Shock Flashcards
(103 cards)
1
Q
when O2 supply< O2 demand and leads to organ dysfunction
A
shock
2
Q
OER (O2 extraction)=
A
VO2/DO2
3
Q
VO2=
A
CO(CaO2-CvO2)
4
Q
DO2=
A
COxCaO2
5
Q
what happens if cardiac output (CO) decreases
A
DO2 and VO2 decrease
6
Q
total O2 content in arterial blood
A
CaO2
7
Q
CaO2=
A
(Hbx1.34xSaO2/100)+(0.003xPaO2)
8
Q
depends on pulmonary gas exchange
A
PaO2
9
Q
the supply of O2 depends on
A
CaO2
10
Q
systemic O2 demand increases in what situations
A
stress, pain, fever, exercise
11
Q
shock that has decrease in blood volume and CO
A
Hypovolemic shock
12
Q
2 types of hypovolemic shock
A
hemorrhagic and fluid loss
13
Q
2 types of hemorrhagic hypovolemic shock
A
traumatic: spleen rupture
non-traumatic: bleeding ulcer
14
Q
types of fluid loss hypovolemic shock
A
diarrhea, vomiting
burn
ascites
polyuria
15
Q
type of shock dealing w/ heart not functioning properly
A
cardiogenic shock
16
Q
main ways cardiogenic shock can happen
A
MI
myocarditis
arrythmia
aortic and mitral regurgitation
17
Q
shock due to blood not flowing (venodilation)
A
distributive shock
18
Q
most common form of shock and fatal form
A
septic shock
19
Q
3 main types of distributive shock
A
septic
anaphylactic
neurogenic
20
Q
shock due to diastolic filling not happening due to restriction
A
obstructive shock
21
Q
tension pneumothorax
cardiac tamponade
restrictive pericarditis
pulmonary embolism
aortic dissection
all lead to what shock
A
obstructive shock
22
Q
best example of obstructive shock due to fluid in pericardial sac
A
cardiac tamponade
23
Q
leads to obstructive shock due to L ventricle basically empty due to oxygenated blood unable to come back from lungs
A
pulmonary embolism
24
Q
shock due to O2 not being able to be utilized/consumed
A
Dissociative shock
25
2 main things that can lead to dissociative shock
CO poisoning
Cyanide poisoning
26
contractility (inotropy) of heart depends on what
Ca2+ sensitivity and binding to troponin C
27
sarcomere length based on diastolic filling (preload)
Starling effect
28
preload is measured by what
pulmonary artery catheter
29
end diastolic sarcomere length=
preload
30
how to measure pulmonary capillary wedge pressure
catheter goes from SVC all the way to pulmonary a. and is measured based on end diastolic sarcomere length
31
decrease in SVR (primary); CO increases (secondary)
distributive shock
32
decrease in CO (primary); SVR increases (secondary)
cardiogenic shock
obstructive shock
hypovolemic shock
33
difference b/t cardiogenic LV and cardiogenic RV shock
cardiogenic LV has increased PCWP (wedge pressure)
cardiogenic RV has decreased PCWP (wedge pressure)
34
ultimately what happens to compensate in shock
baroreceptor reflex and chemosensors respond (sympathetic activation)
35
one of the earliest and very important signs of shock (most sensitive indicator of shock)
tachycardia
36
what happens to HbO2 curve to compensate for shock
shifts to the R (O2 unloading)
37
when DO2 decreases in shock, what compensates
increase in OER (O2 extraction)
38
what happens if increasing OER doesn't meet systemic O2 demands
switch metabolism to anaerobic (lactic acidosis)
39
critical lab to order and diagnose shock
lactate
40
stage of shock that is reversible; tissue hypoperfusion
compensated
41
stage of shock where there is vital organ failure
progressive
42
stage of shock that is irreversible and has multisystem organ failure
decompensated
43
could be the only sign to diagnose shock
compensatory tachycardia (>100 BPM)
44
MAP when diagnosing shock
<65 mmHg
45
levels of lactic acidosis that would diagnose shock
>2 mmol/L
46
2 main organ dysfunctions due to hypoperfusion
brain (anxiety/confusion) and kidneys (oliguria)
47
sign of heart failure
S3 gallop
48
shock index=
HR / SBP (systolic bp)
49
shock index of 1.5 means what
patient in shock
50
most common type of shock
distributive (vasodilatory) shock
51
main vasodilator in distributive shock
NO
52
NO binds what receptor
B2 (Gs signaling)
53
low dose effect of histamine
H1 (Gq) ---> NO release
54
