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Flashcards in Wk5: Shock Deck (27):
1

Definition of shock

Hypoperfusion of vital organs including brain, heart, kidneys, lungs, gut. NOT low BP.

2

How to evaluate/track level of oxygen supply/demand imbalnce

Lactic acid

3

Autonomic response to anaerobic metabolism

Constriction of arterioles and veins, increased HR, increased contractility, release of ADH, epi, dopamine, NE, cortisol

4

Cellular cascade response to O2 imbalance (ATP depletion -->)

ATP depletion -> ion pump dysfunction -> Na influx/K efflux -> cellular edema -> lysosomal enzyme release -> cell death
(cytokine mediated)

5

Typical lab findings in shock (5)

Hyper-K, Hypo-Na, Metabolic and Lactic acidosis, Hyperglycemia

6

What are SIRS and MODS (define acronym)

Systemic Inflammatory Response Syndrome, Multi-Organ Dysfunction Syndrome

7

What findings constitute a patient on the shock continuum? (SIRS criteria)

2+ of the following:
Temp 38, HR ≥ 90, RR ≥ 20, PaCO2 <32 mmHg, WBC ≤ 4k or ≥ 12k or 10% bands

8

4 Clinical Stages of Shock: Stage 1

Mild resp alkalosis + oliguria + hyperglycemia

9

4 Clinical Stages of Shock: Stage 2

Tachypnea + hypocapnia + hypoxia. Mod liver dysfx and poss hematologic abnormalities

10

4 Clinical Stages of Shock: Stage 3

Azotemia + acid-base disturbance + sig coag abnormalities

11

4 Clinical Stages of Shock: Stage 4

Vasopressor dependent + olig/anuria + ischemic colitis + lactic acidosis

12

What is azotemia?

Abnormally high levels of nitrogen-containing compounds e.g. BUN and creat

13

Classic clinical findings in shock

Hypotension: sys 30 < usual, urine <20 cc/hr, elevated lactic acid, altered mental status

14

How might skin findings differ between types of shock?

Generally cool and clammy in shock BUT warm, flushed with distributive/dissociative

15

Calculate shock index. What's normal?

HR/sys BP: inversely related to effective LV stroke work. Normal: 0.5 - 0.7. Note ≥1 = inc mortality

16

How does capillary wedge pressure work? (Not done due to associated increase in mortality)

Insert catheter through subclavian -> heart -> lung capillaries. Inflate balloon to stop pressure from behind. All pressure is assumed to be from front (estimate of LA and LV pressure)

17

Examples of cardiogenic shock

Acute MI, arrhythmia, hypertrophic cardiomyopathy, aortic stenosis -> decreased CO

18

Examples of distributive/ dissociative shock

Spinal cord injury, anaphylaxis, endo (gram neg) or exotoxin (gram pos). Dissociative = something stopping O2 from reaching cells e.g. CO, cyanide

19

Extracardiac shock - definition and examples

Outflow obstruction -> decreased CO due to external path e.g. PE, pericardial tamponade, pulm htn

20

Hypovolemic shock causes

Diarrhea, vom, diuretics, sweating, hemorrhage, burns, 3rd spacing (ascites)

21

Step 1 of shock treatment

Volume replacement: NS 20-30 mL/kg, blood if hgb <7

22

Treatments other than NS for shock

Vasopressors: NE, epi, dopamine (less so because of 3rd receptor - dopaminergic), dobutamine

23

How does epi work?

a1 @ post-syn a2 -> arteriolar vasoconstriction. Pre-syn a2 inhibit NE release. B1 ->pos chron and inotropic. B2 -> arteriolar vasodilation, bronch sm musc relax, inc glycogenolysis

24

How does dobutamine work as a vasopressor

Beta-adrenergic inotropic effects

25

How does dopamine work as a vasopressor?

alpha -> vasoconstriction. beta -> ino and chronotropic + vasodilation. Nonadrenergic splanchnic and renal vasodilation

26

How does NE work?

alpha -> vasoconstriction. beta -> ino and chronotropic

27

Other than NS and vasopressors, what treatments are possible depending on the situation?

antibiotics, surgery, thrombolytics, anticoagulants