Test #2 Shock - Josh Flashcards Preview

Principles 4 > Test #2 Shock - Josh > Flashcards

Flashcards in Test #2 Shock - Josh Deck (41):
1

Shock:

what is the def on shock

  • inadequate O2 delivery to meet metabolic demands
  • Results in global tissue hypoperfusion and Metabolic acidosis

2

Shock:

Shock can occur with a normal ____ _____ and _______ can occur without shock

blood pressure

hypotension

3

Shock:

Inadequate systemic O2 delivery activates ____ responses to maintain systemic O2 delivery

Autonomic

4

Inadequate systemic O2 delivery activates Autonomic responses to maintain systemic O2 delivery. the ____, ___, and ____ blood flow is preserved; other regional beds are constricted

heart

kidney

brain

5

Inadequate systemic O2 delivery activates Autonomic responses to maintain systemic O2 delivery. the Heart, kidney, and brains blood flow is preserved; other regional beds are constricted. pain , hemorrhage, cortical perception of traumatic injury cause the release of _____ and ____ mediators

  • Hormone
  • Inflammatory

6

Shock: SNS

the SNS releases catecholamines. what are they?

 

 

  • NE
  • Epinephnine
  • dopamine
  • cortisol

7

Shock:

the SNS's release of the catecholamines NE, epi, Dopamine, and cortisol cause what?

  • vasoconstriction
  • increase HR
  • Increase CO

8

Shock: SNS

besides the release of catecholamines what else does the SNS activate during shock

Renin-angiotension axis

9

Shock: SNS

what does the renin angiotensin axis do?

 

  • Water and Sodium conservation
  • Vasoconstriction
  • Increase in blood volume
  • Increase in Blood pressure

10

Shock: Cellular response

what is the cellualr response to decreased systemic O2 delivery?

  • ATP depletion -> ion pump dysfunction
  • Hydrolysis of cellular membranes and cellualr death
  • Individual cells take up interstitial fluid
  • Fuurther depletion of IVF
  • cellualr edema occludes adjacent capllaries; no re-flow phenomenon prevents reveral of ischemia even restoration of adeuate macrocirculation

11

Shock:

what is the boddies intrinsic goal?

  • maintain cerebral and cardiac perfusion

12

Shock:

how does the body accomplish it's goal of maintaining cerebral and cardiac perfusion?

  • Vasoconstriction of splenic, musculoskeletal, and renal blood flow

13

Shock:

ischemic cells produce what

  • lactate
  • free radicles
  • Inflammatory factors

14

Shock:

the ischemic cells that produce lactate, free radicles, and inflammatory factors, result in __ ___ ___ that overcomes the bodies compensatory mechanisms

systemic metabolic acidosis

15

Global Tissue Hypoxia

is the _______ inflammation and disruption and inability of ____ delivery to meet demand. it results in ____, _____, and ______

  • endothelial
  • O2
  • lactic acidosis
  • Cardiovascular insufficiency
  • Increased demands

16

Organ System Response: CNS

what does teh CNS trigger?

 

 

  • neuroendocrine response

17

Organ System Response: CNS

the neuroendocrine response causes changes in the uptake of what in the brain?

glucose

18

Organ System Response: CNS

what happens to the reflexes and cortical activity?

depressed

19

Organ System Response: Kidney and Adrenal Glands

the kidneys maintain GFR how?

  • selective vasoconstriction and concentration of blood flow in the medulla and deep cortical area

20

Organ System Response: Kidney and Adrenal Glands

how is renal failure caused in Shock?

  • prolonged hypotension
  • decreased cellular energy
  • inability to concentrate urine
  • patchy cell death
  • tubular necrosis
  • Renal failure

21

Organ System Response:

____ fxn is well preserved until the late stages

Cardiac

22

Organ System Response:  Heart

Lactate, free radicals, and other humoral factors act as ____ ____ and in a bleeding pt, may produce cardiac dysfuntion

Negative inotrope

23

Organ System Response:  Heart

the trauma pt w/ cardiac dz or direct cardiac trauma is at great risk for what?

decompenstion

24

Organ System Response:  Heart

why is the cardiac pt prone to decompensation?

  • Fixed stroke volume (inhibits the bodies ability to increase blood flow in response to hypovolemia and anemia)
  • tachycardia is the only option

25

Organ System Response:

what organ is a filter for the inflammatory by-products of the ischemic body?

Lungs

26

Organ System Response: Lungs

immune complexes and cellular factors accumulate in the pulmonary _____

Capillaries

27

Organ System Response: Lungs

what is te patho of ARDS in the Shock pt?

  • Neutophil and platelet aggregation
  • Increased Permeability of cappillary
  • Destruction of lung architecture
  • ARDS

28

Organ System Response:

what is one of the earliest organs affected by hypoperfusion

gut

29

Organ System Response: Gut

may be the prime trigger of _____

MOSF

30

Organ System Response: Gut

the intense vasoconstriction occurs early and frquently leads to a _________ phenoomenon

no-reflow

31

Organ System Response: Gut

how can the Gut cause ARDS?

  • intestinal cell death
  • Breakdown of barrier function of gut
  • increased translocation of bacteria to liver and lung
  • potentiates ARDS

32

Organ System Response: Liver

is a complex organ of microvasculation; and holds the potential for ______ injury during recovery from shock

repurfusion

33

Organ System Response:

what organ is not metabolically active during shock; and tolerates inchemia well?

Skeletal Muscle

34

MODS:

is the progression of physiologic effects as shock ensues (Cardiac depression, resp distress, renal failure, DIC) and results in ?

End organ failure

35

Shock:

what are the S/S of shock

 

  • pallor
  • Diaphoresis
  • hypotension
  • Tachycardia
  • prolonged cap refill
  • Diminished UOP
  • NARROWED PULSE PRESSURE

36

Shock:

what should you ask about in the physical?

  • recent illness
  • Fever
  • CP
  • SOB
  • Abd pain
  • Comorbidities
  • Meds
  • Toxins
  • Recent hospitalizationa
  • Baseline mental status

37

Shock:

what will you want to examine on the physical examination

  • CNS - Mental changes
  • VS
  • Skin-color temp, rash sores
  • CV-JVD
  • Resp- lung sounds, RR, O2 sat,.
  • Gi- abd pain, rigidity, Guarding,rebound
  • Renal- urine output

38

Shock:

is the pt in shock? whata are 6 Signs that all indicate shock

  • Looks Ill
  • AMS
  • Skin cool and mottled or hot and flushed
  • weak or absent pulses
  • SBP < 110
  • Tachycardia

39

Shock:

if you can palpate a pulse here what is the SBP at least

  • Carotids
  • Radial
  • Femoral
  • posterior tibial

  • 60
  • 70
  • 80
  • 90

40

Shock:

what are the 6 types of shock?

  • Hypovolemic
  • Septic
  • Cardiogenic
  • Anaphylactic
  • neurogenic
  • Obstructive

41