SHOCK Flashcards
(23 cards)
Shock causedby a alrge tension pneumothorax
Obstructive shock
Most common type of shock
Hypovolemic
results from decreased resistance within capacitance vessels. usually seen in sepsis
Vasogenic shock
form of vasogenic shock in which spinal cord injury or spinal anesthesia causes vasodilation due to acute loss of sympathetic vascular tone
Neurogenic
results from failure of the heart as a pump
Cardiogenic shock
soft tissue and bony injury lead to the activation of inflammatory cells and the release of circulating factors such as cytokines and intracellular molecules that modulate the immune response
traumatic shock
Baroreceptors
- receptors in the aortic arch and carotid bodies inhibit the autonomic nervous system when stretched.
- Volume receptors, sensitive to changes in both chamber pressure and wall stretch, are present within the atria of the heart
- inhibit induction of the autonomic nervous system (ANS).
Chemoreceptors in the aorta and carotid bodies are sensitive to ____________
- Oxygen tension
- Hydrogen ion concentration
- carbon dioxide levels
Results in vasodilation of the coronary arteries, slowing heart rate and vasoconstriction of the splanchnic and skeletal circulation
Effects of colloid solutions in resuscitation
- draw extracellular fluid into the vascular space, increasing extracellular fluid deficit
- Circulating levels of immunoglobulins are decreased
- colloid solutions may bind t the ionied fraction of serum calcium
- endogenous production of albumin is decreased
Which categories of shock are associated with vasodialtion of larger arterioles?
Septic and Neurogenic shock
antidiuretic hormone
- acts as potent mesenteric vasoconstrictor
- released in response to hypovolemia
- sensed by baroreceptors and left atrial stretch receptors, and increased plasma osmolality detected by hypothalamic osmoreceptors
Effects of epinephrine and norepinephrine
- hepatic glycogenolysis
- gluconeogenesis
- ketogenesis
- skeletal muscle protein breakdown
- adipose tissue lipopylis
Findings in hypovolemic shock
- low BP
- high lactate levels
- low central venous pressure
- low cardiac output
Which cytokineis anti inflammatory and increases after shock and trauma
IL-10
- secreted by T cells, monocytes, and macrophages
- inhibits pro-inflammatory cytokine sectrion, oxygen radical production, adhesion molecule expression and lymphocyte activation
Tumor necrosis alpha
- Can be released as a response to bacteria and endotoxin
- released by monocytes, macrophages, and T cells
- peak within 90 minutes
- produce peripheral vasodilation
- induce procoagulant activity
Classification of hemorrhage
Vasodilatory shock
- can also be caused by carbon monoxide poisoning
- failure of the vascular smooth muscle to constrict approppriately
- elevated cateholamines
- Activation of RAAS
- Other causes
- hypoxic lactic acidosis
- decompensated and irreversible hemorrhagic shock
- terminal cardiogenic shock
- post cardiotomy shock
What is often given to patients with hypotension and refractory to norepinephrine
Arginine vasopressin
- firts line therapy of septic patient with antibiotics, IV fluids, and intubation
- Vasopressirs may be used (most common NE)
Tight glucose management in critically ill and septic patients
- Decreases length of antibiotic therapy
- intensive insulin therapy (80 -110 mg/dl)
- Mortality is decreased by 42 %
- decreased ventilatory support and renal replacement therapy
Cardiogenic Shock
- Cardiogenic shock occurs in 5 - 10% of acute MI
- sustained hypotension for at least 30 mins
- reduced cardiac index (<2.2 L/min per square meter)
- elevated pulmonary wedge pressure (>15 mmHg)
- Mortality rate of 50-80%
- Extensive MI is the most commo (develop signs within 24 hours after onset of infarction (average of 7 hours) )
- typically not found on admission
Effects of intra-aortic balloon
- Reduction of systolic afterload
- Increase cardiac outpu
- augmentationof diastolic perfusion pressure
no effect on myocardial oxygen demand
Corticosteroids in the treatment of septic shock
- Improves mortalityin patients with relativvve adrenal insufficiency
- single IV doseof 50 mg ofhydrocortisone improvd MAP
- if SBP remains less than 90 mm Hg despite appropriate fluid and vasopressor therapy, hydrocortisone at 200mg/day
Serum Lactate
- The admission lactate level, highest lactate level, and time interval to normalize serum lactate are important prognostic indicators for survival
- Generated from pyruvate in the setting of insufficient oxygen
- Metabolized by liver (50%) and kidneys (30%)
- Indirect measure of the magnitiude and severity of shock
