A.3-7 Flashcards by demon of the semen

shock definition?

Acute hymodynamic disorder, independant of cause, leading to insufficient O2 supply and tissue hypoxia

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which part of our circulation is the main thing in shock?

microcirculation due to shunting and skipping this part causing hypoxia

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phases of shock?

compensated: initially, reversible

decompensated: critical pH7.2. irreversible

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pahtophysiology of compensated phase?

-centralized circulation
-catecholamines outflow

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what do we need to examine during the compensated phase of shock?

organ perfusion:
- brain: consciousness, orientation
- skin: CRT, extremity temp
- bowel: paralyisis, sounds
- kidney: diuresis/hr (nromal:0.5-1.5ml/kg/h)

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pahtophysiology of decompensated phase?

-cetralized circulation become affected
-catecholamines are ineffective

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what are the hypodynamic shocks?
what do they all have in common)

cardiogenic (increased preload)
hypovolemic
obstructive
all: cold and clammy
decreased CO, preload
Increased SVR (afterload)

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what are the hyperdynamic shocks?
what do they have in common?

The three distributiv shocks (septic, anaphylactic, neurogenic)
All: flushed, warm

increased CO, later decreases due to CMP
decreased SVR (afterload), PCWP (preload)

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what is Neurogenic shock?

loss of normal SYMP innervation after damage to CNS by a spinal cord injury

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what happens in Neurogenic shock?

loss of the ability of normal vasoconstriction

blood shunts from a–>v in shortest way instead of capillary

tissue is still hypoperfused !!

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symptoms of shock?

skin: alpha1 rec. –> vasoconstriction –> pale clammy

brain: cerebral hypoperfusion –> confusion

kidney: alpha1 rec. –> vasoconstriction –> oliguria

heart: beta1 rec. –> tachycardia

lungs: increase in O2 supply requirement + acidosis compensation –> tachypnoe

low BP: depletion of compensation

bowel: splanchnic vasoconstriction –> absence of bowel sounds

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how do you diagnose shock?

physical examination
hemodynamic monitoring
invasive BP monitoring
invasive MAP monitoring
CVP monitoring
CO monitoring
ABG
ECG
RUSH protocol

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non-invasive hemodynamic monitoring in shock?

non-invasive BP
ECG
pulse oximetry
echo
esophageal doppler
ultrasonic CO monitoring

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invasive hemodynamic monitoring in shock?

invasive BP monitoring
CVP measurement
PiCCO
Swan-Ganz catheter

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indications of invasive BP monitoring?

unstable hemodynamics
vasoactive therapy required
perioperative monitoring of high risk surgery

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advantages of invasive BP monitoring?

continuous and accurate

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shock therapy main goals?

restoration of homeostasis before compensation

elimination of local acidotic mediators from hypoperfused regions

maintenance of O2 level and tissue perfusion

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shock therapy initial management?

O2 supplimentation: face mask

obtaining 2 large IV catheters: 14G and 16G
or central line

admission to ICU

Etiology of cardiogenic shock?

decrease in pump function
valvular disorder
intracardiac shunt
arrythmia

how do you treat cardiogenic shock?

supportive
drugs
circulatory support

supportive therapy in cardiogenic shock?

oxygenation
IV access
fluid resuscitation

Drug used in Cardiogenic shock?

Dobutamine
Levosimendan
milirinone

mechanical circulatory support in cardiogenic shock?

VAD: ventricular assist device

ECMO: Veno-Venous, Arterio-Venous

Anaphylactic shock definition?

Generalized immunological condition of sudden onset, which develops after the exposure to a foreign subtsance

symptoms of typical anaphylactic shock? (the triad)

angioedema bronchoconstriction hypotension

other important clinical features of anaphylactic shock?

skin and mucosa: -erythma -urticaria -pruritus resp.: -chest tightness -dyspnoe -stridor, wheezing -hypoxia, cyanosis G.I.: -nausea and vomiting -diarrhea and pain cardiovascular: -hypotension -tachycardia -weak peripheral pulses

signs of End-organ failure in anaphylactic shock?

brain: syncope kidney: oliguria, anuria skin: motteling, low temp, CRT >2s

therapy of anaphylactic shock?

allergen removal drugs resp. support fluids

Drugs of choice in anaphylactic shock?

1st line: Epinephrine/Adrenalin (0.5 mg IM or 0.1 IV) Antihistamines: H1-rec. antag steroids (resp) beta2 agonists (resp) muscarinic antag. (resp)

resp support in anaphylactic shock?

- high flow O2 - early intubation in stridor after epineph.

Hemmorrhagic shock signs and symps?

- cold peripheries - decrease: CO, SVR, BP - tachycardia - altered mental status ABG: -low Hgb -high lactate -metabolic acidosis

Hemorrhagic shock diagnostics?

ABCDE and physical examination ABG coagulation studies, bleeding time and elastography

Hemorrhagic shock therapy?

- stop bleeding - aggressive fluid resusci. (isotonic ringer 2L) -blood transfusion: packed RBC FFP: if coagulopathy -PLT transfusion

what to give if refractory to NE of in severe pulmonary hypertension?

Argipressin

Hemodynamic parameters you look at in shock?

CVP CO PCWP SVR HR SVO2

Why is temperature important in bleeding?

Temperature affects coagulation Hypothermia decreases coagulation!!!!

what the deal with distributive shock?

there is a loss of vasoconstriction and blood is going "everywhere" and not to the tissue really needing it

Obstructive shock definition?

obstruction of blood flow into or out of the heart due to impaired diastolic filling or excessive afterload

Obstructive shock etiology?

- pulmonary embolism - temponade - tension PTX

symptoms of obstuctive shock?

cold peripheries hypotension tachycardia tachypnoe oliguria subcutanous emphysema chest/abd. pain

obstructive shock diagnosis?

ABCDE ABG RUSH Pulmonary angiography/scintigraphy

obstructive shock treatment? PE

- Anticoagulation: Heparin - thrombolysis: Alteplase - Trend.el.burg procedure: surgical thrombectomy

obstructive shock treatment? Temponade

Pericardiocentesis surgery: seldinger technique

obstructive shock treatment? TPTX

needle thoracostomy