Cpp Shock Ex 1

Front 1

Shock Definitions

Back 1

Low BP causing inadequate organ perfusion and oxygenation

Front 2

Shock clinical manifestations

Back 2

Skin is pale, cold, sweaty
Pulse is rapid, weak, thready
Blood pressure low (It must be hypotension)
Respiratory rate increased
Altered mental status (anxiety, apprehension, coma)
Decreased urine output

Front 3

Shock in essence is due to either

Back 3

decreased CO or blood is not distributed in the right way.

Front 4

Shock stages are

Back 4

Stage I - Compensated shock
Stage II - Decompensated shock
Stage III - Irreversible

Front 5

Shock Reflex responses

Back 5

Increased sympathetic activity
Catecholamine secretion
Vasoconstriction
Increased pulse
Increased cardiac output

Front 6

Compensatory mechanism to shock

Back 6

Blood redistributed to vital organs (, heart, brain, kidney)
Blood shunted away from skin, gut, and muscles. All these fail in late stage of shock

Front 7

Cellular Hypoxia in shock

Back 7

Inadequate substrate delivery
Anaerobic metabolism
Increased lactate production
Acidotic state

Front 8

Pulmonary function under shock

Back 8

Respiratory alkalosis
Impaired oxygenation
Respiratory acidosis

Front 9

Renal function Shock

Back 9

Oliguria
Renal Vasoconstriction
Decreased renal blood flow
Acute renal failure
Ischemic cellular injury

Front 10

Shock class 1 characteristic

Back 10

Minimal tachycardia

Front 11

Class II shock characteristics

Back 11

Tachycardia, tachypnea
Subtle CNS findings (anxiety)

Front 12

Class III shock chracteristics

Back 12

Marked tachycardia, tachypnea, altered mental status
Fall in systolic blood pressure(SBP)

Front 13

Class IV shock characteristics

Back 13

Marked tachycardia, decreased SBP
Depressed mental status
No urine output
Skin cold and pale

Front 14

Hemorragic shock characteristics

Back 14

Etiology is rapid blood loss
Blood loss may be internal or external
Decreased circulating blood volume

Front 15

Hemorragic shock causes

Back 15

Traumatic
Gastrointestinal bleeding (esophageal varices)
Vascular (Abdominal Aortic Aneurysm)
Pregnancy (ectopic, placenta previa, placental abruption)

Front 16

Hemorragic shock Pathophysiology

Back 16

Rapid blood loss
Decreased venous return
Reduced ventricular filling pressures
Decreases stroke volume, CO
Hypotension

Front 17

Hemorragic shock clinical manifestations

Back 17

Clinical manifestations
Skin is pale
Increased pulse, respiratory rate
Decreased BP
Altered mental status

Front 18

Hemorragic shock treatment

Back 18

Restore intravascular volume
Intravascular fluids
Blood
Identify and treat cause

Front 19

Hypovolemic Shock
characteristics

Back 19

Fluid or electrolyte losses
Pathophysiology same as hemorrhagic
Common etiologies
Severe vomiting and diarrhea
Diabetes mellitus
Burns

Front 20

Septic shock early manifestation

Back 20

(increased CO) warm shock
Vasodilatation
Skin warm and flushed
Hyperdynamic
Altered mental status
Fever

Front 21

Septic shock late phase

Back 21

Late phase (decreased SV, CO) cold shock
↓ cardiac output, blood pressure
↓ urine output
Peripheral vasoconstriction
Mortality rate in septic shock is ~ 45%

Front 22

Septic shock Tx

Back 22

Oxygen/ventilation
Fluids
Antibiotics
Removal/drainage of infection
Inotropic/vasoconstrictive agents

Front 23

Neurogenic Shock
caused by

Back 23

Spinal cord trauma
Loss of sympathetic tone
Vasodilatation
Decreased preload and CO
Bradycardia (unusual in shocks)*

Front 24

Neurogenic Shock Clinical presentation

Back 24

Decreased blood pressure
Spinal trauma
Bradycardia

Front 25

Neurogenic Shock
Tx

Back 25

Fluids with caution
Vasopressor ( alpha-adrenergic activity)

Front 26

Cardiogenic Shock
characteristics

Back 26

Decreased pumping ability of the heart causing inadequate perfusion to tissues
Over 40% of the myocardium must be affected or ischemic to go to cardiogenic shock

Can occur with cardiac trauma, cardiomyopathy

Front 27

Cardiogenic shock leads to myocardium damage leading to

Back 27

↓ contractility
↓ ejection fraction
↓ CO
↑ ventricular filling pressures
cardiac chamber dilatation
ventricular failure
systemic hypotension, pulmonary edema

Front 28

Cardiogenic shock cellular eventsCascade of events -

Back 28

endogenous substances (myocardial depressant factor, bradykinin, leukotrienes, etc)
inhibits cardiac function
increases myocardial depression
worsening shock

Front 29

Cardiogenic shock Clinical presentation

Back 29

Hypotension
Cool, diaphoretic skin
Cyanosis, SOB
Altered mental status

Front 30

Cardiogenic Shock
Tx

Back 30

Myocardial preservation (rapid revascularization)
Best treatment is prevention
Oxygen
Fluid challenge
Cardiac monitoring
Vasopressors, inotropes

Front 31

Anaphylactic Shock

Back 31

Severe allergic reaction
Immunologically mediated systemic vasodilation
Type I hypersensitivity reaction
IgE mediated
Release of histamine from basophils and mast cells

Front 32

Anaphylactoid reaction

Back 32

- not immune mediated, direct release of mediators (histamine, leukotriene C4, tryptase, prostaglandins
)

Front 33

Anaphylactic Shock
characteristics

Back 33

Diffuse vasodilation
Increased capillary permeability
Increased secretions from mucous membranes
Increased bronchial smooth muscle tone
Distributive shock

Front 34

Anaphylactic Shock Etiologies

Back 34

Drugs (PCN, sulfonamides)
Foods (nuts, shellfish)
Toxins (bee, snake venom)
Latex
Animal sera (tetanus antitoxin)

Front 35

Anaphylactic Shock Symptoms

Back 35

Increased HR, low BP
Urticaria, pruritis, erythema, angioedema (>90% have skin involvement)
SOB, wheezing, airway obstruction
Facial/pharyngeal/laryngeal edema
Eyes tearing, itching

Front 36

Anaphylactic Shock Treatment

Back 36

Epinephrine
Oxygen/airway support/B agonists
Antihistamines, H1 and H2 blocking agents