Assessment and Treatment of Shock Flashcards Preview

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Flashcards in Assessment and Treatment of Shock Deck (23):
1

hypoperfusion - define

Local or generalized deficit in tissue blood flow which
results in inadequate oxygen and nutrient delivery and
failure to remove metabolic by-products

2

Forms/types of shock

Hypovolaemic
Cardiogenic
Obstructive
Maldistributive

3

Contributors to shock state but not direct causes

Anaemia
Hypoxaemia

4

key determinants of tissue oxygen delivery

Cardiac output - most important
Perfusion - vasomotor tone
Oxygen carrying capacit

5

Cardiovascular assessment

Mucous membrane colour
Capillary refill time
• Heart rate: normal 60-120 dog, 140-200 cat
Pulse quality
Auscultation
Cross reference

6

causes of hypovolaemia

Haemorrhage, third spacing, severe other fluid losses
Decr venous return
Mismatch in oxygen supply/demand
Anaerobic metabolism
Incr plasma lactate concs
Compensatory through to decompensated stages of
shock

7

the bodies reaction to hypovolaemia

incr HR
white mucous membranes
incr CRT
decr in pulse amplitude + duration
decr metatarsal pulse
incr lactate concs

8

causes of cardiogenic shock

Forward failure
Valvular disease
Cardiomyopathies
Conduction abnormalities

9

assessment of cardiogenic shock

Signalment and history
Murmur or gallop
Usually left sided failure

10

Findings in animals with cardiogenic shock

Membranes may be pink
Lactate may be normal
May not be hypotensive
No murmur in some DCM / bradycardic cats
Radiography - Enlarged cardiac silhouette, May have congestive signs
Large left atrium

11

Treatment of cardiogenic shock

Positive inotropes
Anti-arrhythmics
Furosemide
Vasodilators

12

SIRS [systemic inflammatory distress syndrome] - define

clinical diagnosis of systemic inflammation, systemic vasculitis and oedema, multiple organ dysfunction or failure

13

Sepsis - define

SIRS + documented infection site

14

Septic shock - define

sepsis + hypotension

15

Septicaemia - define

sepsis and bacteraemia

16

Hypodynamic sepsis/SIRS - PE

Tachycardia
Congested/cyanotic mucous membranes
Fast CRT
Tall narrow pulses

17

cats - 2 types of response to sepsis

Compensated (Completely happy)
Decompensated (Dead or dying)

18

maldistributive shock - PE

Bradycardia (<140BPM – that’s a relative bradycardia)
Hypotension
Hypothermia
Pale mucous membranes

19

maldistributive shock - treatment

fluids*
treat underlying disease

20

Obstructive shock - causes

Poor filling pressures due to obstruction
Pericardial effusion
Gastric dilatation and volvulus
Tension pneumothorax
Pulmonary thromboembolism

21

obstructive shock - diagnosis

Signalment
History
Auscultation
Palpation
Radiographs - Size of caudal vena cava relative to perfusion status

22

Pericardial effusion - signs on PE

Muffled heart sounds
No apex beat
Pulsus paradoxus
Weak femoral pulses
Jugular distension

23

Treatment of obstructive shock

Address underlying disease
Can you relieve the “obstruction”?
Not necessarily fluids, but can be used in conjunction in certain cases