Shock (MR) Flashcards Preview

Clinical Medicine Master > Shock (MR) > Flashcards

Flashcards in Shock (MR) Deck (81):
1

Define shock?

Circulatory system failure to supply O2 and nutrients to meet metabolic and cellular demand

2

Equation for BP?

BP = CO * SVR (systemic vascular resistance)

3

Equation for CO?

CO = HR * SV

4

What does Stroke Volume depend upon?

Preload Afterload Contractility

5

Equation for Delivery of O2 (DO2)?

CO * CaO2 (Arterial O2 Content)

6

Equation for CaO2?

CaO2 = [Hb]*1.34*SaO2 + (PaO2 * 0.003)

7

What does SaO2 mean?

Arterial O2 Saturation

8

TQ!!! What are the Abnormalitites in Perfusion Parameters (6)? When is shock likely?

Mentation CRT MM Color Extremity Temp Pulse Quality An abnormality in ANY of them!

9

Why does mentatin represent perfusion?

Brain O2 dependent perfusion

10

Why do Mucous Membranes represent perfusion?

White/pale = Vasocontriction & Anemia Red – Vasodialation Venous pooling

11

Why does CRT represent perfusion? What Lengthens CRT? Shortens?

Time to refill capillaries after digital pressure Vasoconstriction Vasodialation

12

How does pulse quality represent perfusion?

Shows fullness or body of pulse

13

How does ↓ Extremity Temperature represent pulse?

Vasoconstriction

14

How does HR represent perfusion?

HR will ↑ to ↑ CO

15

What are the 3 parts of the Circulatory System?

Pump Fluid Tubes

16

What are the tube types?

Low Pressure High Pressure

17

Low pressure tubes?

Systemic Capillaries -> Right Heart -> pulmonary circ -> left atrium

18

High Pressure tubes?

Left ventricle to capillaries

19

When patient comes in and you are assessing for shock, what will you check?

A = Airway B = Breathing C = Circulation D = Disability E = External

20

How will you check Airway?

Determine Patency

21

What will you check for Breathing?

RR, Posture, Effort, Character, Breath Sounds

22

How will you assess circulation?

MM color CRT Pulse Cardiac Auscultation

23

What is CRT < 1 sec? What else can you assess to find this condition? What causes it?

Hyperdynamic Pulse Anemia or Sepsis

24

How will you assess pulse?

1 per Heart Beat Strength

25

Things to asses upon auscultation?

Rate Rhythm Murmurs

26

What should be assesed for disability?

Level of consciousness Ambulation Sensation

27

What to assess Externally?

Fractures Open Wounds Augulations/Deformities Crepitus Hernias Hemorrhage Swelling/Bruising

28

What type of event is shock?

Cellular - Inadequate cellular energy production

29

3 Main types of Shock?

How many types can a patient have at once Hypovolemia - The Fluid Cardiogenic - The Pump Distributive - The Tubes ≥ 1

30

Events leading to shock?

↓ effective circulating VOLUME Reduced O2 Carrying Capacity ↓ Pump Efficiency Changes in Vascular Tone & Responsiveness

31

How do the tissues initially deal with ↓ O2 delivery (DO2)?

They pull more blood from circulation for O2

32

What is critical point?

A critical ↓ in DO2 (Delivery of O2 to tissues) where Shock ensues.

33

When O2 isnt available what happens?

Anaerobic metabolism -> Lactic Acidosis

34

What are high leels of Lactic Acidosis correlated with?

Reduced survival

35

What is Lactic Acidosis created by? What is produced?

Anaerobic glycolysis Lactate & H+

36

Where does Lactate accumulate? What does this Reduce?

INTRAcellularly EXTRAcellulat HCO3-

37

What conditiondoe lactic acidosis contribute to?

Metabolic Acidosis

38

Stages of Shock?

Compensated Uncompensated Terminal/Reversible

39

Describe compensated shock?

Blood Flow: Normal -> ↑ Possibly Maldistributed Vital Organ Function= Maintained

40

Describe Uncompensated Shock?

Micro-vascular perfusion compromised Significant reduction in circulating volume

41

Describe Terminal/Irreversible shock?

Inadequate perfusion to bvital organs Irreparable damage Incompatible with life

42

What is hypovolemic shock?

↓ Effective Circulating Volume (ECV)

43

What is ECV?

Volume of Arterial Blood perfusing Tissues

44

Severely reduced tissue perfusion leads to?

Cellular hypoxia and eventually death

45

Causes of hypovolemic shock?

