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Physiology I Block 4 > Circulatory Shock & Treatment > Flashcards

Circulatory Shock & Treatment Flashcards

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1
Q

what is the definition of circulatory shock

A

Generalized inadequate blood flow through the body to the extent that the tissues are damaged

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2
Q

heart failure vs. heart shock

A

failure: tissues aren’t supplied what they are needed, it can progress to shock and tissues are damaged

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3
Q

heart failure can lead to

A

shock

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4
Q

circulatory shock can be caused by

A

decreased in cardiac output

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5
Q

what cardiac abornoalities that decrease ability of heart to pump lead to cardiogenic shock

A

Myocardial infarction
Severe valvular dysfunction
Heart Failure

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6
Q

what factors taht decrease venous return can lead to schock

A

Decreased blood volume
Decreased vascular tone
Obstruction to blood flow

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7
Q

what situation can lead to circulatory shock without a decrease in cardiac output

A

hyperthyroidism

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8
Q

thyroid hormone does what

A

increases metabolic activity of tissues in body

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9
Q

how can hyperthyroidism cause shock

A

there is increased metabolism in all the tissues so they can’t get enough blood even with increased CO

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10
Q

what would happen in pt with hyperthyroidism, why do vessels dilate?

A

metabolism - local control

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11
Q

increased in metabolism with hyperthyroidism releases vasodilators and causes

A

vessels to dialte

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12
Q

what happens to peripheral resistance in individual with hyperthyroidism

A

falls tremendously (all the vessels are dilating)

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13
Q

what happens to venous return with individuals with hyperthrydoism

A

increases

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14
Q

what is CO in individuals with hyperthyroidism

A

very high

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15
Q

what are baroreceptors trying to do in pt with hyperthyroidism

A

lots of sympathetic stimulation but they can’t decrease vessels b/c of local stimulation

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16
Q

what is HR in individual with hyperthyroidism

A

high and high contractility

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17
Q

AV fistula stands for

A

arteriol venous fistula

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18
Q

what is AV fistula

A

blood vessel that connects arteries to veins

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19
Q

what does AV fistula do to total peripheral resistance?

A

put one vessel of low resistance there so total peripheral resistance will decrease

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20
Q

what does arterial pressure do with AV fistula

A

decrease

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21
Q

what are the two ways to have circulatory shock without decrease in CO

A 
hyperthyroidism
AV fistula (abnormal tissue perfusion patterns)
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22
Q

