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Circulatory Shock Flashcards

(58 cards)

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1
Q

Clinical shock

A

Acute circulatory failure with inadequate or inappropriately distributed tissue perfusion resulting in cellular hypoxia and end organ damage

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2
Q

What are the main mediators of vasodilation

A

Nitric oxide
Prostacyclin

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3
Q

How does vasodilation regulate blood flow

A

Enhances blood flow to certain areas
Decr systemic vascular resistance

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4
Q

What hormones cause vasoconstriction

A

Noradrenaline - a2
Angiotensin
Vasopressin

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5
Q

Is vasoconstriction controlled by the sympathetic or parasympathetic nervous system

A

Sympathetic

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6
Q

Which receptors does noradrenaline work on to cause vasoconstriction

A

Alpha 2

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7
Q

What are the 3 causes of shock

A

Decr cardiac output
Reduced systemic vascular resistance
Incr afterload

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8
Q

How is shock a vicious cycle

A

Inadequate blood flow -> heart and circ system failure -> further cardiac output decr -> worsening shock and perfusion

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9
Q

Why is shock very difficult to reverse once initiated

A

Involves lots of positive feedback mechanisms

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10
Q

How does hypoxia cause cell death

A

Cells switch to anaerobic metabolism -> lactic acid made -> cell function ceases + swells -> ICF membrane permeability -> electrolytes + fluids enter + leave -> Na/K+ pump impaired -> cells swell -> mitochondria damage -> cell death

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11
Q

4 stages of shock

A

Initial
Compensatory
Progressive
Refractory

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12
Q

Which stage of shock is irreversible

A

Refractory

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13
Q

What causes a patient to go from compensatory to progressive stage shock

A

Body can’t compensate anymore

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14
Q

Features of initial stage shock

A

Body switches to anaerobic metabolism
Incr lactic acid
Subtle clinical sign changes

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15
Q

Features of compensatory stage shock

A

Sympathetic stimulation
Incr catecholamine release
Incr cardiac contractility
Vasoconstriction
Aldosterone release
Decr urine output
Incr heart rate
Incr glucose level

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16
Q

Features of progressive stage shock

A

Electrolyte imbalance
Metabolic acidosis
Respiratory acidosis
Peripheral oedema
Irregular tachyarrhythmia
Hypotension
Pallor
Cool clammy skin
Altered level of consciousness

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17
Q

Features of refractory stage shock

A

Irreversible cellular and end organ damage
Impending death

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18
Q

4 types of shock

A

Obstructive
Distributive
Cardiogenic
Hypovolaemic

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19
Q

Obstructive shock

A

Physical obstruction to vessels entering or leaving heart reduces flow to heart, decreasing preload and cardiac output

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20
Q

What causes obstructive shock

A

Physical obstruction to large vessels entering or leaving heart

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21
Q

What type of shock can a pulmonary embolism cause

A

Obstructive

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22
Q

What type of shock can a tension haemothorax cause

A

Obstructive

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23
Q

How does a pulmonary embolism cause shock

A

Clot blocks artery in lungs increasing heart afterload

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24
Q

How does tension haemothorax cause shock

Study These Flashcards
A

Obstructs venous return to heart impairing left ventricular filling

25
What type of shock does cardiac tamponade cause
Obstructive
26
How does cardiac tamponade cause shock
Increases intra pericardial pressure, restricting cardiac filling and decr cardiac output
27
Distributive shock
Excessive vasodilation impairs blood flow distribution
28
Characteristic signs of distributive shock
Drop in peripheral vascular resistance Hypotension
29
What type of shock is septic shock a form of
Distributive
30
Septic shock
Life threatening organ dysfunction due to dysregulated host response to infection
31
Signs of septic shock
Altered mental status Systolic BP <100mmHg RR >22 breaths/min Signs of infection
32
How does septic shock cause hypotension
Bacteria in blood release chemicals causing uncontrolled hypotension
33
What type of shock is anaphylactic shock a form of
Distributive
34
What causes anaphylactic shock
Pathological allergy response
35
How does anaphylactic shock cause uncontrolled hypotension
Exposure to antigen -> IgE mediates mast cell degranulation -> histamines released -> vasodilation + capillary leaking -> decr peripheral vascular resistance -> hypotension
36
Neurogenic shock
Sudden loss of vasomotor tone throughout body due to loss of sympathetic input
37
What causes neurogenic shock
Loss of sympathetic input leaving unopposed parasympathetic activity
38
Cardiogenic shock
Failure of heart to pump blood due to ventricular dysfunction
39
What is the most common cause of Cardiogenic shock
Acute myocardial infarction
40
What type of shock can acute myocardial infarction cause
Cardiogenic
41
Hypovolaemic shock
Reduced circulating volume causes reduced venous return and preload
42
Hypovolaemia causes
Haemorrhage GI losses Surgery Burns
43
How can GI system issues cause hypovolaemia
Diarrhoea and vomiting cause dehydration
44
How can surgery lead to hypovolaemia
Internal structures exposed to air and heat
45
What types of shock can burns lead to
Distributive and hypovolaemic
46
How can burns lead to hypovolaemia
Fluid shift into Extravascular space due to inflam response Loss of fluid due to loss of skin barrier
47
Why is bleeding into the skull not likely to cause Hypovolaemic shock
Patient would die from coning before Anouilh blood was lost to go into shock
48
Haemorrhage signs and symptoms (inc internal)
Confusion Anxiety Clammy skin Cold Low BP Hugh heart rate Slow capillary refill Greyish pallor Bruising Bleeding Melaena
49
What happens to arterial pressure and cardiac output during haemorrhage
Decr
50
How many classes of Haemorrhagic shock are there
4
51
How much blood loss is needed for class 4 Haemorrhagic shock
2 lites
52
How much blood loss is class 1 Haemorrhagic shock
<750 ml
53
How much blood loss for class 2 Haemorrhagic shock
750ml - 1.5 litres
54
How much blood loss for class 3 Haemorrhagic shock
1.5 - 2 litres
55
Acute compensatory mechanisms for Haemorrhagic shock
Constriction of small arterioles Constriction of veins and venous reservoirs Increased heart rate and contractility Noradrenaline and adrenaline from adrenal medulla
56
How is Haemorrhagic shock detected by body
Decreased arterial pressure detected by baroreceptors
57
Long term compensatory mechanisms for Haemorrhagic shock
RAAS system activation Vasopressin release Albumin and other plasma protein synthesis stimulation in liver Incr fluid absorption from GI tract Incr erythropoietin release
58
How is shock treated
A - E Treat underlying cause Supportive management

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