Physiology of Shock Flashcards

(47 cards)

1
Q

what is shock?

A

inadequate organ perfusion leading to inadequate oxygen delivery to tissues and eventually organ failure

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2
Q

where is the problem in shock?

A

problem with the heart, blood vessels or the flow of blood

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3
Q

name the types of shock

A
anaphylactic (distributive)
cardiogenic
septic
hypovolaemic
neurogenic
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4
Q

what is distributive shock?

A
umbrella term for:
septic
anaphylactic
neurogenic
- sufficient fluid but in the wrong place
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5
Q

what should you give to restore coagulation factors?

A

calcium

FSP

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6
Q

CO = _ x _

A

HR x SV

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7
Q

MAP = _ x _

A

CO x TPR

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8
Q

what is stroke volume?

A

volume of blood pumped from the left ventricle per heartbeat

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9
Q

what is TPR?

A

resistance offered by the systemic vascular circulation

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10
Q

state the oxygen delivery equation

A

CO x arterial oxygen content (CaO2)

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11
Q

CO is increased in what type of shock?

A

septic

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12
Q

how can oxygen delivery to tissues be improved in shock?

A

give a blood transfusion

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13
Q

describe BP and HR in anaphylactic shock

A

BP reduced profoundly

tachycardia

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14
Q

main pathological process in anaphylactic shock

A

mast cell degranulation causes release of inflammatory mediators

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15
Q

what type of shock is the only one to cause bradycardia?

A

neurogenic

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16
Q

what causes bronchoconstriction in anaphylaxis

A

leukotrienes

prostaglandins

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17
Q

Tx anaphylactic shock

A
  1. adrenaline
  2. IV fluids
  3. chloramphenamine
  4. hydrocortisone
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18
Q

why do you need to give IV fluids in anaphylaxis

A

capillaries are vasodilated and leaky so you need alot of fluid to perfuse it to where you want to go

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19
Q

describe BP and HR in cardiogenic shock

A

low BP

tachycardia

20
Q

CO is increased initially increased and then reduces in what type of shock?

21
Q

skin is swollen and oedematous in what type of shock?

22
Q

what does the skin look like in neurogenic shock?

A

vasodilated below lesion

23
Q

what does skin look like in anaphylactic shock?

A

urticarial rash

24
Q

when does BP reduce in hypovolaemia?

A

maintained by compensation then reduces in a late stage

25
Tx hypovolaemia
fluids blood replacement stop bleeding
26
Tx cardiogenic shock
careful fluid management inotropes eg dobutamine vasopressor drugs
27
Tx septic shock
sepsis 6 eg fluids | vasopressors if fluid unresponsive
28
give an example of a vasopressor
adrenaline
29
give an example of an inotrope
dobutamine
30
Tx neurogenic shock
vasopressors
31
describe the progression of the skin in septic shock
patient will be flushed and warm and then cool and pale
32
septic shock tends to be caused by gram _ve bacteria
positive
33
what is septic shock
dysregulated immune response to infection eg when BP drops below 90/30% drop in systolic
34
why is lactate measured in sepsis
it is an anaerobic metabolism product because theyre not getting enough oxygen perfusion
35
why is urine output measured in sepsis
it is a measure of organ function; if the kidney isnt perfused/oxygenated it wont produce urine
36
most common bacteria to cause sudden death in young adults
GABHS
37
cause of leaky capillaries and decreased BP in septic shock?
dysfunctional endothelial barrier as a result of bacteria adhering to it
38
main cause of cardiogenic shock
failure of the heart
39
cause of neurogenic shock?
loss of sympathetic outflow in thoracic spine leading to lack of feedback
40
why do patients with septic shock need so many fluids?
capillaries have become extremely leaky
41
skin appearance in hypovolaemic shock?
cool | pale
42
how can you improve oxygen delivery in septic shock? name 1st and 2nd line options
1. IV fluids | 2. vasopressins
43
if someone is confused and they are septic, what are they thinking of and why?
septic shock | poor perfusion to the brain
44
describe qSOFA
systolic BP <100mmHg altered mental status RR >22
45
why is heart rate low in neurogenic shock?
sympathetic outflow taken out by an injury so parasympathetics take over by slowing the heart down and vasodilating BVs
46
name the 2 shockable rhythms
VF | pulseless VT
47
name the 8 reversible causes of shock
``` 4 Hs 4 Ts hypoxia hypovolaemia hypothermia hyperkalaemia + other metabolic cardiac Tamponade tension pneumo thrombus toxins ```