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22 Cards in this Set
- Front
- Back
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What are the 4 stages of shock?
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Initial, compensatory, decompensatory, and refractory
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What are the 4 different main types of shock?
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Hypovolemic, Cardiogenic, Obstructive, and Distributive
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What characterizes the initial stage of shock?
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Conversion to anaerobic metabolism due to hypoxia, which results in acidosis through lactate production and sequential tissue damage--also cells that require large amounts of energy go into metabolic failure and cell death
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What characterizes the compensatory stage of shock?
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Five elements: Baroreceptor reflex, RA system, peripheral and central Chemoreceptors, and Capillary fluid movement
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Does the baroreceptor reflex cause veinous constriction too?
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YES
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Where is renin stored and released? What causes its release? What are its three effects?
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Juxtaglomerular cells of the afferent arteriole--low renal perfusion pressure--
1. Peripheral VASOCONSTRICTION 2. Aldosterone release 3. ADH release |
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Where are the peripheral chemoreceptors and what do they stimulate?
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In the aortic arch and carotid bifurcation and they stimulate increased breathing rate
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What are the features of the decompensatory stage of shock?
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Acidosis due to RA system inducing renal vasoconstriction leading to reduced urine output and high [H+]--Cardiac failure from reduced coronary blood flow--agglutination of RBC's forming clots(sludged blood)--immune cell dysfunction--low intestinal blood flow leading to death of gram negative bacteria
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What are the effects of shock acidosis in the body?
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Depress myocardial function and impair responsiveness of heart to Symp stimulation--Reduces sensitivity of vessels to catecholamines and blunts the symp affect there too!
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What characterizes the refractory stage of shock?
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Brain damage and cell death
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Losing how much blood volume leads to hypovolemic shock?
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1-2 L
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What does the body do in response to hypovolemic shock?
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Tachycardia and increased TPR--rapid and shallow respirations due to symp activation and acidosis
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How do you treat hypovolemic shock?
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If blood loss is >20% then give a transufsion--otherwise give electrolytes to boost blood volume
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How should you NOT treat hypovolemic shock?
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Vasoconstrictive therapy--ineffective in the context of acidosis
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What are the two obstructive shock scenarios? What are the symptoms? What are the treatments?
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Cardiac tamponade and pulmonary embolism
Jugular vein distention and Pulsus Paradoxus(can't detect radial pulse during heard heart beat) Anticoag for embolism and draining for tamponade |
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What are the three types of distributive shock?
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Anaphylactic, neurogenic, and Septic
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See Slide 31 for cardiogenic shock treatments
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Slide 31
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What changes in the peripheral vasculature during distributive shock?
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Dilation of non-vital vascular beds that results in a redistribution of blood volume and significant reduction in venous return
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What is a sign of neurogenic shock?
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Skin remains warm due to lack of Symp mediated vasoconstriction
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What happens during early stage sepsis?
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Endothelial injury causes chemokine release that attracts immune cells--cytokines are also released--nitric oxide causes peripheral vasodilation and increased metabolism--an increase in cardiac output
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What can be detected in late stage sepsis?
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Cyclooxygenase-2 and Nitric Oxide Synthase 2--Also increased vascular permeability with loss of protein rich fluid in the interstitium
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What happens with age that is related to shock risk?
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Changes in organ function increases susceptibility--see slide 55 for more details
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