylactic shock ?

A

Death

39
Q

What is cardiogenic shock?

A

Failure of the pump action of the heart. Sustained hypotension for longer than 30 mins. Tissue hypoperfusion

40
Q

What is the mortality rate for patients with cardiogenic shock ?

A

Up to 50%

41
Q

What is the clinical presentation of cardiogenic shock? Give 3 symptoms and 3 signs

A

Symptoms: Chest pain, nausea, dyspnoea, profuse sweating, confusion/disorientation, palpitations, syncope Signs: pale mottled skin, slow capillary refill, hypotension, hypotension, tachycardia/bradycardia, raised JVP and peripheral oedema

42
Q

What is the pathophysiology of cardiogenic shock?

A

Cardiac dysfunction Inability to perfuse vital organs and tissues Acute hypoperfusion and hypoxia of tissues and organs despite adequate intravascular volume

43
Q

What is the aetiology of cardiogenic shock?

A

Acute myocardial infarction Other intrinsic heart problems - pulmonary embolism, arrhythmia, cardiac tamponade

44
Q

What are the risk factors for cardiogenic shock?

A

History of infarction Diabetes Peripheral vascular disease

45
Q

What is the epidemiology of cardiogenic shock

A

5-10% of patients with MI

46
Q

What diagnostic tests are done for cardiogenic shock?

A

FBC, U&E, and echocardiocardiogram

47
Q

Why is a FBC done for cardiogenic shock?

A

To rule out anaemia

48
Q

Why is U&E done for cardiogenic shock?

A

To check renal function

49
Q

What is the treatment for cardiogenic shock?

A

If MI revascularise immediately with thrombosis

50
Q

What is a complication of cardiogenic shock?

A

Death

51
Q

What is this? And what kind of shock is associated with this?

A

Cardiogenic shock

Phase 2A - Cardiovascular (8 decks)

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