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MOHD Keystone Exam 3 > Shock > Flashcards

Flashcards in Shock Deck (18)
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1

What is shock?

Maldistribution of blood flow causing an imbalance between oxygen delivery and demand --> Leading to tissue hypoxia

2

Beta1 agents...

Increase HR and contractility

3

What are the etiologies of shock?

Cardiogenic
Hypovolemic
Distributive
Obstructive
Neurogenic

4

What quantities affect shock?

Arterial O2 content
O2 delivery (heart rate, stroke volume, cardiac output)
Perfusion pressure
Systemic vascular resistance

5

How do you treat shock?

Optimize volume status (Frank-Starling)

Optimize oxygen demand (Intubation)

Support circulation (vasopressors/inotropes)

6

What three things is cardiac function dependent on?

Preload
Contractility
Afterload

7

Alpha agents ...

cause vasoconstriction

8

How does preload (initial sarcomere length) affect cardiac function?

Stroke volume INCREASES in response to an increase of the volume of blood filling the heart (increase in sarcomere length)

9

What are extrinsic controls on hemodynamics?

Baroreceptors (change in BP --> CNS, negative feedback via inhibition of symp, activation of parasymp)

Cardiopulmonary receptors (detect changes in central blood volume)

10

What are intrinsic controls on local blood flow hemodynamics?

Nitric oxide
hypoxia

11

Beta2 agents...

cause smooth muscle dilation within vessels and bronchioles

12

What type of shock is sepsis?

Distributive shock: uncontrolled inflammation and dysregulated immune response (cytokine storm) -->
systemic vasodilation, endothelial dysfunction, hypovolemia, cardiac depression

13

What is failing in cardiogenic shock?

The pump!

May be due to MI, cardiomyopathy, myocarditis, arrhythmia, valve malformation

14

What is failing in hypovolemic shock?

Tank is empty!

Intravascular volume loss, depleted body fluids/volume

Hemorrhage, trauma, GI loss, body cavity loss, severe hypovolemia/dehydration

15

SVO2 measurements are NORMAL/HIGH in ________________ but are low in _________________

Normal/high in DISTRIBUTIVE shock

low in LOW-FLOW state or ANEMIA

16

What is failing in distributive shock?

The pipes are leaky!

Systemic vasodilation

Sepsis, anaphylaxis, liver cirrhosis, pancreatitis

Neurogenic shock is a form of Distributive shock

17

What is failing in obstructive shock?

mechanical factors are interfering with filling or emptying of heart/great vessels

cardiac tamponade, pulmonary embolism, tension pneumothorax

18

What is failing in neurogenic shock?

Loss of vascular tone d/t inhibition of normal tonic activity of sympathetics
(form of distributive shock)

Spinal cord injury
Deep anesthesia
Reflex response to trauma