what is the end result of circulatory shock

A

tissue deterioration

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23
Q

once shock gets to a critical point, shock leads to

A

more shock

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24
Q

what kindo f loop once shock gets to critical point

A

positive feedback loop

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25
positive feedback loop of shock leads to
death
26
what are the three stages of shock
Non-progressive Stage progressive irreversible
27
what is the non-progressive stage of shock
(Compensated stage) | Normal circulatory compensatory mechanisms will eventually cause full recovery without help of therapy.
28
what is the progressive stage of shock
in which, without therapy, shock becomes progressively worse.
29
what is the irreversible stage of shock
Shock has progressed to a stage where no known therapy will avert eventual death.
30
without therapy, progressive shock will
become worse
31
progressive shock can degrade into
irreversible shock
32
no matter what you do, if person has irreversible shock
you can't save them
33
if you remove 10% of blood volume, blood pressure and CO do what
remain normal
34
why do BP and CO remain normal if you remove 10% of blood
baroreceptors kick in and make the the veins squeeze, more blood back to heart
35
how much blood does it take to lose to have a change in cardiac output
20%
36
why does cardiac output change before arterial pressure does (in regards to blood loss)
arterial pressure is controlled independently of anything else
37
body is set up to keep arterial pressure high - why? (even at the expense of other things)
need high arterial pressure always to get blood to brain
38
past 20% blood loss, what happens to Arterial pressure and CO
both fall
39
at what point do both arterial pressure and CO fall
after 20% blood bloss
40
what is plateau phase at about 35% blood loss due to?
CNS Ischemic response
41
if blood pressure falls realy low we get
massive sympathetic stimulation
42
if there is 35% blodo loss and you are in ischemic response, what is happening with blood vessels
they are almost all constricted
43
if you lose 40-45% of blood what happens
body can't do anything about that, BP is 0
44
is there a number for the amoutn that there is critical shock
no there is not number, but there is a point where non-progressive shock goes into progressive shock
45
go through pg 7 and understand why each reflex contributes to non-progressive shock
pg 7
46
why is renin-angiotensin system activated in compensated shock
pressure is low so kidney sense and rekease renin
47
vasopressin is also known as
anti-diuretic hormone
48
vasopressin is a
vasoconstrictor
49
what does vasopressin do
puts water pores in collecting ducts of kidney so kidneys reabsorb all the water that might leave through urine
50
what kind of urine does hemorrhaging person have
concentrated
51
in shock in capillaries is ther net absorption or secretion
absorption back into capillaries
52
of the four capillary pressure what changes the most in shock
capillary pressure
53
if blood goes through capillary, rather than filtration and lymphatics removing it in shock, there is
re absorption from itnerstitium back into capillaries to try to increase blood volume
54
cardiac degeneration is what
heart itself begins to deteriorate
55
progressive shock does what to heart
cardiovascular deterioration
56
when heart starts to deteriorate in progressive shock what does that do
makes the shock worse - more positive feedback
57
sludged blood, what is it
happens with progressive shock tissue levels of oxygen decrease lactic acid and other things are released, CO2 not removed, pH acidic, the acidic pH causes sludged blood
58
acidic pH in blood causes
blood cells to agglutinate with each other
59
increased capillary permeability in late stage of schock:
movement of fluids from blood into tissues
60
what is released by ischemic tissue
endotoxin
61
endotoxin is released from what
dead gram negative bacteria in intestines
62
endotoxin does what to heart
inhibitory - depresses cardiac function
63
non-progressive vs. progressive shock depends on if
negative feedback mechanisms can overcome the positive feedback mechanisms
64
what are forms of hypovolemic shock
intestinal obstruction severe burns dehydration
65
hypovolemic shock is caued by
plasma loss
66
if you lose vasomotor tone (constant firing of vasoconstrictor area) what will happen
sympathetic nerves stop firing and blood vessels and veins will dilate
67
in neurogenic shock what do you see
increase vascular capacity
68
why does vascular capacity increase in neurogenic shock
because no more vasomotor tone
69
what happens to mean systemic circulatory pressure in neurogenic shock
decreased
70
what are causes of neurogenic shock
Deep general anesthesia - depression of vasomotor center Spinal anesthesia - blocks sympathetic outflow. Brain damage - brain concussion or contusion of basal regions of brain  profound neurogenic shock.
71
in neurogenic shock you have decreased in CO etc without
losing any fluid
72
anesthesize spinal cord how can this cause neurogenic shock
can block sympathetic outflow
73
how can brain tdamage cause neurogenic shock
brain concussion or contusion of basal regions of brain  profound neurogenic shock.
74
how can deep general anesthesia cause neurogenic shock
depression of vasomotor center
75
if pt is in deep general anesthesia what do you do for them if BP drops dramatically (neurogenic shock)
don't give fluids, they have got enough fluids | want to constrict the arteries and veins - alpha antagonist like NE
76
does person in neurogenic shock have enough fluids
yes -the problem is the vessels are too dilated to get enough blood back to the heart. all the blood vessels are dilated
77
anaphylactic shock - what is this
due to allergic reaction and CO and arterial pressure fall dramatically
78
what is released into blood in anaphylactic shock
histamine basophils mast cells release
79
what happens to arteries in anaphylactic shock
dilation
80
arteriol dilation does what to arterial pressure in anaphylactic shock
decrease
81
what happens to vascular capacity in anaphylactic shock
increased capacity - decreased (I think it might actually be increased) compliance
82
what happens to capillary permeability in anaphylactic shock
increased permeability
83
what happens to venous return in anaphylactic shock
decreased
84
what is septic shock
Bacterial infection widely disseminated to many areas of the body Many varieties of septic shock because of the many types of bacterial infections
85
most cases of septic shock are caused by
Gram-positive bacteria, followed by endotoxin-producing Gram-negative bacteria
86
what is Disseminated intravascular coagulation
micro blood clots everywhere in body - and the clots use up all the clotting factors so you can have hemorrhaging
87
what does DIC stand for
Disseminated Intravascular Coagulation
88
DIC can happen in
septic shock
89
endotoxic shock often occurs when
large segment of gut becomes strangulated & loses blood supply
90
when blood supply is reintroduced in endotoxic shock what happens
the endotoxins go everywhere, especially the eart
91
when endotoxin is released to body in endotoxic shock what happens to heart
similar to anaphylaxis - sever e shock, inhibits myocardial contractility
92
how can you treat shock (2 main treatments)
replacement therapy | sympathomimetics
93
describe replacement therapy for treatment of shock
plasma is best b/c it keeps fluid in capillaries - blood and plasma transfusion
94
what are sympathomimetics
sympathic like
95
what can be used as sympathomimetics
Ne EPI Dopamine
96
why is dopamine good for sympathomimetics
it has alpha, beta, properties depending on dose | and dopamine receptors in kidney to increase renalblood flow
97
sympathomimentcs are not useful in what kind of shock
hemorrhagic

Physiology I Block 4 (13 decks)

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