Circulatory Insufficiency Flashcards

1
Q

What is circulatory collapse

A

This is defined as the general or specific failure of the circulation, either cardiac or peripheral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a milder or preliminary form of circulatory collapse called?

A

Circulatory insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Types of circulatory collapse

A

1) CARDIAC circulatory collapse:-
Affects the vessels of the heart. Sometimes called Acute circulatory failure

2) PERIPHERAL circulatory collapse:-
Affects other vessels in the body. Sometimes called Shock, Peripheral vascular failure, Peripheral vascular shutdown.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List the causes of circulatory collapse

A

• Dehydration

• Surgery (from loss of excess blood)

•Heart conditions (MI, acute or chronic heart failure, ruptured or dissecting aortic aneurysm)

• Shock (Cardiogenic shock, hypovolemic shock, distributive or vasodilatory shock etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List the 5 types of circulatory shock

A

●Septic shock
●Anaphylactic shock
●Cardiogenic shock
●Hypovolaemic shock
●Neurogenic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the formula for measuring MAP and what is the normal MAP

A

MAP = (2 x DBP) + SBP/3

Normal range is 70-110mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is Septic shock

A

It is defined as persisting hypotension required vasopressors to maintain mean arterial pressure (MAP) of 65 mmHg or higher and a serum lactate level greater than 2 mmol/L, despite adequate volume resuscitation.

Usually caused by toxin releasing bacteria.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the clinical features of septic shock

A

● Fever, chills or rigor
● Confusion
● Anxiety
● Difficulty breathing
● Fatigue, malaise
● Nausea and vomiting
● Cold skin and extremities
● Delayed capillary refill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How works you manage septic shock?

A

Initial resuscitation
● 30 ml/kg of IV crystalloid fluid should be given within the first 3 hours
● Reassessment should include HR, BP, Arterial O­2 saturation, RR, Urine Output ≥ 0.5 ml/kg/hr and CVP of 8 – 12 mmHg
● Additional fluids if the initial fluid therapy is insufficient
● Decrease in lactate levels may guide resuscitation

IV antimicrobials
● Emperical broad spectrum should be initiated within 1 hour and switched after sensitivity result is out.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is anaphylactic shock

A

This is a widespread and very serious allergic reaction due to release of histamine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the clinical features of anaphylactic shock and list the complications

A

Clinical Signs
●Bronchospasm
●Laryngeal oedema
●Urticaria
●Vascular collapse

Complications
●Brain damage
●Kidney failure
●Cardiogenic shock
●Arrhythmias
●Heart attacks/myocardial infarction
●Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How would you manage anaphylactic shock

A

● Supportive measures including O2 therapy
● IV Epinephrine (Adrenaline)
● IV Glucocorticoid eg Hydrocortisone
● IV Anti-histamine
● IV β-agonist eg Albuler

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is cardiogenic shock

A

It may be defined as a state of inadequate tissue perfusion due to cardiac dysfunction or a state of end-organ hypoperfusion due to cardiac failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the diagnostic criteria for cardiogenic shock

A

● Persistent (> 30 minutes) hypotension with systolic BP < 90 mmHg
● Reduction in cardiac index less than 2.2 L/min/m2
● Presence of elevated left ventricular filling pressure (PCWP > 18 mmHg)
● Signs and symptoms of end organ hypoperfusion
● Restlessness, confusion, cold cyanotic extremities, oliguria (< 30 ml/hr urinary output)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List the causes of cardiogenic shock

A

●Extensive acute myocardial infarction ( most common cause)
●Patients with previous impairment of ventricular function
●Myocardial injury causing systolic and diastolic dysfunction
●Decrease in cardiac output leading to decrease in systemic and coronary perfusion

Others
●Acute MI
●Left ventricular failure
●Papillary muscle rupture
●Acute ventricular septal defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List the predisposing factors for cardiogenic shock

A

●Age
●Systolic blood pressure
●Diabetes
●Anterior infarction
●Previous infarction
●Peripheral vascular disease
●Reduced ejection fraction

17
Q

What are the signs and symptoms of cardiogenic shock

A

●Low blood pressure
●Severe shortness of breath and rapid breathing
●Loss of consciousness
●Clammy or cool skin which may be grey or pale
●Eye lacking luster with dilaled pupil
●Mental alteration or confusion
●Increased respiratory rate
●Decreased heart rate
●Decreased urine output
●Elevated JVP

18
Q

How would you treat cardiogenic shock?

A

●Vasopressors and inotropes
●Diuretics
●Cardiac catheterization
●Intra-aortic balloon pumps (IABPs)
●Left ventricular assist devices

19
Q

What is hypovolemic shock

A

This is a condition in which severe blood and fluid loss make the heart unable to pump enough blood to the body due to decreased pre-load

20
Q

List the clinical features of hypovolemic shock

A

Mild symptoms
●Headache
●Fatigue
●Nausea
●Profuse sweating
●Dizziness

Severe symptoms
●Cold or clammy skin
●Pale skin
●Rapid shallow breathing
●Rapid HR (tachycardia)
●Little or no urinary output (oliguria/anuria)
●Confusion
●Weakness
●Thread pulse
●Cyanosis
●Light headedness
● Loss of consciousness

21
Q

What is neurogenic shock

A

This is defined as the injury to the spinal cord with associated anatomic dysregulation. It is due to a loss of sympathetic tone and an opposed parasympathetic response.

22
Q

List the clinical features of neurogenic shock

A

●Lack of normal sympathetic tone
●Hypotension
●Paradoxical bradycardia
●Decreased vascular tone (vasodilation)
●Absent diaphoresis

23
Q

How would you manage neurogenic shock?

A

Management
●Careful fluid replacement
●Vasopressors (norepinephrine is preferred)