shock and mod (FINAL) Flashcards
(31 cards)
1
Q
what is shock?
A
- imbalance between oxygen supply and oxygen required at the cellular level, so cells get damaged and die at mass amounts
2
Q
what is the common factor among all types of shock?
A
- HYPOPERFUSION & impaired cellular oxygen utilization
- could progress to irreversible organ damage
3
Q
what does cellular hypoxia cause?
A
- impairment in cellular function !!
1. anaerobic metabolism ( = lactate production = pain)
2. failure of ion pumps = hydropic swelling
3. formation of free radicals (reperfusion injury)
4. induction of inflammatory cytokines
5. failure if microcirculation to auto regulate blood flow
4
Q
how can shock lead to metabolic acidosis?
A
- due to the cells not having air
- kidneys holding onto H+
metabolic acidosis
5
Q
what are the 5 different types of shock
A
- cardiogenic
- hypovolemic
- neurogenic
- anaphylactic
- septic
- 3 through 5 are all under the distributive category
6
Q
what are the signs of shock in the progressive stage?
A
- tissue / organ hypoxia = oliguria
- weak but RAPID pulse
- low pH
- sensory neural changes
- pale & cold (late stage)
- high RR
- low BP
7
Q
what happens in cardiogenic shock?
A
- decreased contractility
- low CO = reduced o2 delivery to tissues
- Usually result of severe
ventricular dysfunction
associated with MI
8
Q
CM of cardiogenic shock?
A
- decreased CO
- pulmonary edema
- increased SVR in diastole
9
Q
Tx for cardiogenic shock?
A
- Aimed at improving
CO and myocardial
oxygen delivery,
decreasing workload - decrease work load of heart
10
Q
what are examples of diseases that could cause cardiogenic shock?
A
- MI (!!)
- cardiomyopathy
- valvular heart disease
- Decrease ability of
cardiac contractility
11
Q
what is the pathos behind hypovolemic shock & diseases that cause it
A
- is due to inadequate circulation of blood volume
- ex: hemorrhage, burns, dehydration, or leakage of fluid into interstitial spaces
- External hemorrhage: most common cause
- patho: Low CO and intra cardiac pressures (low preload) lead to SNS activation = elevated
HR, vasoconstriction, increased contractility
12
Q
CM of hypovolemic shock?
A
- Severity of symptoms correlates with
amount of blood loss - ex: mental changes, sunken eyes, poor skin turgor, thirst, oliguria, increased HR
- diagnosis is made after loss of 15% volume loss
13
Q
Tx for hypovolemic shock?
A
- Therapy is aimed at fluid replacement and
controlling the source of volume loss - IV fluids & blood products
14
Q
what is disruptive shock & the 3 types?
A
- Excessive vasodilation, Peripheral pooling
of blood, Cardiac output inadequate
due to reduced preload - types:
1. anaphylactic shock = IgE, mast cells, histamine
2. neurogenic shock = decreased SNS
3. septic shock = infection in blood
15
Q
what is the patho & cause of anaphylactic shock?
A
- patho = Result in IgE and mast cell degranulation response to antigen
- mast cells release histamines which cause vasodilation resulting sever HYPOTENSION
- cause: Allergic reaction, Antibiotics, peanuts,
insect & snake bites
16
Q
CM of anaphylactic shock?
A
- Urticaria (hives)
- Bronchoconstriction
- Angioedema (lip swelling)
- Wheezing
- Itching
- edema
17
Q
Tx for anaphylactic shock?
A
- Maintenance of airway
patency, use of epinephrine,
bronchodilators, antihistamines,
vasopressors, and IV fluid - goal = open airway, increase SVR & BP
18
Q
A
18
Q
what is the patho of neurogenic shock?
A
- Results from loss of sympathetic activation, causes vasodilation and peripheral pooling of blood.
19
Q
what is the cause of neuro shock?
A
- Causes include medullary depression (brain injury, drug overdose) or lesions of sympathetic nerves (spinal cord injury
20
Q
CM of neurogenic shock?
A
- Decrease in pulse (!!!) the only one where pulse decreases
- Hypotension,
- syncope/fainting
21
Q
Tx for neurogenic shock?
A
- Vasopressors (vasoconstrict), fluids, elevation of the legs, slow position changes, and the use of pressure stockings on the legs
- goal = increase BP & SVR
22
Q
what is septic shock?
A
- infection in blood stream
- massive vasodilation
23
Q
CM of septic shock?
A
- Release of immune mediators = widespread
- Inflammation causes increased capillary permeability and third spacing (edema)
- Profound vasodilation with hypotension and tachycardia (fast & weak)
24
Tx for septic shock?
- Administration of fluids and medications to increase systemic vascular resistance and improve distribution of blood flow
- Improvement seen when increase in systemic vascular resistance because massive vasodilation stops!!
25
what are the complications of shock?
- shock = not enough 02 to the cells and then they get injured and that affects all organs & systems of the body = (MODS, kidney, lung)
- or there is an excessive immune response leading to leaking capillaries, so much that cells get injured due to inflammation
- Inflammation triggered by hypoxic injury to cells
26
in septic shock how does the body try to compensate?
- Inflammatory cytokines: mediate organ damage by altering metabolism, recruiting neutrophils, initiating the coagulation cascade, and altering capillary
permeability (DIC)
27
how is ARDS related to shock?
- Most commonly associated with septic shock
- Development of refractory hypoxemia, decreased pulmonary compliance, and pulmonary edema
- Primary cause of death in ARDS: multiple organ failure, not severe hypoxemia
28
what is MODS?
- multiple organ dysfunction (MODS)
- When 2 or more systems are affected
- Most common causes of secondary MODS:
1. Sepsis and septic shock
29
what happens in MODS?
- Initiated by immune mechanisms that are overactive and
destructive
- Cytokines affect endothelium, recruit neutrophils, and activate inflammation in vascular beds leading to tissue destruction and organ dysfunction
29
what happens in acute renal failure?
- Kidneys undergo long periods of hypoperfusion
- Vasoconstriction causes decreased glomerular blood low—reduced hydrostatic pressure and filtration rates
- aka not making pee, aka oliguria
- risk for metabolic acidosis