Hemorrhage - Whole blood or plasma ↓ in Na+ Excessive losses - dxa/vomit

46

Dehydration represents loss of fluid from what space?

Interstitial

47

What does Extracellular space is represented by?

interstitial and intravascular

48

How does body initially react to hypovolemia? How does it compensate?

↓ CO 2º to ↓ Venous Return Compensation: ↑ Sympathetic Tone - Vasoconstriction - 1º compensation ↑ Cardiac Contractability Tachycardia to ↑ CO – initially Microvasculature alteration - fluid from interstitium ↓ Renal Perfusion RAAS Activation - Na+ & H2O retention

49

Clinically what will hypovolemic shock patients look like?

Mildly depressed Normal -> slightly ↓ Pulse Quality Normotension Normothermia Sluggish - CRT 2 - 2.5 sec Pale MM color

50

Can patient in shock have normla BP?

YES!!!

51

What will Late shock patient look like clinically?

Severe Depression Poor Pulse Quality Hypotension Hypothermia CRT > 3 sec MM Pale

52

What does MODS mean?

Multiple Organ Dysfunction Syndrome

53

TQ!!! How are Cats different in Hypovolemic Shock?

Bradycardia! Dull Mentation Hypothermia

54

Shock organs for Cats?

Liver*** & Lungs

55

Shock organ for Dogs?

GIT

56

Dx of Hypovolemic Shock?

PCV/TS Lactate Blood Gas Analysis BUN/CRE SpO2 - Saturation O2 NIBP - non-invasive BP LATER - Radiographs, full CBC, Chem, UA

57

Distributive Shock (Vasodilatory): Loss of systemic vascular resistance is a problem with which part of the circulatory system? What is happening?

TUBES Maldistribution of Blood Flow

58

Why does Distributive shock occur?

Sepsis Vascular obstruction Anaphylaxis - MOST COMMON

59

What are the two phases of Distributive Shock?

Hyperdynamic - tachycardic, febrile, bounding pulses Hypodynamic

60

Hyperdynamic phase of Distributive look like?

Tachycardia to ↑ CO Febrile Bounding Pulses Rapid CRT < 1 sec Hyperemic Mucus Membranes - CYTOKINES

61

What is the cause of Peripheral vasodialation with Distributive Shock?

Nitric Oxide

62

When does Hypodynamic phase of Distributive shock occur? CX?

after Hyperdynamic phase Compensation is failing Still Tachycardic – CYTOKINES Prolonged CRT Pale/Icteric MM Hypothermia

63

What will occur once in hypodynamic phase?

Organ damage or failure

64

Cardiogenic Shock: why?

PUMP failure CHF Arrhythmias Cardiac tamponade Drugs -> Myocardial Depression

65

What types of drugs lead to myocardial depression?

Anesthetics Beta-Blockers Ca2+ Channel Blockers

66

Is there a volume issure with cardiogenic shock?

NO

67

What is failure of forward flow? What can cause this?

Systolic Failure Ventricular Tachycardia What type of failure is Restrictive Filling? Condition that can cause this? Diastolic Failure Hypertrophic Cardiomyopathy

68

Presentation in cardiogenic shock? Clues it is cardiogenic?

Low mentation Pale MM Weak Pulses Tachycardic Slow CRT Crackles, tachypnea, dyspnea, murmur, arrhythmia, abd distention, fluid thrill

69

What tells you if you are treating shock appropriately?

Profusion parameters!

70

Terminal Shock: What occurs?

↓ Coronary Blood FLow - myocardial damage ↓ CNS Blood Flow – Vasoconstriction Cytokine Release - cell damage/death

71

What are the expected changes in vascular tone: Hypovolemic Shock?

Constriction

72

What are the expected changes in vascular tone: Distributive Shock?

Dialation

73

What are the expected changes in vascular tone: Cardiogenic Shock?

Constriction

74

What are the expected changes in Cardiac Output: Hypovolemic Shock?

↑ with Vasoconstriction then ↓ with continued loss

75

What are the expected changes in Cardiac Output: Distributive Shock?

76

What are the expected changes in Cardiac Output: Cardiogenic Shock

77

What are the expected changes in Systemin Vascular Resistance: Hypovolemic Shock?

78

What are the expected changes in SVR: Cardiogenic Shock?

79

What are the expected changes in SVR: Distributive Shock?

80

What are the expected changes in mechanism of organ damage: Hypovolemic Shock?

ischemia Inflammatory Mediators

81

What are the expected changes in mechanism of organ damage: Cardiogenic Shock?

Ischemia