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Flashcards in L35 Deck (18):
1

What is shock?

Decreased tissue perfusion
Aerobic -> anaerobic metabolism
Lactic acidosis

2

4 types of shock

Cardiogenic
Extra cardiac
Hypovolemic
Septic shock

3

2 requirements for clinical dx of shock

BP

4

What is cardiogenic shock

Shock post-MI

5

Patho for what MI causing shock that looks like:
- HIGH LV EDP
- Low CO

Large MI
- Stunned vs hibernation
Stunned - ischemic but now has O2 back
Hibernation - no return of O2 flow

6

Which drugs don't you use for cardiogenic shock

Anything to decrease contractility or rate:
- BB
- Ca CB
- Class 1A

7

Treat cardiogenic shock

1. Short term inotopes + pressors - maintain downstream organ perfusion
- Dopamine
- NE
- Dobutamine/milrinone
2. ASA or heparin for anti-thrombosis
3. Mechanical
- Intra aortic balloon pump
- LVAD or ECMO

8

What does the intra aortic balloon pump do in systole vs diastole

Systole = balloon collapses
Diastole = inflate, push low pressures in shock to make sure coronary arteries profusing

9

What type of MI causes shock that looks like:
- Normal or high LV EDP
- High RV edp
- Low CO

Inferior MI due to RV infarct

10

How do you treat RV infart

1. + Fluids
You know this!
Can't add fluid to any other RHF
2. Less afterload
3. Inotropes

11

EKG for RV infarct

ADD R sided leads!

12

What drug do you avoid in pts with RV failure

Nitroprusside
Don't want to drop compensatory BF here

13

What cardiac pathology causes shock w/
- High LVEDP
- Low CO
- Systolic murmur

Structural abnormalities:
Mitral regurg
VSD

14

Diagnose LSV (vs MR)

SG cath
O2 sat between RA and RV no the same - higher in RV

15

Why does tamponade lead to low CO

Decreased filling
= obstructive // extracardiac shock

16

Why does cardiogenic shock lead to low CO

Post- MI - myocardial injury or necrosis
Impaired systolic fxn

17

What type of shock presents with LOW everything - LVEDP, RVEDP, CO

Hypovolemia - volume depletion or hemorrhage

18

Which subset of cardiogenic shock had the worst prognosis?

Large MI