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68wm6 p2 Shock
Shock
| Question | Answer |
|---|---|
| Define shock: | A life-threatening response to alterations in circulation that results in inadequate delivery of oxygen to tissues and cells, and their subsequent dysfunction and death. |
| When does shock begin? | Shock begins when cardiovascular system fails |
| Identify the three events that lead to the development of shock: | *Blood volume decreases (volume problem) *Heart failure as an effective pump (pump problem) *Peripheral vessel dilation (tank problem) |
| What are the four main types of shock? | *Hypovolemic. *Distributive. *Obstructive. *Cardiogenic. |
| What types of shock fall under 'distributive shock'? | *Neurogenic. *Septic. *Anaphylactic. |
| Define shock: | A life-threatening response to alterations in circulation that results in inadequate delivery of oxygen to tissues and cells, and their subsequent dysfunction and death. |
| When does shock begin? | Shock begins when cardiovascular system fails |
| Identify the three events that lead to the development of shock: | *Blood volume decreases (volume problem) *Heart failure as an effective pump (pump problem) *Peripheral vessel dilation (tank problem) |
| What are the four main types of shock? | *Hypovolemic. *Distributive. *Obstructive. *Cardiogenic. |
| What causes septic shock? | *Systemic inflammatory response syndrome to toxins *Multiple organ dysfunction syndrome *Simular vascular response as in anaphylactic shock |
| What types of shock fall under 'distributive shock'? | *Neurogenic. *Septic. *Anaphylactic. |
| What does septic shock lead to? | *Fluid shift *Hypotension *COAGULATION |
| What are the characteristics of distributive shock? | *Volume is adequate, but perfusion is inadequate. *Vascular beds are dilated. *Blood flow is not sufficient. |
| What is the characteristic cardiogenic shock | *Compression of the heart or great vessels. *Compression reduces blood that can enter and leave the heart. *Heart is unable to fill. *Cardiac output is reduced |
| What is the characteristic cardiogenic shock | |
| What are causes of Neurogenic (distributive) shock? | *Injury or disease to upper spinal cord *Spinal anesthesia *Drugs that vasodilate |
| What does anaphylactic shock lead to? | *Capillary hyperpermeability – causes the release of plasma through the capillary walls. *Hypovolemia |
| What causes septic shock? | *Systemic inflammatory response syndrome to toxins *Multiple organ dysfunction syndrome *Simular vascular response as in anaphylactic shock |
| What does septic shock lead to? | *Fluid shift *Hypotension *COAGULATION |
| What are the characteristics of obstructive shock? | *Compression of the heart or great vessels. *Compression reduces blood that can enter and leave the heart. *Heart is unable to fill. *Cardiac output is reduced |
| What is the characteristic cardiogenic shock | Heart failure |
| What are the causes of cardiogenic shock? | *Myocardial infarction *Dysrhythmias *Cardiomyopathy *Myocarditis *Valvular disease and structural disorders |
| What is the mortality rate of cardiogenic shock? | 50% - 80% |
| What are the four stages of shock? | *Initiation *Compensatory *Progressive *Refractory (Irreversible) |
| What characterizes stage 1 of shock? | Subclinical hypoperfusion |
| What characterizes stage 2 of shock? | Activation of compensatory mechanisms to maintain homeostasis |
| What are the three specific compensatory mechanisms that begin to work indipendently in phase 2 shock? | *Neural *Endocrine *Chemical |
| What are Baroreceptors sensitive to? | Pressure changes |
| What does shock stimulate the pituitary gland to produce? | adrenocorticotropic hormone (ACTH) |
| During shock, ACTH acts on the adrenal cortex to release what? | Aldosterone (antidiuretic hormone) to stimulate the retention of Na+ *Glucocorticoids for Glyco/Glucogenesis *Mineralcorticoids (renin-angiotensin response) |
| What is the Renin-Angiotensin-Aldosterone Response (RAAS) process? | Kidney releases renin in response to poor perfusion to the kidneys --> Renin stimulates the conversion of angiotensinogen to angiotensin I. --> Angiotensin I is converted to angiotensin II in the lungs. --> Angiotensin II is a potent vasoconstrictor |
| A drop of how many mmHg below PTs normal systolic BP indicates impending or actual shock? | >20mmHg |
| What is the normal difference between systolic and diastolic pressure? | 30mmHg to 50mmHg |
| What happens to the difference in systolic/diastolic pressure in the PT with impending shock? | The pulse pressure narrows (systolic pressure nears diastolic pressure) |
| A systolic change of what during an orthostatic (tilt) test indicates hypoperfusion? | 10+ drop in systolic |
| Distended neck veins is indicative of what kind of shock? | cardiogenic/obstructive |
| Flat neck veins is indicative of what kind of shock? | hypovolemic/distributive |
| Hypothermia is characteristic of all shock except which? | septic shock |
| What is a sensitive indicator of systemic perfusion? | Urine output: >30ml/hr |
| What is an indicator that blood needs to be transfused for shock? | Hct is less than 30% |
| What pharmacologic therapy affects preload and afterload? | *Vasopressors: epinephrine and norepinephrine *Reduces preload: nitroprusside |
| What are the actions of an intra-aortic balloon pump? | *Reduces afterload *Improves coronary artery perfusion *Improves perfusion to vital organs |
| What is used to control hemorrhage and hypotension from pelvic fractures? | Pneumatic anti-shock garment (PASG) or Military anti-shock trousers (MAST) |
| What types of fluids are administered to the patient with hypovolemic shock? | Crystalloid, colloid, blood |
Created by:
Shanejqb
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