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Cardiovascular > Shock and hypertensive emergencies > Flashcards

Shock and hypertensive emergencies Flashcards

1
Q

define shock

A

serious and life threatening conditions resulting in tissue hypoperfusion

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2
Q

what can shock lead to?

A

hypotension which if prolonged an result in organ failure

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3
Q

what are the two signs in BP indicating shock?

A

low BP -90/60
or any drop of 30mmHg

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4
Q

what will a patients body do to maintain BP in shock?

A

increase cardiac output - not sustainable hence large drop

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5
Q

how do you calculate shock index?

A

Hr divided by systolic BP

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6
Q

why is shock index more accurate than BP itself?

A
  • More accurate sign of shock than BP
  • Should be 0.5-0.8
  • 0.8< - suspicion of shock
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7
Q

what types of shock affect stroke vol?

A
  • Anaphylactic shock
  • Neurogenic shock
  • Septic shock
  • Vasodilator shock
  • Induced shock
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8
Q

what are general signs of shock?

A
  • Tachycardia
  • Increased resp rate
  • Signs of tissue hypoperfusion – delayed capillary refill time (2 sec< ), may have bounding pulses/ warm peripheries
  • Weak pulse
  • Decreased urine output – keep fluids in to maintain BP
  • Confusion – by-products of everything
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9
Q

how is shock a vicious cycle?

A

inflammatory mediators are released
blood diverted - more hypoxia etc

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10
Q

what can cause hypovolaemic shock?

A

haemorrhage
fluid loss/ dehydration

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11
Q

how can DKA contribute to hypovolaemic shock?

A

blood glucose so high, excreted with urine - more water follows - more dehydration

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12
Q

what is the mechanism of hypovolaemic shock?

A

reduced cardiac output due to reduced fluid volume

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13
Q

how does body respond in hypovolaemia to increase fluid?

A

shift interstitial fluid
ADH secreted
splenic discharge

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14
Q

what occurs to the heart during hypovolaemic shock?

A

heart increased contractibility due to more noradrenaline

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15
Q

how do you treat hypovolaemic shock

A

more fluids
need to find initial cause

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16
Q

what is cardiogenic shock

A

failure of heart to pump effectively

17
Q

what can occur as a result of cardiogenic shock?

A

large MI
arrhythmia
heart failure - congestive, cardiomyopathy/ myocarditis
pulmonary oedema

18
Q

what is the mechanism responsible for cardiogenic shock

A

poor myocardial contractility
- high venous pressure leads to fluid extravasation and oedema (build up of fluid in the body which causes affected tissues to be swollen)

19
Q

what is distributive shock?

A

inappropriate peripheral vasodilation causing pool of blood/ fluid in tissues

20
Q

what types of shock can cause distributive shock?

A

septic shock
anaphylactic shock
neurogenic shock

21
Q

what is the mechanism responsible for distributive shock?

A
  • pooling of blood by peripheral vasodilation
  • capillary leak worsens hypovolaemia and causes odema (inc pulmonary)
  • changes above lead to reduction in BP and organ perfusion
  • vessels dilate causing relative hypovolaemia and reduction in SVR
22
Q

which type of shock is the biggest emergency?

A

obstructive

23
Q

what is obstructive shock?

A

obstruction of blood flow

24
Q

what can cause obstructive shock?

A

cardiac tamponade
pulmonary embolus
aortic stenosis

25
Q

what is cardiac tamponade?

A

collection of fluid in pericardial space and prevents effective contraction of heart

26
Q

what is a PE?

A

pulmonary embolus - blockage of major pulmonary artery

27
Q

what is afterload?

A

amount of work the heart has to do to pump blood to the rest of the body

28
Q

what are the stages of shock?

A

initial compensation
decompensated/ refractory

29
Q

what occurs during initial compensation?

A

hypoperfusion causing anaerobic resp
acidosis - increasing resp rate
increased hr and increased systemic vascular resistance

30
Q

what builds up during anaerobic respiration and part of initial compensation of shock?

A

lactic acid

31
Q

what happens during decompensated/ refractory period- shock

A
  • cell injury results in loss of function
  • worsening acidosis and inflammatory mediators released – peripheral vasodilation, leaky capillaries
  • blood and fluid pool – sludging of microcirculation, reduced intravascular volume and worsening hypotension
  • vital organs fail and cell damage cannot be reversed
  • death
32
Q

how do you treat shock?

A
  • give 100% oxygen
  • IV normal saline (1l in adult, 500ml – if small, frail, cardiogenic shock)
  • Keep warm
  • Seek senior
  • Try identify cause
33
Q

what is a hypertensive emergency in terms of BP?

A

Sudden increase in BP ≥ 180/110 but usually 220/120

34
Q

what is hypertensive urgency?

A

no signs of acute end stage organ damage – only 10% survival after 1 yr if untreated. Want slow and steady reduction to 160/100 over 24hrs. For discharge should be 140/90

Cardiovascular (14 decks)

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