Cardio. Shock 09-x (1)

Question 1

What belongs to distributive shock?

Answer 1

SEPTIC
ANAPHYLAXIC
NEUROGENIC

Question 2

Neurogenic shock. Primary disturbance?

Answer 2

Nerve injury –> no SNS response

Question 2

Sepsis. Primary disturbance?

Answer 2

peripheral vasodilation

Question 3

Sepsis. Result of venous dilation?

Answer 3

decr preload –> decr. CVP and PCWP

Question 4

Sepsis. Result of arterial dilation?

Answer 4

decr. afterload (decr. SVR) –> decr. BP.

Question 5

Sepsis. Mechanism that leads to decr. CVP and PCWP? 2

Answer 5

1. peripheral venous dilation (due to proinflammatory mediators) –> pooling of blood in dilated veins
2. increased vascular (capilary) permeability (third-spacing).

Question 6

Sepsis early stage features?

Answer 6

EARLY STAGE (hyperdynamic stage):
decr. SVR, decr. BP, incr. CO and HR. (warm)

Question 7

Sepsis early stage mechanism that incr. CO?

Answer 7

Hypotension + inflammation from sepsis –>

A compensatory increase in sympathetic drive increases
I. cardiac contractility and II. HR
resulting in increased cardiac output (CO)/cardiac index (CO per body surface area) despite reduced left ventricular preload).

ALSO:
1. the large decrease in SVR and 2. a baroreceptor reflex–mediated increase in heart rate (ie, tachycardia) –> incr. CO.

Question 8

sepsis. whats the point of incr. CO?

Answer 8

CO increased to maintain tissue perfusion.

Question 9

sepsis. what venous oxygen?

Answer 9

Incr. MvO2
The high rate of blood flow through the systemic capillaries prevents complete extraction of oxygen by the tissues=incomplete extraction of oxygen, resulting in high mixed venous oxygen saturation –> May develop lactic acidosis from tissue hypoperfusion.

Question 10

sepsis. late stage features?

Answer 10

LATE STAGE (hypodynamic):
incr. SVR, decr. CO –> grave deterioration (cold)

!!!As shock progresses, tissue ischemia and accumulation of cytotoxic mediators eventually cause a reduction in CO –> with end-organ dysfunction./In shock end-organ damage = due to inadequate oxygen delivery to the organs and tissues of the body.

Question 11

septic shock temperature?

Answer 11

SEPTIC SHOCK – hyper and hypothermia. Septic shock can present with either hyper- or hypothermia; hypothermic presentation may be due to cytokine-induced dysregulation of temperature control in the hypothalamus and is associated with poorer outcomes.

Question 12

neurogenic shock. mechanism?

Answer 12

No SNS response –> NO SNS mediated incr. in HR and cardiac contractility –> decr. CO.

Question 13

neurogenic shock. features?

Answer 13

decr. SVR, bradycardia, low cardiac index (output), low PCWP

Question 14

neurogenic shock. what oxygen (MvO2)?

Answer 14

decr. MvO2 = improved peripheral oxygen extraction due to lower flow

Question 15

CVP distributive - septic?

Answer 15

decreased

Question 16

PCWP distributive - septic?

Answer 16

decreased

Question 17

Cardiac index (LV output), distributive - septic?

Answer 17

increased (early phase)
decreased in late stage when deterioration happens

Question 18

SVR distributive - septic?

Answer 18

decreased

Question 19

SvO2 distributive - septic?

Answer 19

increased (fast flow –> incomplete extraction of O2 in tissues)

Question 20

CVP distributive - neurogenic?

Answer 20

decreased

Question 21

PCWP distributive - neurogenic?

Answer 21

decreased

Question 22

Cardiac index (LV output), distributive - neurogenic?

Answer 22

decreased (no SNS response, reflex)

Question 23

SVR, distributive - neurogenic?

Answer 23

decreased (no SNS response, reflex)

Question 24

SvO2, distributive - neurogenic?

Answer 24

decreased (slow flow --> maintained extraction of O2 in tissues)

Question 25

Cardiogenic shock. primary disturbance?

Answer 25

Left ventricle failure

Question 26

PCWP cardiogenic shock?

Answer 26

increased

Question 26

CVP cardiogenic shock?

Answer 26

increased Also incr. pressure in right atrium

Question 27

Cardiac index (LV output) cardiogenic shock?

Answer 27

DECREASED (main feature)

Question 28

SVR cardiogenic shock?

Answer 28

increased (compensatory increase due to low CO)

Question 29

SvO2 cardiogenic shock?

Answer 29

decreased

Question 30

Hypovolemic shock main disturbance

Answer 30

decreased blood volume

Question 31

CVP Hypovolemic shock?

Answer 31

decreased

Question 32

PCWP Hypovolemic shock?

Answer 32

decreased

Question 33

CO Hypovolemic shock?

Answer 33

decreased

Question 34

SVR Hypovolemic shock?

Answer 34

Increased (compensatory incr.)

Question 35

SvO2 Hypovolemic shock?

Answer 35

decreased

Question 36

in hypovolemic what is activated as compensation?

Answer 36

SNS and RAAS

Question 37

hypovolemic. How CO is maintained?

Answer 37

Stimulation of the heart (SNS) results in increased contractility and heart rate, helping to maintain cardiac output.

Question 38

hypovolemic. kidney role?

Answer 38

Increased renal sodium and water retention help to prevent further volume loss. Per raas sistema

Question 39

hypovolemic resuscitation with i/v fluids. what is result? 2

Answer 39

Intravenous fluids increase the intravascular and left ventricular end-diastolic volumes. The increase in preload stretches the myocardium and increases the end-diastolic sarcomere length, leading to an increase in SV and CO by the Frank-Starling mechanism.

Question 40

if hypovolemia due to diarrhea. what electrolyte disturbance?

Answer 40

loss of bicarbonate in the stool, further contributing to metabolic acidosis and a compensatory increase in ventilation.

Question 41

obstructive shock primary disturbance?

Answer 41

impeded cardiopulmonary blood flow (PE, PTX, tamponade)

Question 42

CVP in obstructive shock?

Answer 42

increased

Question 43

PCWP in obstructive shock?

Answer 43

decreased

Question 44

CO in obstructive shock?

Answer 44

decreased

Question 45

SVR in obstructive shock?

Answer 45

increased (compensation)

Question 46

SvO2 in obstructive shock?

Answer 46

decreased

Question 47

PCWP specifically in tamponade (obstructive shock)?

Answer 47

preload of left heart is decreased, BUT duo to external compression PCWP is paradoxically increased