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Flashcards in Hemorrhage Deck (49):
1

What is shock?

Oxygen delivery to body is compromised

2

What happens with shock?

Body will compensate as long as possible

3

What is seen in as a compensatory reaction to shock?

tachycardia + tachypnea + peripheral vasoconstriction

4

Reason in Shock: Tachycardia

Increase oxygen delivery

5

Reason in Shock: Tachypnea

Increase oxygenation

6

Reason in Shock: Peripheral vasoconstriction

Maintain perfusion to vital organs

7

What is a major consequence of perfusion and hypoxia?

Mental depression

8

What are the four types of shock?

Hypovolemia
Cardiogenic
Distributive
Hypoxic

9

What is hypovolemic shock?

Inadequate circulating volume

10

What can cause hypovolemic shock?

Hemorrhage
-- and --
Loss of fluids

11

What occurs pathophysiologically with hypovolemic shock?

Reduced venous return = decreased preload
= less CO
= less oxygen to tissues

12

What are the classes of hemorrhagic shock?

I to IV

13

In what class of hemorrhagic shock do you see change in BP?

III

14

Blood loss amount: Class I

up to 15%

15

Blood loss amount: Class II

15 to 30%

16

Blood loss amount: Class III

30 to 40 %

17

Blood loss amount: Class IV

>40%

18

What is cardiogenic shock?

Primary problem in the heart

19

What are the two types of cardiogenic shock?

Diastolic
-- and --
Systolic

20

What is diastolic failure?

Heart has problems filling

21

What is systolic failure?

Heart has problems pumping

22

What is distributive shock?

problems regulating vascular tone

23

What are the common causes of distributive shock?

Sepsis + SIRS

24

What are the least common causes of distributive shock?

Anaphylactic reaction
Anesthesia
CNS damage

25

What is the result of distributive shock?

Not enough BV to fill vascular space
Relative hypovolemia results

26

What is hypoxic shock?

Adequate tissue perfusion but blood not carrying enough oxygen

27

What are common causes of hypoxic shock?

Anemia
Hypoxemia
Toxins
Carbon monoxide poisonig

28

What two structures in the body sense shock?

Baroreceptors
-- and --
Low pressure stretch receptors

29

Location: Baroreceptors?

Carotid sinus
-- and --
Aortic arch

30

Location: Low pressure stretch receptors

Atria
-- and --
Pulmonary arteries

31

What happens once the SNS system is activated?

Increase in HR = Increase CO
Constrict arterioles = blood to vital organs
Constrict large veins = effective vascular volume

32

What does the SNS activation do chemically?

Activates the neuroendocrince response
Release angiotensin + vasopressin

33

What are that three levels of hypovolemic shock?

compensatory
early compensatory
compensatory

34

When do you start seeing hypovolemic induced tachycardia?

early compensatory

35

What is a very reliable indicator that early compensatory response is occurring?

Tachycardia

36

At what heart rate do you stop worrying about shock and more about a heart problem?

HR greater than 240

37

Shock organ: Dog

Gut

38

Shock organ: Cat

Lungs

39

What is the normal lactate level in a dog or cat?

40

What is considered hyperlactatemia?

6.0 mmol/L

41

What two blood alterations are seen in hypovolemic shock?

Increased lactate
-- and --
Metabolic acidosis

42

What is the most common cause of hyperlactatemia?

Inadequate oxygen (type A)

43

What organs metabolize lactate?

Liver + Kidneys

44

What is the initial goal of treatment in shock?

Stabilize airway + breathing + circulation + neurologic derangements

45

What are the three components of therapy?

optimize oxygen delivery
aggressive support of organ function
ID and treatment of underlying disease

46

What are the components to treatment of shock?

Oxygen
Fluids

47

What amount of oxygen is give in shock?

100 ml/kg/min = FiO2 of 40 to 60%

48

What is a shock bolus?

dose of fluids/blood products given
normally give 1/4 to 1/3 and reassess patient

49

When should NSAIDS be avoided in shock patients?

Hypoperfusion--- will arm kidney