Shock

Question 1

Define shock

Answer 1

State of organ hypoperfusion causing cellular damage and death due to lack of oxygen

Question 2

True or false

Shock is a pathological state

Answer 2

True

Question 3

True or false

Shock isn’t always an emergency

Answer 3

False

It is ALWAYS an emergency

Question 4

What is the difference between emotional and pathological shock

Answer 4

Pathological shock is a physiological state of being

Emotional shock occurs after a distressing event

Question 5

What are some basic causes of shock

Answer 5

Trauma
Dehydration
Blood loss
Lack of oxygen

Question 6

What are the 3 major categories of the causes of shock

Answer 6

Hypovolemic shock

Cardiogenic shock

Distributive/vasogenic shock

Question 7

What is hypovolemic shock

Answer 7

Most common

Occurs when there is a loss in blood/fluid volume which results in inadequate circulatory volume and hypotension which causes decreased perfusion

Or due to plasma volumes being lost through burns, dehydration, vomitting, diarrhea, or effusions

Question 8

Define perfusion

Answer 8

The passing of fluid through vessels to a tissue or organ

Question 9

Define effusion

Answer 9

The escape of fluid into a body cavity

Question 10

What is hemorrhagic shock

Answer 10

Type of hypovolemic shock caused hy acute blood loss (trauma, surgery, bleeding disorders, DIC)

Question 11

What is cardiogenic shock

Answer 11

When the heart is unable to pump there is a decreased cardiac output which causes hypotension and decreased perfusion

Question 12

When does cardiogenic shock occur

Answer 12

With end stage congestive heart failure, arrythmias, myocardial infarcation, ventrical abnormalities, pericardial effusion, trauma

Question 13

What is myocardial infarcation

Answer 13

Obstruction of the blood supply to the heart

Question 14

What is vasogenic shock or distributive shock

Answer 14

Something causes the blood vessels to dilate which causes blood to pool in capillaries and decreases blood flow ti other organs or tissues

Question 15

What are 4 of the many causes of vasogenic shock (and therefore vasodilation)

Answer 15

Anaphylactic shock

Endotoxic shock

Neurogenic shock

Septic shock

Question 16

What is anaphylactic shock

Answer 16

A type of vasogenic shock caused by a secere allergic reaction that affects multiple organ systems

If enough histamine is released during reaction and enter circulation, it causes wide spread dilation of the capillaries

Question 17

True or false

Vasodilation is always part of inflammation

Answer 17

True

Question 18

How fast does anaphylactic shock occur

Answer 18

Minutes to hours

Question 19

What is endotoxic shock

Answer 19

A type of vasogenic shock, it is systemic vasodilation that occurs due ti an underlying gram negative infection, the bacteria release large amounts of endotoxin (lipid A of lipopolysaccharides) which enters circulation and creates widespread inflammation/vasodilation

Question 20

What is neurogenic shock

Answer 20

A type of vasogenic shock, occurs with trauma to the brain or soinal cord that disrupts the autonomic NS

Question 21

What happens in neurogenic shock due to lack of sympathetic innervation

Answer 21

Causes a lack of vascular resistance (vasoconstriction) in the capillaries (especially in the GIT and skin)

Can causes slowing down of the heart (cardiogenic component)

Question 22

What is septic shock

Answer 22

A type of vasogenic shock, caused by wide spread inflammation due to an underlying systemic bacterial infection (most common), fungus or virus. causing widespread inflammation

Question 23

When is septic shock seen

Answer 23

Perforated GI foreign bodies

Neonatal foal spesis

And severe infections

Question 24

What are some other causes of vasogenic/distributive shock not related to inflammation

Answer 24

Hyperthermia

Overdose with inhalant anesthetic

Question 25

In human medicine, what is obstructive shock

Answer 25

Shock due to an obstruction of blood flow

Question 26

True or false | You can be classified as having mutiple different types of shock at once

Answer 26

True

Question 27

Give an example of the type of shock a hit by car patient would have

Answer 27

Hypovolemic (bleeding) Distributive (damage to brain spinal cord)

Question 28

Once shock has set in, what are the two levels of shock that occur

Answer 28

Compensatory shock Non compensatory shock

Question 29

What is compensatory shock

Answer 29

This is the Early stage of shock, in this stage is when the systems not affected/causing the shock will increase fucntion to try and offset the failing parts

Question 30

If there is blood volume loss how does the body compensate

Answer 30

Increasing heart rate and constricting vessels

Question 31

If the heart fails, how does the body compensate

Answer 31

Blood vessels constrict and the body will retain water

Question 32

If the blood vessels dialte, how does the body compensate

Answer 32

The heart will be faster and try to retain water

Question 33

Increased heart rate and vasoconstriction is driven by the

Answer 33

Sympathetic nervous system

Question 34

Water retention and vasoconstriction are also driven by

Answer 34

The hormonal system based in the kidneys

Question 35

In early stages of shock, there may be a normal or mildly affected blood pressure, normal CRT, pink to pale pink MM, normal temp, with an increased ____

Answer 35

Heart rate and respiratory rate

Question 36

How long is the compensatory stage of shock

Answer 36

Very short

Question 37

If the underlying cause of shock is not treated during the early stages of shock what happens

Answer 37

Patient will go into non compensatory shock

Question 38

What is non compensatory shock

Answer 38

When the body cannot keep up or compensate enough to the causes of shock, at this point blood pressure will start/continue to drop Blood flow shifts to vital organs and away from others causing ischemic damage which causes lactic acid production and acidosis, then myocardial disfunction and death

Question 39

What are the initial signs of non compensatory shock

Answer 39

Drop in blood pressure Increased HR and RR CRT >2 Light pink to pale MM

Question 40

What are the clinical signs of non-compensatory shock after it has advanced

Answer 40

``` Drop in blood pressure Decreased HR and RR temp drops (can feel in extremities and mouth) Weak pulse Coma/stupor Pale MM (cyanotic or muddy) Long CRT ```

Question 41

Once acidosis develops in non compensatory shock due to decreased heart function, what occurs

Answer 41

Decreased blood flow and hypothermia this then leads to issues with clotting There is rapid death at this point

Question 42

Why is compensatory shock difficult to diagnose

Answer 42

It has a normal BP with an increasing HR and RR (must determine whether its shock based on history) Temp is normal (may be high with inflammation) CRT is normalish

Question 43

What are the steps in treating shock

Answer 43

Place IV catheter and starte shock fluid rate Stop bleeding Give oxygen Restore acid-base imbalances/correct electrolytes Support organ function Treat underlying problem

Question 44

What are the shock fluid rates

Answer 44

90ml/kg for dogs 50ml/kg for cats 80ml/kg for large animal

Question 45

What are the steps in giving shock fluid rates

Answer 45

Give the first 25% of the volume ASAP assess vitals If vitals are still low Give another 25% If they are still low again, add a colloid Go to regular fluid plan once they are stable

Question 46

How long does it take for each fluid portion to stabilize the patient

Answer 46

Approx 20 minutes

Question 47

What is the therapeutic objective in shock

Answer 47

To return blood pressure to normal to restore tissue perfusion

Question 48

How do you support organ function in shock

Answer 48

Intestinal protectants Heart medication Vasoconstrictors

Question 49

How may you treat underlying causes of shock

Answer 49

``` Antibiotics Surgery Anti-inflammatories Transfusions Anti-arrhythmia drugs Antihistamines ```