Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Acute Care I > Shock > Flashcards

Shock Flashcards

(97 cards)

Start Studying
1
Q

Regardless of “type” of shock, there is an inability to obtain or utilize what?

A

O2 in sufficient quantities to meet metabolic requirements; from compromised CO &/or BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Shock causes what demand and supply imbalance?

A

demand > supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Shock is most often from changes in O2 delivery; as delivery decreases, extraction increases as compensatory mechanism.
What is a normal extraction ratio?
What is the maximal extraction ratio?

A

20%
60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

As O2 delivery decreases, extraction eventually decreases (point of critical O2 delivery) leading to what?

A

Dysoxia (o2 debt), anaerobic metabolism/lactic acidosis leading to
cellular dysfunction leading to
Organ dysfunction leading to
death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is cytopathic hypoxia?

A

adequate O2 delivery but inability to use O2 d/t mitochondrial dysfunction (sepsis) which is mediated by inflammatory cytokines and NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

O2 delivery equation
DO2 =?
Example question
Hb = 12.3
SaO2 = 98%
CO = 3.5

A

[1.39 x Hb x SaO2] x CO x 10

586.4 ml O2/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

CNS complications of shock?

A

Encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cardiac Complications of shock?

A

Tachycardia
Decreased coronary artery perfusion, possible ischemia
Myocardial depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Respiratory Complications of shock?

A

Increased MV resulting in hypocapnia & respiratory alkalosis
Increased ventilation/perfusion mismatch
Respiratory failure d/t increased workload, muscle impairment
ARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Renal Complications of shock?

A

ARF secondary to ATN from hypoperfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

GI Complications of shock?

A

Ileus
Erosive gastritis
Pancreatitis
Acalculous cholecystitis
Submucosal hemorrhage
Bacterial translocation d/t ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Liver Complications of shock?

A

“shock liver” is atypical in absence of hepatocellular dz or very severe injury
Mild elevations of LFTs, bili, alk phos more common
Impaired synthetic fxn - decreased albumin, coag factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hematologic Complications of shock?

A

DIC
Dilutional thrombocytopenia following resuscitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Metabolic Complications of shock?

A

Hyperglycemia d/t increased ACTH, glucocorticoids, glucagon
Decreased insulin release results in glycogenolysis, gluconeogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Immunologic Complications of shock?

A

Immune dysfunction d/t mucosal injury
Decreased T& B lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Compensatory Mechanisms of Shock
Maintenance of MAP

A

Fluid redistribution to vascular space
Decreased Renal losses
Increased sympathetic activity
Increased adrenal epi
Increased angiotensin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Compensatory Mechanisms of Shock
Maintenance of MAP
Where does Fluid redistribution to vascular space come from?

A

From interstitium
from intracellular space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Compensatory Mechanisms of Shock
Maintenance of MAP
Decreased Renal losses occurs because of?

A

decreased GFR
Increased aldosterone from adrenals
increased vasopressin from pituitary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Compensatory Mechanisms of Shock
Cardiac performance

A

increased contractility d/t
sympathetic stimulation
adrenal stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Compensatory Mechanisms of Shock
Perfusion distribution

A

Extrinsic regulation of arterial tone systemically
Autoregulation of vital organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Compensatory Mechanisms of Shock
O2 unloading

A

Increased RBC 2,3-diphophoglycerate
decreased tissue PO2
tissue acidosis
pyrexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

2,3-diphosphoglycerate has what effect on Hemoglobin-O2 dissociation curve?

A

Shifts it to the R increasing O2 offloading at the level of tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Classifications of Shock
Hypodynamic:

A

Low CO
Narrow pulse pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Classifications of Shock
Hypodynamic Types of shock?

