Hemodynamics Part II: shock Flashcards Preview

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Flashcards in Hemodynamics Part II: shock Deck (31):
1

define shock

transition between illness and death

2

shock aka

cardiovascular collapse

3

clinical manifestations of the inability of the circulatory system to adequately supply tissues with nutrients and remove toxic waste

shock

4

inadequate blood flwo secondary to decreased CO or mal-distributed output that results in irreversible tissue damage

shock

5

sequela of shock

hypotension --> impaired tissue perfusion --> cellular hypoxia

6

three major classifications of shock

cardiogenic
hypovolemic
septic

7

neurogenic shock

neurogenic dysfunction causes loss of vascular tone and peripheral pooling of blood (severing above T6)

8

anaphlactic shock

genrealized IgE mediated hypersensitivity response associated with vasodilation and increased vascular permeability

9

etiological classificiation

SSHHOCCKE

septic
spinal (neurogenic)
hypovolemic
hemorrhagic
obstructive
cardiogenic
cellular toxins
anaphylactic
endocrine/adrenal crisis

10

common final pathway of shock

cellular injury

11

five unifying features of shock

intracelllular calcium overload

intracellular hydrogen ion

cellular and interstitial edema

catabolic metabolism

inflammation

12

rosen's empiric criteria for the diagnosis of shock (need 4 out of 6)

1. ill appearance of decreased LOC

2. HR > 100

3. RR> 22 or PCO2 < 32

4. Base deficit < -5 or lactate > 4

5. urine ouput < 0.5 ml/kg/hr

6. hypotension > 20 min duration

13

can you be in shock without being hypotensive?

yes

14

what is the base deficit?

amount of base required to neutralize the pH (normal is > -2)

15

three stages of shock

nonprogressive stage

progressive stage

irreversible stage

16

reflex compensation

mechanisms maintain tissue perfusion

nonprogressive stage of shock

17

worsening circulatory/ metbolic imbalance

acidosis

progressive stage of shock

18

at what shock stage to arterioles dilate --> poolin gin microcirculation

microcirculation

19

define cardiogenic shock

decreased CO adn evidence of tissue hypoxia in presence of adequate intravascular volume

20

criteria for cardiogenic shock (4)

hypotension < 90 for 30 min
30 mmHg below baseline
cardiac index < 2.2. L/mi/m2
PCWP pulmonary capillary wedge pressure >15 mmHg

or 4/6 rosens

21

1500-2000 volume blood loss and patient is confused- what class of hemorrhagic shock ?

class III

22

what is the advantage of giving a colloid in hemorrhagic shock?

less fluid required

more volume in vascular space

potential to draw fluid in from tissues

23

what clinical characteristics define SIRS systemic inflammatory response syndrome

1. Temp > 38 or < 36
2. HR > 90
3. RR >20 or PaCO2 12 or 10% bands

24

sepsis =

SIRS + documented infection

25

sever sepsis =

sepsis + multi-organ dysfunction

26

septic shock =

sepsis + hypotension refractory to volume resuscitation

27

neurogenic shock

loss of symphatetic autonomic function due to spinal cord injury

28

pathophysiology of neurogenic shock

hypotension (due to loss of sympathetic tone thus vasodilation and decreased SVR) and bradycardia (due to unopposed parasympathetic (vagal) tone to the heart)

29

lesion at or above T6

hypotension beacuse lower lesions leave enough of the body with intact sympathetics so that blood pressure doesnt drop

30

lesions at or above T4

bradycardia beacuse sympathetic innervation to heart is at T4

31

what type of hypersensitivity reactor is anaphylactic shock?

type 1 hypersensitivity rxn

IgE mast cells