high dose effect of histamine
H2 (Gs) VSMC relaxation
55
histamine release causes bronchoconstriction how
H1 (Gq) BSMC contraction
56
Rhoa and ROCK activation can lead to what
blood leaking through cells
57
why Epi over NE for anaphylactic shock
Epi binds B2 and bronchodilates (taking care of dyspnea)
58
primary cause of septic shock
massive vasodilation due to NO production
59
caused by infection + SOFA >/= to 2 points (acute organ dysfunction)
Sepsis
60
sepsis + circulatory failure (need vasopressors) + tissue hypoxia
septic shock
61
worst case SOFA for each individual organ
4
62
maximum total SOFA score
24 (worst case)
63
main pathogens that cause septic shock
S. aureus
S. pneumo
E. coli
64
why does uncomplicated infection become sepsis
damage by pathogen
host's immune response
coagulation abnormalities
hypoxia
65
clinical features of septic shock (5 things)
warm initially
acute lung inflammation
heart failure
acute kidney injury
CNS
66
quick test to see whether patient will respond to fluids (fluid responsiveness in shock)
passive leg raise
67
broad spectrum Ab therapy
VANCOMYCIN (IV)
68
2 main things to monitor with shock
lactate and MAP
68
example of distributive shock that deals with spinal cord trauma due to someone falling from a height; disruption of sympathetic outflow
neurogenic shock
69
triad of bradycardia, hypotension, and peripheral vasodilation
neurogenic shock
70
HR 50/min; BP 80/40 mmHg after patient fell from height
neurogenic shock
71
2 main things to do to help w/ cardiogenic shock
1. increase BP
2. ventilation
72
in RV failure, LV CO low and PCWP low means what for the lungs
clear lungs b/c no pulmonary congestion
73
what would make RV failure cardiogenic shock worse
VASODILATORS
74
B1 and B2 agonist and a1 agonist
dobutamine
75
"renal dose" does not improve renal function; used in bradycardia and hypotension
dopamine
76
used in septic shock
vasopressin
77
vasodilatory shock; best for supraventricular tachycardia
phenylephrine
78
1st line vasopressor for septic shock
NE
79
used for anaphylactic shock
Epi
80
used for cardiogenic shock and septic shock
dobutamine
81
used in cardiogenic shock and CHF
milrinone
82
blood loss of 750-1500 mL
tachycardia
class II hemorrhagic shock
83
sweating
pale and cold
thirsty
hypovolemic shock
84
3 things to do to Rx hemorrhagic shock
control source
give fluids
take to OR
85
used to check for free fluid in abdomen
FAST exam
86
used to replenish volume in hemorrhagic shock
crystalloids
87
no parasympathetic input to VSMC; but how does Ach cause vasodilation
88
sodium nitroprusside (used for HTN emergency) produces what 2 things
NO and cyanide
89
has high affinity for complex IV (holds O2)
cyanide
90
what can happen from administering sodium nitroprusside that causes O2 not to be able to bind complex IV (leading to dissociative shock)
cyanide poisoning
91
drug that blocks cyanide from binding complex IV
hydroxocobalamin
92
patient will have cherry red hue to them from what
cyanide bound to complex IV
93
what has higher affinity for complex IV than cyanide; and how to treat effect of it
MetHb; methylene blue to treat Methemoglobinemia
94
how to stop CN- from binding complex IV; and allows O2 to bind
sodium nitrite (will produce CN-Hb(Fe3+)
95
hepatic enzyme that will take off CN- from MetHb and convert to sodium thiosulfate
Rhodanase
96
kit to give patient in emergency room with cyanide poisoning
cyanide kit
97
4 main things you can treat cyanide poisoning with after administering fluids
cyanide kit
hydroxocobalamin
sodium nitrite
sodium thiosulfate (has sulfur)
98
in neurogenic shock, what drug to administer to increase HR (due to bradycardia)
M-antagonist (ATROPINE)
99
sympathomimetic agent used in anaphylactic shock
Epi
100
B1 agonist(Gs---cAMP) that is used in cardiogenic shock
Dobutamine
101
how would propranolol affect SVR and CO when patient is in rebound HTN
blocking B2 (SVR increases)
blocking B1 (CO decreases)
102
what will reverse effects of sodium nitroprusside overdose (cyanide poisoning)
sulfur