A

Hypovolemia (hemorrhage)
Cardiogenic (acute MI)
Obstructive (PE, tamponade, tension PTX)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Classifications of Shock Hyperdynamic aka distributive or vasodilatory:
Low SVR Widened Pulse pressure
26
Classifications of Shock Hyperdynamic aka distributive or vasodilatory types of shock?
Sepsis Anaphylaxis Liver failure Neurogenic
27
Hypovolemic shock occurs d/t what?
Decreased ventricular preload
28
Hypovolemic shock types?
Hemorrhagic Non-hemorrhagic Venodilation
29
Hypovolemic shock Hemorrhagic occurs from?
Trauma GI Bleed RP bleed
30
Hypovolemic shock Non-hemorrhagic occurs from?
dehydration vomiting/diarrhea polyurea thermal injury anaphylaxis
31
Hypovolemic shock Venodilation occurs from?
Sepsis Anaphylaxis Toxins/drugs
32
Cardiogenic aka decreased pump function shock types are?
Myopathic Mechanical Arrhythmias
33
Cardiogenic aka decreased pump function Myopathic occurs from?
MI (LV or RV) myocardial contusion myocarditis CM Post-ischemic stunning Septic myocardial depression meds (CCB)
34
Cardiogenic aka decreased pump function Mechanical occurs from?
valvular d/os (stesnosis, regurg) Hypertrophic CM VSD
35
Cardiogenic aka decreased pump function Arrhythmias occur from?
brady/tachycardias
36
Obstructive - obstruction of flow in CV circuit types are?
impaired diastolic filling Impaired systolic contraction / increased afterload
37
Obstructive - obstruction of flow in CV circuit Impaired Diastolic Filling occurs from?
Tension PTX MV w/ PEEP, volume depletion Constrictive pericarditis Cardiac tamponade
38
Obstructive - obstruction of flow in CV circuit Impaired systolic contraction / increased afterload occurs from?
PE Acute pulm HTN Aortic dissection
39
Distributive - loss of peripheral resistance types are?
sepsis (most common cause) Toxic Shock Anaphylaxis Neurogenic Thyroid storm Toxic (nipride)
40
General Clinical Presentation of shock?
Tachycardia Tachypnea Cyanosis Oliguria Encephalopathy Mottling Hypotension (SBP < 90 mmHg) -
41
Clinical Presentation (hypovolemic shock)
Hypodynamic Orthostatic hypotension Dizziness Tachycardia A fib (elderly) Collapsed peripheral veins Decreased body temp (elderly) Cold, clammy skin Tachypnea Oliguria Peripheral cyanosis
42
Clinical Presentation (cardiogenic shock)
Hypodynamic Ashen or cyanotic Cool skin Mottled extremities Decreased MS Rapid, weak pulse JVD Crackles Palpable precordial heave S3 or S4
43
Clinical Presentation (Obstructive shock - tamponade)
Hypodynamic Dyspnea JVD Hypotension Muffled heart sounds Pulsus Paradoxus (inspiratory fall in SBP > 10 mmHg d/t decreased LV volume on inspiration) Cool, clammy skin Tachycardia
44
Clinical Presentation (Obstructive shock - tension PTX)
Hypodynamic Chest pain Dyspnea Tachycardia Tachypnea Decreased breath sounds, hyperresonance on affected side JVD
45
Clinical Presentation (Obstructive shock - PE)
Hypodynamic Tachycardia Dyspnea Hypotension Chest Pain Hemoptysis
46
Clinical Presentation (distributive shock - sepsis)
Hyperdynamic Fever or hypothermic Tachycardia Tachypnea Hypotension (SBP < 90 mmHg) Warm or cold extremities
47
Clinical Presentation (distributive shock - neurogenic)
Hyperdynamic Bradycardia Warm extremities Bounding pulses
48
Lab Studies to collect with shock state?
WBC count Hb Plt count ABG BUN/Cr ECG Lactate Central Venous O2 saturation
49
Why collect WBC count in shock state?
often elevated early may be decreased in sepsis & late shock
50
Why collect Hb in shock state?
May be elevated in non-hemorrhagic, hypovolemic shock, septic shock d/t extravasation
51
Why collect plt count in shock state?
may be elevated early decreased w/ sepsis, hemorrhage
52
Why collect ABG in shock state?
anion gap acidosis w/ elevated lactate
53
Why collect BUN/Cr in shock state?
BUN may be elevated if GI blood loss, hypovolemia Elevated creatinine w/ ongoing decreased tissue perfusion
54
Why collect EKG in shock state?
To evaluate for cardiac ischemia in cardiogenic shock or secondary to other shock R heart strain/R axis deviation, RBBB in PE
55
Why collect Lactate in shock state?
Relatively late marker of decreased tissue perfusion/oxygenation Cleared by liver; may be elevated in liver failure Serial levels can be used as markers of adequacy of resuscitation
56
What imaging should be collected for shock state?
CXR CT scan if suspect hemorrhage, PE, Sepsis US (RUSH exam) VQ scan if suspect PE
57
Why get a CXR in shock state?
Infiltrates in septic shock Pulmonary Edema in cardiogenic shock PTX Cardiac tamponade (obstructive shock)
58
HD monitoring in shock state can include?
Arterial catheter CVP PAC Esophageal doppler
59
Why monitor CVP in shock state?
May be useful in otherwise healthy patients may differentiate b/t different forms of shock (low in hypovolemia, high in cardiogenic shock)
