L21: Shock

Question 1

What is shock

Answer 1

Clinical syndrome (collection of symptoms and signs) that arise from different pathophysiology that result in inadequate perfusion of tissue oxygenation due to an imbalance between oxygen deliver and oxygen demand

Question 2

What is tissue perfusion dependent on

Answer 2

Mean arterial pressure

Question 3

What is mean arterial pressure dependent on

Answer 3

Systemic vascular resistance

Cardiac output

Question 4

What is cardiac output dependent on

Answer 4

Stroke volume

Heart rate

Question 5

What is stroke volume dependent on

Answer 5

Pre load
Contactility
Afterload

Question 6

What are the categories of shock

Answer 6

Cardiogenic
Obstructive
Distributive
Hypovolaemic

Question 7

What is cardiogenic shock

Answer 7

Ventricular pump failure e.g mi or acute valve dysfunction, when stroke volume decreases, cardiac output decreases so mean aterial blood pressure decreases

Question 8

What is obstructive shock

Answer 8

This is impaired ventricular filling or obstruction to the outflow tract due to pe or cardiac tamponade

Question 9

What is distributive shock

Answer 9

Reduced systemic vascular restiance (vasdodilation) with normal cardiac function e,g due to sepsis

Question 10

What is hypovolaemic shock

Answer 10

Loss of circualtinf volume with normal cardiac function e.g gi bleed, burns and diarrhoea

Question 11

When the body is in shock how does the body compensate

Answer 11

1. Increase cardiac output: stimulates sns to increase heart rate and stroke volume and systemic vascular resistance:
2. Redistribution of blood to vital organs by vasoconstriction and release adh and renin to reduce urine production
3. Increased oxygen delivery to the cell: bronchodilation, increased respiration

Question 12

What is the emergency asessment for shock

Answer 12

ABCDE assessment/approach

Question 13

What is dextrose fluid made of

Answer 13

Glucose dissolved in water

Question 14

What happens when dextrose is given to someone

Answer 14

Glucose is taken up by cells and this leaves water behind so its distributed in the body water

Question 15

What is saline made of

Answer 15

Sodium and chloride dissolved in water

Question 16

What happens in the body when saline is given

Answer 16

Saline distributes to the interstitital fluid and plasma by 3:1 ratio

Question 17

Where will hartmanns most end up

Answer 17

In the extracellular space

Question 18

What are the 2 categories of flid

Answer 18

Cystalloid

Colloid

Question 19

What is cystalloid

Answer 19

Small molecules dissolved in water e.g saline, dextrose and hartmanss

Question 20

What is colloid

Answer 20

Large molculesin isotonic fluid

Question 21

How do colloid fluids act

Answer 21

Counteract the hydrostatic pressure by exerting a osmotic pressure in the blood causing the fluid to remain within the vascular system
It increases the intravascular volume

Question 22

When are cystalloid fluids used

Answer 22

Replacement of fluid e,g septic shock
To meet daily requirements
Special circumstances: traumatic brain injury, metabolic acidosis to renal failure

Question 23

What are the 4 main groups of blood

Answer 23

O
A
B
Ab

Question 24

What is a o group blood

Answer 24

Has no antigens has anti a and anti b antibodies in the plasma

Question 25

What is blood group a

Answer 25

Has a antigens and anti b antibodies in the plasma

Question 26

What is b blood group

Answer 26

Has b antigen and anti a antibodies in plasma

Question 27

What is ab blood group

Answer 27

Has a and b antigens and no antibodies in the plasma

Question 28

When we give blood where does it stay in the body

Answer 28

Intravascular space

Question 29

In fluid resusitation what do we do

Answer 29

Give fluid first to correct the physiology and give cystalloids (500mls over than 15 minutes)