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saecc > exam 1 - SIRS and shock > Flashcards

exam 1 - SIRS and shock Flashcards

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1
Q

define shock

A

state of inadequate cellular energy production
decreased delivery of oxygen to tissues
inadequate utilization of oxygen and/or decreased energy production

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2
Q

where is the bulk of ATP made - glycolysis or ETC

A

ETC

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3
Q

big 3 ends to cellular dysfunction

A

necrosis - organ failure - death

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4
Q

equation for oxygen delivery to tissues

A

DO2 = CaO2 x CO

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5
Q

CaO2

A

oxygen content in arterial blood
(1.34 x Hb x SaO2) + (0.003 x PaO2)

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6
Q

CO

A

cardiac output
CO = HR x SV

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7
Q

classic causes of shock(four)

A

hypovolemic, cardiogenic, distributive, obstructive

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8
Q

extra classification of shock

A

hypovolemic, cardiogenic, distributive, metabolic, hypoxemic

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9
Q

how much body fluid does ECF take up

A

33%
plasma volume and interstitial volume

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10
Q

how much of ECF does plasma and interstitial make up

A

1/4 plasma, 3/4 interstitial

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11
Q

dehydration

A

decrease in total body water
intracellular and interstitial

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12
Q

hypovolemia

A

decreased circulating plasma volume

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13
Q

absolute hypovolemia

A

intravascular volume lost - out of body

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14
Q

relative hypovolemia

A

intravascular volume is lost from the normal space

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15
Q

what is the most important aspect of shock treatment

A

early recognition

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16
Q

primary goal of shock tx

A

restoration of appropriate oxygen delivery to tissues

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17
Q

what are some ways to restore oxygen delivery

A

correct hypovolemia, increase CO, address hypoxemia and hypoglycemia, target appropriate renal perfusion

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18
Q

what happens in hypovolemic shock

A

decrease in circulating blood volume
decreased preload, SV, CO and DO2

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19
Q

history and PE of hypovolemic shock

A

vomiting diarrhea, PU/PD, lethargic, trauma
increased HR, fair to poo pulse, pale MM, long CRT, recumbent, cool extremities

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20
Q

noninvasive diagnostics of hypovolemic shock

A

BP < 90-100 mmHg
sinus tachycardia on ECG
effusion on FAST scan
hyperlactatemia
thrombocytopenia - hemorrhage

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21
Q

what is first stage of shock

A

compensatory - activation of neurohurmonal response, hyperdynamic
normal to slightly elevated CS

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22
Q

what is second stage of shock

A

early decompensatory - redistribution of blood flow to essential organs, shift to anaerobic metabolism
altered CS here, seems shocky

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23
Q

third stage of shock

A

decompensatory - failure of autoregulation, loss of sympathetic control
terminal if not treated

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24
Q

how do cats with shock present

A

bradycardia, hypothermia, hypotension
miss compensatory phase in cats

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25
how to treat hypovolemic shock
fluids or blood products
26
"dose" for crystalloids
10-20 ml/kg over 10-15 min dont exceed total blood volume (90 dogs, 60 cats)
27
dose for hetastarch
4-5 ml/kg or 2-3 in cats max 20 dogs and 10 cats
28
dose for hypertonic saline
3-5 ml/kg bolus over 20 min
29
what can happen if hypertonic saline given rapidly
refractory hypotension
30
colloids remain in the _______
intravascular compartment expand the IV volume and draw fluid in
31
do crystalloids or colloids have more potential for negative effects
colloids - avoid in sepsis coagulopathies, renal injury
32
when is hypertonic saline contraindicated
dehydrated or hyperosmolar patients
33
what catheters deliver fluids faster and why
large bore, short catheters doubling catheters radius will increase flow 16x Poiseuilles law
34
what is resuscitation to endpoint mean
tailor resuscitation to patient endpoints normotensive, improved lactate/acid-base
35
what type of shock do we avoid fluids
cardiogenic shock
36
why does cardiogenic shock occur
decrease in CO due to pump failure
37
what conditions can cause cardiogenic shock
CHF, DCM, HCM, severe arrhythmias
38
CS of cardiogenic shock
cyanosis, resp distress, abnormal auscultation, hypotension, poor pulses, depressed, jugular distension
39
how to treat cardiogenic shock
diuretics, positive inotropes, antiarrhythmics, vasodilators
40
what is distributive shock
obstruction of blood flow or maldistribution of blood
41
what conditions can cause distributive shock
sepsis, anaphylaxis, GDV, mesenteric torsion, heartworm, saddle thrombus, pneumothorax
42
how to treat obstructive conditions
relieving obstruction is most important goal to restore perfusion GDV - trocar then surgery heartworm - extract worms saddle thrombus - anticoagulants pneumothorax - thoracocentesis
43
how to treat anaphylaxis
IV crystalloid bolus, consider epi, antihistamines, steroids for flare ups
44
additional therapies for sepsis
IV crystalloid bolus, early Abx, catecholamines, source control vasopressor/inotropic support
45
what are causes for metabolic shock
hypoglycemia, cyanide
46
causes of hypoglycemia
insuline OD, xylitol, addisons, sepsis, insulin secreting tumors
47
treatment of hypoglycemia
dextrose bolus with crystalloids
48
is cyanide common in vet med
no smoke inhalation, Na nitroprusside
49
cyanide pathophysiology
reversible binding of cytochrome oxidase-3 in mitochondria stops cellular respiration - stops reduction of oxygen to water
50
reasons for hypoxemic shock
anemia, CO, hypoxemia
51
tx for anemia
transfusions of packed RBC
52
tx for CO
oxygen therapy reduces oxygen carrying capacity of Hg and ability to release oxygen to tissue
53
tx for hypoxemia
oxygen, sedation
54
what is SIRS
systemic inflammatory response syndrome body wide inflammatory response to local insult secondary to infectious insult or endogenous inflammatory mediators
55
relationship between SIRS and shock
SIRS can cause shock and be caused by shock
56
signs of SIRS in dog
low or high temp tachycardia tachypnea low or high WBC increased band cells
57
signs of SIRS in cats
low or high temp low or high heart rate tachypnea low or high WBC high band cells
58
sepsis is ____ + ______
SIRS, bacteria
59
non-infectious etiologies of SIRS
heatstroke, burns, pancreatitis, trauma, snake venom, immune mediated
60
pathophysiology of SIRS
local inflam - activated AA cascade - release of pro-inflam mediators - activate target cells - system wide release of mediators - secondary negative effects
61
consequences of systemic inflammation
multiple organ dysfunction and death
62
MODS
severe acquired dysfunction of 2+ organ systems for longer than 24-48 hrs harder to fix
63
what to do before diagnostics for SIRS
stabilize
64
diagnostics for SIRS
blood gas, electrolytes, lactate, USG, AFAST, CBC, chem, coagulation
65
SIRS tx
Abx - broad spectrum - unisyn and baytril GI protectants nutrition resp support recumbency care serial monitoring
66
prognosis of SIRS
depends on severity, organs, and ability to control cause mods = worse

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