Clinical Cardiac Part 5 Flashcards by Marah Kays

What are the main physiologic determinants of tissue perfusion?

Cardiac output

Systemic vascular resistance

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What is the equation for BP?

BP= CO x SVR

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What is the equation for cardiac output?

CO= HR x SV

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What is stroke volume determined by?

1) Preload
2) Myocardial contractility
3) Afterload

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What is shock?

Inadequate tissue perfusion to meet metabolic demand and tissue oxygenation

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How is shock classified according to stage?

Compensated
Decompensated
Irreversible

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How is shock classified according to physiology?

Cardiogenic
Hypovolemic
Distributive
Obstructive

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How is shock classified according to what actually caused it?

Septic
Neurogenic
Hemorrhagic
Anaphylactic

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What is compensated shock?

Reflex compensatory mechanism activated and BP to vital organs is maintained

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Is there a decrease in BP with compensated shock?

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What happens in compensated shock?

Sympathetic vascular tone is increased
Release of catacholamines
RAAS activated
HR increased
Contractility increased
Blood vessels contract shunting blood centrally

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What is decompensated shock?

Issue hypoperfusion and onset of worsening circulatory and metabolic derangment including lactic acidosis
Hypotension
Lactic acidosis

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Is there a decrease in BP with decompensated shock?

Yes

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What is irreversible shock?

Organ and tissue injury is so severe that even if the hemodynamic defects are corrected survival is not possible

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Is compensated shock progressive?

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Is decompensated shock progressive?

Yes

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What are the causes of septic distributive shock?

Gram positive
Gram negative
Fungal
Viral
Parasitic
Myocobacterium

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What are non-septic causes of distributive shock?

Inflammatory shock
Neurogenic shock
Anaphylactic shock

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What are cardiomyopathic causes of cardiogenic shock?

MI
Myocarditis
Beta-blocker induced

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What are arrhythmogenic causes of cardiogenic shock?

Tachyarrythmia

Bradyarrhythmia

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What are mechanical causes of cardiogenic shock?

Valvular insufficiency
Valvular rupture
Valve stenosis

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What are hemorrhagic causes of hypovolemic stroke?

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Trauma
GI bleeding
Retroperionteal bleeding

What are non-hemorrhagic causes of hypovolemic shock?

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Third space losses into the extravascular space or body cavities
GI losses (vomiting)

What are pulmonary vascular causes of obstructive shock?

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Hemodynamically significant PE

Pulmonary HTN

What are the mechanical causes of obstructive shock?

Tension pneumothorax | Pericardial tamponade

What are mixed causes of shock?

Adrenal insufficiency Thyrotoxicosis Acidosis Hypothermia

Cardiogenic shock is what?

Bad pump

Hypovolemic shock is what?

Decreased intravascular volume

Distributive shock is what?

Dilated peripheral vasculature (decreased SVR)

Obstructive shock is what?

Mechanical obstruction of circulatory system

What is cardiac output in cardiogenic shock?

Decreased

What is SVR in cardiogenic shock?

Increased

What is PCWP or CVP in cardiogenic shock?

Increased

What is cardiac output in hypovolemic shock?

Decreased

What is SVR in hypovolemic shock?

Increased

What is PCWP or CVP in hypovolemic shock?

Decreased

What is cardiac output in septic and anaphylactic distributive shock?

Increased

What is SVR in septic and anaphylactic distributive shock?

Decreased

What is PCWP or CVP in septic and anaphylactic distributive shock?

Decreased

What is the cardiac output in neurogenic distributive shock?

Decreased

What is SVR in neurogenic distributive shock?

Decreased

What is PCWP or CVP in neurogenic distributive shock?

Decreased

What is cardiac output in obstructive shock?

Decreased

What is SVR in obstructive shock?

Increased

What is PCWP or CVP in obstructive shock?

Variable

What is an example of third spacing that resulting in hypovolemic shock?

Cirrhosis

What is an example of hypovolemic shock through the skin?

Burns

What is an example of dehydration hypovolemic shock?

Vomiting, diarrhea, decreased intake

What causes distributive shock?

Vasodilation of the vascular beds causes decreased systemic vascular resistance

What are signs of shock?

``` Hypotension Tachycardia Oliguria Abnormal mental status Tachypnea Cool, clammy, cyanotic skin Metabolic acidosis Elevated serum lactate ```

How do you stabilize a patient with shock?

``` Airway Breathing Circulation Disability (neuro) Exposure (check the back and the "nether" regions) *Primary survey ```

How do you treat shock?

IVF (in bolus) Vasopressors US evaluation Broad spectrum antibiotics if infection (sepsis) thought to be cause

What is unique about shock in kids?

Don't see hypotension until the very end

What is unique about shock in the elderly?

Medications mask the symptoms

Clinical Cardiac Part 5 Flashcards

(54 cards)