Shock

Question 1

what is shock?

Answer 1

severe cardiovascular failure caused by poor blood flow or inadequate distribution of flow

Question 2

what are complications of shock?

Answer 2

organ failure and death unless a cause can be identified

Question 3

what are the physical responses of shock medicated by?

Answer 3

catecholamines, renin, ADH, glucagon, cortisol, and GH

Question 4

what is hypovolemic shock?

Answer 4

caused by hemorrhage, loss of plasma, loss of fluid and electrolyes, resulting in decreased intravascular volume

Question 5

what can cause hypopvolemic shock?

Answer 5

thin 3rd spacing or by obvious loss

Question 6

what is cardiogenic shock

Answer 6

caused by MI, dysrhythmias, heart failure, defects in the valves or septum, HTN, myocarditis, cardiac contusion, rupture of ventricular septum or cardiomyopathyies

Question 7

what are causes of obstructive shock?

Answer 7

tensino PTX, pericardial tamponade, obstructive valvuar dz, pulmonary problems including massive PE

Question 8

distributive shock?

Answer 8

poorly regulated distribution of blood volume

-includes septic shock, systemic inflammatory response syndrome (systemic inflammation w/o end-organ damage)

• anaphylaxis
• neruogenic shock

Question 9

what ist he most common cause of distributive shock?

Answer 9

septic

Question 10

what bacteria is most associated with septic shock?

Answer 10

gram negative (ppl of extreme ages)

Question 11

what other pt population is septic shock found int?

Answer 11

DM or immunosuppression, those that have recently had an invasive procedure

Question 12

what are causes of neurogenic shock

Answer 12

spinal cord injury, or adverse effects of spinal or epidural anesthesia

Question 13

what are signs and symptoms of shock?

Answer 13

hypotension, orthostatic changes, tachycardia, peripheral hypoperfusion, AMA, oliguria or anuria, insulin resistance, and metabolic acidioss

Question 14

what are signs of end-organs hypoperfusion?

Answer 14

cool/mottled extremities, diminished capilarry ref, weak or thready/ or absent peripheral pulses

Question 15

what type of diagnostic studies can be done?

Answer 15

CBC, blood type and cross matc, coagulation parameters

-CMP, glucose, UA, serm cretinin-aid in dx

Question 16

tx of shock

Answer 16

depends on specific cause and manifestations

Question 17

first step of shock tx?

Answer 17

ABCD

Question 18

what is the trendelenburg postions

Answer 18

get blood back to brain

Question 19

what should urine flow be at?

Answer 19

0.5 ml/kg/hr

Question 20

what labs should be done in critically ill patients

Answer 20

central venous pressure, pulmonary arter catheters, capillary wedge pressure monitoring

Question 21

what meds can be used to tx shock?

Answer 21

inotropes: dobutamine, dopamin, epi

Question 22

how do inotropes work?

Answer 22

increase CO by increased contractility

Question 23

what can be used to alter heart rate?

Answer 23

chronotropes: adrenaline (+); dig (-)

Question 24

what do pressors do?

Answer 24

increase vascular tone

dopamine, phenylephrine

Question 25

what are the major deerminants of tissue perfusion>

Answer 25

Systemic BP, CO, systemic vascular resistance

Question 26

what is stroke volume determined by

Answer 26

preload, myocardial contractiliyt, afterloa

Question 27

what is systemic vascular resistance determined by?

Answer 27

vessel length, blood viscosity, vessel diameter

Question 28

what does cellular hypoxia cause?

Answer 28

on pump dysfunction, intracellular edema, leakage of intracellular contents into the extracellular space, and inadequate regulation of intracellular pH. These biochemical processes, in turn, progress to acidosis, endothelial dysfunction, and further stimulation of inflammatory and anti-inflammatory cascades.