60
SvO2 is low w/ decreased O2 delivery w/ what conditions?
decreased Hb Decreased CO Decreased saturation
61
SvO2 is low w/ increased O2 extraction occurs from?
fever shivering seizures
62
SvO2 is elevated w/ maldistribution of blood flow from?
sepsis
63
Hemodynamic Profiles Hypovolemic Shock
Decreased CO Increased SVR Decreased PWP Decreased CVP Decreased SvO2
64
Hemodynamic Profiles Cardiogenic from Mi, MR, RV infarction
Decreased CO Increased SVR Increased PWP Increased CVP Decreased SvO2
65
Hemodynamic Profiles Obstructive (cardiac tamponade)
Decreased CO Increased SVR Increased PWP Increased CVP Decreased SvO2
66
Hemodynamic Profiles Obstructive (massive PE)
Decreased CO Increased SVR NL or low PWP Increased CVP Decreased SvO2
67
Hemodynamic Profiles Distributive (sepsis, anaphylaxis)
NL or elevated CO Decreased SVR NL or low PWP NL or low CVP Elevated SvO2
68
Management of Shock Depends on what? but goal is the same which is?
underlying pathology prompt restoration of perfusion to vital organs & tissues before cellular injury ensues
69
Management of Shock Goal of volume?
Increase stroke volume/SVO
70
Management of Shock General management goals
BP support (>60-65 mmHg) CI > 2.1 L/min/m squared (cardiogenic & obstructive) Lactate Level < 2.2 mmol/L ScvO2 > 70% (sepsis) Fluid resuscitation < 6hrs (sepsis) Antibiotics < 1hr (sepsis)
71
Stroke Volume Optimization Indications
age HF Low UOP Bleeding Monitoring fluid boluses/vasopressors Cardiac conditions risk of hypoperfusion
72
Stroke Volume Optimization Methods
Noninvasive doppler imaging Esophageal doppler imaging Bioimpedence Endotracheally applied bioimpedence Pulse coutour Exhaled CO2 PAC
73
HD parameters Reference range CO
4-8 L/min
74
HD parameters Reference range Stroke Volume
50-100 ml
75
HD parameters Reference range Stroke Index
25-45
76
HD parameters Reference range Flow time corrected (FTc)
330-360 ms
77
HD parameters Reference range Peak velocity
30-120 cm/s
78
HD parameters Reference range Stroke distance
10-20
79
HD parameters Reference range CI
2.8-4.2
80
HD parameters Reference range SVR
900-1600 dyne sec cm
81
HD parameters Reference range ScvO2
65-80
82
HD parameters Reference range CVP
2-8 mmHg
83
HD parameters Reference range Stroke volume variation
< 10-15%
84
SVO With Low SV or FTc do what?
Give 200 ml colloid or 500 ml crystalloid
85
SVO If after giving 200 ml colloid or 500 ml crystalloid the SV increased < 10% do what? If SV increases > 10% do what?
stop giving fluids Give additional volume
86
Hypovolemic shock Goals?
Rapid restoration of circulating volume, tx underlying cause
87
Hypovolemic Shock Support needed? Access required? Resuscitation is done w/?
Airway/breathing 2 large bore IVs Isotonic (LR or NS), blood products if hemorrhage
88
Hypovolemic Shock Lab studies to obtain?
CBC T&C Electrolytes renal fxn ABG Lactate Coagulation ScvO2
89
Cardiogenic Shock Treat underlying cause Support what? Fluid resuscitation? Pressors for what? Inotropic agents for what? IABP to reduce what? & Optimize what?
Thrombolytics, revascularization airway/breathing Predetermined boluses per Starling curve unless frank pulmonary edema present hypotension despite fluid resuscitation inadequate perfusion & adequate intravascular volume afterload; diastolic perfusion pressures
90
Dopamine Dose MOA Notes?
5-15mcg/kg/min Increased HR, Contractility, CI (beta adrenergic), BP (alpha) May cause tachycardia/exacerbate ischemia
91
Norepinephrine Dose MOA Notes?
0.01-3 mcg/kg/min Increased BP & SVR (alpha), increased splanchnic perfusion (beta), Increased HR none
92
Phenylephrine Dose MOA Notes?
40-180 mcg/kg/min Increased BP & SVR (alpha), decreased HR May be useful if tachycardia; caution if reduced cardiac function
93
Epinephrine Dose MOA Notes?
0.1-0.8 mcg/kg/min Increased BP, CI, SV, HR (alpha & beta) For those refractor to fluid resuscitation or other vasopressors, decreased splanchnic perfusion
94
Dobutamine Dose MOA Notes?
2-20 mcg/kg/min Increased contractility & CO (beta) May exacerbate hypotension and precipitate arrhythmias
95
Milrinone Dose MOA Notes?
0.375 - 0.75 mcg/kg/min
96
Obstructive Shock Support what? Tx underlying pathology such as? Fluid resuscitation? Meds to use?
airway breathing needle thoracentisis, chest tube (PTX), pericardiocentesis (tamponade), anticoagulation (PE) Yes Inotropes
97
Distributive shock Support what? Tx what? Fluid resuscitation goal? Vasopressors to use? Surviving ____ campaign Epinephrine dose for anaphylaxis?
airway/breathing underlying cause CVP 8-12, MAP >/= 65, UOP >/= 0.5 ml/kg/h, mixed venous O2 sat > 65% Levo, Epi, Vaso Sepsis 0.3-0.5 ml 1:1000 solution SC or IM q 15 min prn

Acute Care I (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions