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102 Cards in this Set
- Front
- Back
Inadequate delivery of oxygen and nutrients to the tissues relative to tissue metabolic demand.
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Shock
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Forms of shock that have a high cardiac output are?
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sepsis or severe anemia
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inadequate blood volume or inadequate oxygen-carrying capacity type of shock are?
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hypovolemic or hemorragic
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A type of shock due to inappropriately distributed blood volume.
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Distributive shock
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A type of shock due to impairment of heart contractility.
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cardiogenic
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A type of shock caused by restricted blood flow.
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obstructive shock
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A pathologic condition in which a region of the body or an organ is deprived of adequate oxygen supply
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Tissue hypoxia
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Tissue oxygenation depends on the amount of blood pumped per minute (cardiac output) and the _________?
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arterial content of that blood
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The causes of tissue fall into what 4 categories?
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*hypoxemic hypoxia
*anemic hypoxia *ischemic hypoxia *histoxic hypoxia |
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Hypoxemic hypoxia results from?
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reduced arterial oxygen content
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Hypoxemic hypoxia is caused by?
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inadequate partial pressure of O2 (altitude)
Airway obstruction (severe) Inadequate alveolar-capillary transfer Intracardiac shunt ( congenital heart disease). |
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Administration of O2 may be helpful, but will not work alone to adress ______, correction depends on addressing the underlying cause of low arterial O2 saturation
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hypoxemic hypoxia
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_______ is caused by an abnomality in the O2 carrying capacity of the blood, Specifically a low hemoglobin concentration.
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Anemic hypoxia
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Anemic hypoxia can be caused by ____?
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Blood loss
excessive red blood cell destruction (hemolysis) Deficient red blood cell production |
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O2 may help improve symptoms by increasing the concentration in the blood with this type hypoxia.
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Anemic
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The treatment of anemic hypoxia is to restore the _____ and manage the underlying problem
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hemoglobin concentration
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_______ results from inadequate delivery of O2 to the tissues because blood flow is insufficient.
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ischemic hypoxia
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Hemoglobin concentration and oxygen saturation can be normal with this type of hypoxia.
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Ischemic
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Ischemic hypoxia is caused by any condition characterized by a low cardiac output, such as ______?
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hypovoemia
intense vasoconstriction poor heart function severe obstruction (pulmonary embolism, coarctation of the aorta) |
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Treatment for ischemic hypoxia focuses the efforts on ____- and ______
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cardiac output and tissue perfusion
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_____ results from impaired cellular metabolic (mitochondrial) O2 use despite normal or increased O2 delivery.
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Histotoxic hypoxia (also called cytotoxic hypoxia)
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Causes of histotoxic hypoxia include?
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cyanide poisoning, carbon monoxide poisoning and methemoglobinemia.
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During histotoxic hypoxia cyanide poisoning inhibits a critical mitochondrial enzyme called _____?
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Cytochrome oxidase
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Septic shock is characterized by disordered _____?
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mitochondrial function
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The byproduct of anaerobic metabolism is _____?
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lactic acid
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Oxygen content of the blood is determined by ___________________ that is saturated with oxygen
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concentrationa and percent of hemoglobin.
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In children low cardiac output is most often the result of ____ rather than ____?
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low stroke volume
heart rate |
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In children low cardiac output is most often the result of _____?
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heart rate
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Stroke volume is determined by these 3 factors.
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Preload: blood present in the ventricle before contraction.
Contractility: Strength of contraction. Afterload: (resistance against the contracting ventticle) |
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_____ is the most common cause of low stroke volume and therefore low cardiac output.
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inadequate preload
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Inadequate preload may be caused by a number of factors such as ___________ and will result in _____ shock.
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hemorrhage, severe dehydration, vasodilation.
Hypovolemic shock |
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Preload is often estimated by ____?
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central venous pressure (CVP)
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As central venous pressure (CVP) increases, the amount of blood left in the heart at the end of diastole (end-diastolic volume) _____?
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increases
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At a steady state most of the blood volume about ___-% is in the veins
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70%
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An essential component of the treatment of cardiogenic shock is _____?
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afterload reduction
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The body's second line of defense is to ______?
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shunt blood away from nonvital organs.
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When systemic vascular resistance is increased the diastolic blood pressure _____?
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increases
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In this type of shock hypotension is an early sign rather than a later sign of shock.
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Septic shock
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The 4 basic types of shock are?
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Hypovolemic
Distributive Cardiogenic Obstructive |
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The most common type of shock in children worldwide?
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Hypovolemia
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The leading cause of hypovolemic shock?
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fluid loss due to diarrhea
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During hypovolemic shock Preload is _____ Contractility is _____ and afterload is _____?
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Decreased
Normal or increased Increased |
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Distributive shock is characterized by _____?
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inappropriate distribution of blood volume with inadequate organ and tissue perfusion.
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The most common forms of distributive shock are?
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septic
anaphylactic neurogenic |
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There is an abnormal reduction in systemic vascular resistance resulting in abnormal distribution of blood flow in this type shock.
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Distributive
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There is a loss of plasma from distributive shock caused by _____?
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increased capillary permemability
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Venodilation, systemic vasodilation, and increased capillary permeability combine with pulmonary vasoconstriction to reduce cardiac output due to relative hypovolemia and increased right ventricular afterload in this type of shock.
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Anaphylactic
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This type of shock is characterized by a generalized loss of vascular tone, most often following a high cervical spine injury.
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Neurogenic
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Central venous oxygen saturation may be normal or even increased in ______ because of the inappropriate blood flow to the organs.
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septic
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In distributive shock preload is ______, contractility is ______ and afterload is _____.
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normal or decreased
normal or decreased variable |
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Wide pulse pressure is characteristic of _______.
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Distributive shock.
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High cardiac output and low systemic vascular resistance are often observed in ______ shock.
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distributive
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Low cardiac output, and high systemic vascular resistance is typically seen in _____ shock.
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hypovolemic, cardiogenic, and obstructive shock.
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Findings consistent with distributive shock include?
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Hypotension with a wide (warm shock) or narrow (cold shock) pulse pressure.
Bounding peripheral pulses warm flushed skin of pale skin with vasoconstriction. |
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_____ shock is the most common form of distributive shock.
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Septic
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_____ shock is caused by infectious organisms of their byproducts.
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Septic
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Endotoxins of septic shock stimulate the immune system and trigger _________?
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release or activation of inflammatory mediators.
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_____ produce vasodilation and increase capillary permeability in septic shock.
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Cytokines
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The pathophysiology of the septic cascade include _______________?
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1.The infectious organism or its byproducts (endotoxins) activate the immune system.
2. These cells, or their interaction with the infecting organism, stimulate release or activation of inflammatory mediators (cytokines) 3. These cytokines produce vasodilation in increase capillary permeability. |
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Uncontrolled activation of _________ can lead to organ failure in septic shock.
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inflammatory mediators
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Clinical characteristics of pediatric sepsis are ___________?
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Systemic inflammatory response syndrome (SIRS)
Sepsis Severe sepsis Septic shock (the 4 S's_ |
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Systemic Inflammatory Response Syndrome (SIRS) is defined by the presence of at lease 2 of the following 4. But one must include temp or leukocyte count.
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core temp >38.5 c or < 36 c
Tachycardia (over 1/2 to 4 hr) Mean respiratory rate Leukoyte count elevated or depressed. |
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Sepsis id defined as SIRS in the presence of , or as a result of, suspected or proven ____?
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infection
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Severe sepsis is defined as?
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Sepsis + cardiovascular or respiratory distress syndrome. or Sepsis + 2 or more other organ failures.
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Respiratory failure as a sign of organ dysfunction in sepsis is characterized by?
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PaO2/FiO2 <300
PaCO2 > 65mm Hg or 20 mm Hg above baseline. Proven need for O2 greater than 50% need for mechanical ventilation |
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Septic shock is defined as?
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(SIRS) in the presence of, or as a result of, suspected or proven infectiomn. or Cardiovascular dysfunction despite fluid boluses > or = to 40mL/kg in 1 hr
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Because capillary permeability is increased providers should anticipate the development of ______ during volume resuscitation.
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pulmonary edema
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____ is often needed to restore adequate blood pressure in septic shock.
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vasopressor therapy
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In septic shock myocardial dysfunction may develop and is an indication for _____?
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inotropic therapy
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In septic shock, if adrenal dysfunction is present or suspected _____ therapy is indicated.
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Cortisol
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Anaphylactic shock is characterized by?
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Venodilation, systemic vasodilation, and increased capillary permeability combined with pulmonary vasoconstriction.
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The vasoconstriction acutely increases right heart work and may add to the _____?
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hypotension.
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In anaphylactic shock hypotension is caused by ______; hypovolemia is caused by _____?
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vasodilation
capillary leak and intravascular volume loss. |
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Neurogenic shock, including spinal shock, results from an injury to the head or spine that disrupts the _______ innervation of the vessels and the heart.
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sympathetic nervous system
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The cause of neurogenic shock is usually is _____ but may also result from head injury or injury to the thoracic spine above the ___ spine.
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a cervical spine injury
Sixth thoracic |
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In neurogenic shock, The sudden loss of sympathetic nervous system signals to the smooth muscle in the vessel walls result in _____?
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uncontrolled vasodilation
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Primary signs of neurogenic shock are?
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*hypotension with a wide pulse pressure.
*normal heart rate or bradycardia. *may have increased respiratory rate or diaphragmatic breathing. |
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Neurogenic shock is differentiated from hypovolemic shock by?
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In neurogenic shock, hypotension occurs without compensatory tachycardia or peripheral vasoconstriction because sympathetic innervation of the heart is also disrupted
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Hypovolemic shock is differentiated from neurogenic shock by?
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Hypovolemic shock is typically associated with hypotension, a narrow pulse pressure from compensatory tachycardia.
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Cardiogenic shock is a condition of inadequate tissue perfusion resulting from _____
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myocardial dysfunction
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Cardiogenic shock can be caused by ________?
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pump failure, congenital heart disease, myocarditis, cardiomyopathy, arrhythmias, sepsis, poisoning or drug toxicity, injury.
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Cardiogenic shock is characterized by ______?
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decreased cardiac output, marked tachycardia, and high systemic vascular resistance.
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In cardiogenic shock the preload is _____, contractility is _____, and the afterload is _____.
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variable
Decreased Increased |
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Crdiogenic shock is often characterized by sequential compensatory and ____ mechanisms.
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pathologic
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In cardiogenic shock compensatory increases in systemic vascular resistance to _____?
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redirect blood flow to the heart and brain.
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Cardiogenic shock increases both _____ and _____ which increases left ventricular work and O2 consumption.
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heart rate and left ventricular afterload.
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In cardiogenic shock as afterload increases, ______ decreases.
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stroke volume
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Cardiogenic shock increases venous tone, which increases _________ and _______ pressures.
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central venous (right atrial) and pulmonary (left atrial). and renal fluid retention.
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Type - specific signs that distinguish cardiogenic shock are.
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Increased respiratory effort
Signs of congestive heart failure Cyanosis |
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For cardiogenic shock the pulse oxietry may be ___ id there is pulmonary edema.
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low
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Increased respiratory effort often distinguishes _____ shock from hypovolemic shock. Hypovolemic shock is characterized by _________.
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cardiogenic
quiet tachypnea |
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In children with cardiogenic shock volume resuscitation should be given ______.
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gradual with smaller (5 to 10 mL/kg)
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Obstructive shock is caused by?
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impaired cardiac output caused by physical obstruction to blood flow.
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Types of obstructive shock include?
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cardiac tamponade
tension pneumothorax ductal dependent congenital heart lesions. massive pulmonary embolism |
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Early clinical presentation of obstructive shock may be indistinguishable from ________?
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severe hypovolemic
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Obstructive shock may reveal signs of ____ or ____ that would not be consistent with hypovolemic shock.
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systemic or pulmonary venous congestion
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If untreated, cardiac tamponade will result in cardiac arrest characterized by _________.
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pulseless elecrical activity
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Distinguishing signs of cardiac tamponade are?
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muffled or diminished heart sounds.
pulsus paradoxis distended neck veins |
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Pulmonary embolism results in a vicious cycle of events, including?
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vent/perfusion mismatc
systemic hypoxemia increased PVR left shift of the septum Rapid fall in end-tidal CO2 |
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Ductal-dependant are ?
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Cardiac abnormalties (usually present in the 1st week)
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Ductal dependant lesions include?
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Cyanotic (pulmonary blood flow)
left ventricular (systemic blood flow) |
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Left sides lesions include?
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coarcation of the aorta
interrupted aortic arch aortic stenosis hypoplastic left heart syndrome |