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anaesthesiology > Shock > Flashcards

Shock Flashcards

1
Q

Define Shock

A

A syndrome of inadequate tissue perfusion

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2
Q

What is the pathogenesis of shock

A

Decreased perfusion leads to decreased O2 delivery

Tissue O2 requirements exceeds O2 delivery

Cellular hypoxia leads to cell dysfunction

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3
Q

What are the two main determinants of tissue perfusion?

A

Cardiac Output
Peripheral Vascular Resistance

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4
Q

What is the formula for Cardiac Output

A

Stroke volume x Heart Rate

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5
Q

What are the three factors that affect cardiac output

A

Preload
Contractility
Afterload

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6
Q

What are the two factors that affect Peripheral Vascular Resistance

A

Blood vessel diameter
Blood viscosity

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7
Q

What are the 4 main types of shock

A
  • Hypovolemic
  • Cardiogenic
  • Obstructive
  • Distributive
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8
Q

What is the etiology of a hypovolemic shock

A

Excess Fluid Loss

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9
Q

What can cause a hypovolemic shock

A

Hypovolemic shock can be classified as Hemorrhagic or non-hemorrhagic

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10
Q

List some causes of hemorrhagic Hypovolemic shock

A

Hemorrhagic:
- Post partum hemorrhage
- upper GI bleed
- penetrating trauma
- A/V fistula
-

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11
Q

List some causes of non-hemorrhagic Hypovolemic shock

A

GI loss
Increased insensible fluid loss (burn)
Renal fluid loss (adrenal insufficiency, drug induced diuresis)
Third space fluid loss (SBO/LBO, pancreatitis)

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12
Q

What is the pathophysiology of Hypovolemic Shock?

A

< intravascular volume = <preload + SV= < Cardiac Output= compensatory inc. in vascular resistance and heart rate

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13
Q

What is the pathophysiology of cardiogenic shock?

A

An underlying pathology causes dysfunction of the heart =
< contractility/ <stroke volume leading to < cardiac output

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14
Q

List 9 causes of cardiogenic shock

A
  • MI
  • Arrythmias
  • HF
  • Cardiomyopathy
  • Myocarditis
  • VSD
  • Valve Defect (aortic/mitral regurgitation)
  • blunt cardiac trauma
  • drugs (Beta blockers, CCBs)
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15
Q

What is the pathophysiology of obstructive shock

A

Obstruction of the heart and its Great Vessels> inability of the heart to circulate blood > dec. Cardiac Output > compensatory inc. in Systemic vascular resistance >

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16
Q

What are 3 main causes of obstructive shock?

A

Dec. diastolic filling
Dec. venous return
Inc. Ventricular afterload

17
Q

List 3 pathologies that can lead to decreased diastolic filling and then obstructive shock

A

Cardiac Tamponade
Constrictive Pericarditis
Restrictive Cardiomyopathy

18
Q

List 3 pathologies that can lead to decreased venous return and then obstructive shock

A

Tension pneumothorax
Intrathoracic tumour

19
Q

List 3 pathologies that can lead to increased ventricular afterload and then obstructive shock

A

Massive PE
Aortic Dissection
Aortic Stenosis
Severe pulmonary hypertension

20
Q

List 4 types of Distributive Shock

A
  • Septic Shock
  • Anaphylactic Shock
  • Neurogenic Shock
  • Acute Adrenal insufficiency
21
Q

What is the classical presentation in neurogenic shock

A
  • hypotension
  • bradycardia
  • vasodilation
22
Q

What is the main pathophysiology underlying Distributive Shock

A

Vasodilation (relative hypovolemic state)

23
Q

Define Neurogenic Shock

A

This is a type of shock that is caused by sudden loss of signals from the sympathetic system caused by upper spinal cord damage
(Leading to systemic vasodilation)

24
Q

What drug can be administered to correct bradycardia

A

Atropine

25
Q

List 3 vasopressors

A

Norepinephrine
Epinephrine
Phenylepinephrine

26
Q

What are the two specific mechanisms associated with septic shock

A

Dysregulated host response to infection leading to capillary leakage and systemic vasodilation leading to organ dysfunction

Circulating inflammatory cytokines lead to myocardial depression

27
Q

Describe the pathophysiology of anaphylactic shock

A

Immunologic anaphylaxis leads to degranulation of mast cells > massive histamine release> systemic vasodilation and increased capillary leakage

28
Q

What are the two important parts of the history in diagnosing shock

A
  • Initial/ Focus hx
  • hx of end organ function
29
Q

List 6 signs/ symptoms of shock

A
  • tachycardia
  • tachypnoea
  • hypotension
  • altered mental status
  • decrease urine output
  • low output: cold clammy
  • high output: warm dry
30
Q

What determines the investigations done in shock patients

A

Determined by the possible cause

31
Q

What investigations should be done in the event of septic shock

A

Vitals
CBC, UnEs
Blood Culture sensitivity

32
Q

What investigations should be done in the event of cardiogenic shock

A

Vitals
CBC
UnEs
Cardiac Enzymes
ECG
Echo
CXR

33
Q

What general investigations should be done in the event of shock

A

Vital Signs
CBC + UnEs
Urine Output
GCS
CVP/PCWP
Evaluation of tissue oxygenation

34
Q

How do you evaluate tissue oxygenation

A

Arterial Blood Gas

35
Q

Which drugs are useful in distributive shock

A

Vasopressors (to stimulate vasoconstriction)

Noradrenaline, Vasopressin

anaesthesiology (10 decks)

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