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Hemodynamics V Flashcards

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1
Q

What are the causes of shock?

A 
Hemorrhage
Trauma
Burns
MI
PE
Sepsis
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2
Q

What is the definition of shock?

A

Clinical manifestation of the inability of the circulatory system to adequately supply tissues with nutrients and remove toxic wastes

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3
Q

What are the sequela of shock?

A

Hypotension
Impaired tissue perfusion
Cellular hypoxia

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4
Q

What are the four types of cardiogenic shock?

A

Infarction
Arrhythmia
Tamponade
PE

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5
Q

What are the five type of shock?

A 
Cardiogenic
Neurogenic
Anaphylactic
Septic
Hypovolemic
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6
Q

What is neurogenic shock?

A

Neurogenic dysfunction causes loss of vascular tone and peripheral pooling of blood

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7
Q

What is anaphylactic shock mediated by?

A

IgE mediated hypersensitivity response

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8
Q

What are the etiological classifications of shock?

A 
Septic
Spinal
Hypovolemic
Hemorrhage
Obstructive
Cardiogenic
Cellular toxins
Anaphylactic
Endocrine/adrenal crisis

(SSHHOCCKE)

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9
Q

What are the causes of vasodilation seen in shock?

A

Anaphylaxis
Neurogenic impulses
Sepsis

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10
Q

What happens to muscles during shock? What is the major systemic effect?

A

Produce lactic acid, producing metabolic acidosis

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11
Q

What happens to the kidneys in shock?

A

Decreased blood flow = oliguria

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12
Q

What happens to the lungs in severe shock?

A

ARDS

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13
Q

What are the two major cytokines in shock?

A

TNFalpha

IL-1

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14
Q

What is the final common pathway in shock?

A

Cellular injury

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15
Q

What are the five unifying features of shock?

A 
Intracellular Ca overload
Intracellular H ion
Cellular interstitial edema
Catabolic metabolism
Inflammation
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16
Q

What are the 6 Rosen’s Empiric criteria of shock? How many are needed to diagnose shock?

A 
Toxic appearance
Tachycardia
Tachypnea
Acidemia
Anuria
Hypotension

4/6

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17
Q

How long does someone have to be hypotensive for, to be actually considered hypotensive?

A

> 20 minutes

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18
Q

What are the three stages of shock?

A

Non Progressive stage
Progressive stage
Irreversible stage

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19
Q

What happens in the non-progressive stage of shock?

A

Maintain pressure and CO

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20
Q

How does the body attempt to maintain bp and CO in the nonprogressive stage? (3)

A

Tachycardia
Peripheral vasoconstriction
Renal conservation of fluid

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21
Q

What are the five main things that happen in the “progressive stage” of shock?

A 
Widespread hypoxia
Lactic acidosis
Arteriolar dilation
Confusion
Anuria
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22
Q

What causes the widespread cellular injury seen in the irreversible stage of cell injury?

A

Lysosomal enzyme leakage
Decrease myocardial contraction
Renal failure

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23
Q

What happens in the brain during shock?

A

Ischemic encephalopathy

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24
Q

What happens in the heart during shock?

A

Coagulative necrosis

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25
What happens in the kidneys during shock?
Acute tubular necrosis
26
What happens in the lungs during shock?
Diffuse alveolar damage
27
What happens in the adrenal glands during shock?
Cortical cell lipid depletion
28
What happens in the GI tract during shock?
Hemorrhages and necrosis
29
What happens in the liver during shock?
Fatty change, hemorrhagic necrosis
30
What happens to the blood vessel sympathetic tone in cardiogenic shock? What two bad outcomes does this lead to?
Increases (vasoconstriction), leading to edema, and renal ischemia
31
What causes the sympathetic tone in cardiogenic shock?
Decreased myocardial contractility
32
What happens pathologically in cardiogenic shock?
40% loss of myocardium
33
What is the cardiac index, and what happens during cardiogenic shock?
CO/surface area Falls below 2.2
34
What happens to the arteries and vein volume in cardiogenic shock?
Arteries volume decreased | Veins increased
35
What happens to the arteries and vein volume in hypovolemic shock?
both decreased
36
What happens to the arteries and vein volume in obstructive shock?
**Severe** decreased in arteries and increase in veins
37
What are the management steps of cardiogenic shock? (3)
Stabilize ABCs Identify etiology IVFs
38
What percent of volume loss is characteristic of each class (I-IV) of hemorrhagic shock?
I = 40 %
39
At what class of hemorrhagic shock is BP decreased?
Class III
40
At what class of hemorrhagic shock is PP decreased?
Class II
41
Why are colloids given in shock?
Less fluid required | Draw fluids from tissues
42
What are the disadvantages of colloids?
Allergic rxn | Coagulopathies
43
Which type of bacteria has LPS?
Gram negative
44
What are the three major cytokines that are released in response to gram negative bacteria?
IL-1 TNFa IFNgamma
45
What are the three effects of cytokine production in shock?
Coag Leukotrienes Complement activation
46
What are the three major effects of inflammatory cytokines in low quantities?
C5a, C3a increased Endothelial cell activation Leukocyte activation
47
What are the three systemic effects of inflammatory cytokines in moderate quantities?
Leukocytosis Acute phase proteins Fever
48
What are the three systemic effects of inflammatory cytokines in high quantities?
DIC ARDS Low CO
49
What are bands?
Immature white cells that have gotten out into the circulation
50
SIRS + documented infx =?
Sepsis
51
Sepsis + MODS = ?
Severe sepsis
52
Sepsis + hypotension refractory to volume resuscitation = ?
Septic shock
53
What are the three chemicals that are used to treat the coagulation cascade in the shock?
Protein C Protein S Antithrombin III
54
What are the two vasoactive mediators given in septic shock?
Vasopressin | NO
55
What are the inflammatory mediators given in septic shock?
Tissue factor pathway inhibitor | IVIG
56
What is spinal shock?
Initial loss of spinal cord function following spinal cord injury
57
Above what spinal level is neurogenic shock seen?
T6
58
What causes the bradycardia in neurogenic shock?
Unopposed parasympathetic stimulation
59
What causes the hypotension seen in neurogenic shock?
Loss of sympathetic tone
60
What type of T cells are activated in anaphylactic shock? What does this cause?
Th2 cells--promotes B cell class switching to IgE
61
What is the main goal of treating shock?
Prevent organ failure
62
What happens to intracellular Ca levels in shock?
Increases
63
What happens to intracellular hydrogen ion in shock?
Increases
64
What happens to cellular and interstitial fluid in shock?
Increases (edema)
65
What happens to cellular metabolism during shock?
Shift to catabolic metabolism
66
What is a base deficit?
Amount of base required to neutralize the pH (normal is > -2)
67
True or false: hypotension is absolutely necessary to diagnose shock
False--early stages are without hypotension
68
What type of hypersensitivity is anaphylactic shock?
Type I
69
What is the HR for Class I-IV of hemorrhagic shock?
I = 140
70
When does the Pulse pressure decrease in hemorrhagic shock: Class I, II, III, or IV
After I/ at II
71
When does the BP drop in hemorrhagic shock: (class I, II, III, or IV)?
After class II/at class III
72
When does the LOC change from anxious to confused to lethargic in hemorrhagic shock? (Class I, II, III, IV)
Class III = confused | Class IV = lethargic
73
ACtivation of TNFalpha and IL-1 leads to what three inflammatory responses?
1. Coag activation 2. Prostaglandin/leukotriene release 3. Complement activation
74
What is the MOA of Ranitidine?
Blocks release of histamine from mast cells

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