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29 Cards in this Set
- Front
- Back
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hypotension, decreased tissue perfusion, and cellular hypoxia are all indicative of what?
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inadequate tissue perfusion due to decreased cardiac output (relative or absolute)
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What is the etiology for Hypovolemic shock?
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Inadequate blood volume due to
-hemmorrhage -Trauma - Surgery - Burns - Fluid loss --> vomiting * Fluid loss is very dangerous in children! |
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What is the etiology of Vasogenic distributed) shock ?
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Blood volume is NORMAL but not available for distribution due to..
- neurogenic shock (syncope, spinal cord injury) -anaphylaxis -septic shock |
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What is the etiology of Cardiogenic shock?
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Circulatory collapse (decreased cardiac output) resulting from pump failure due to
-myocardial infarction - congestive heart failure -arrhythmias |
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What is the etiology of Obstructive shock?
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Obstruction of blood due to
- pulmonary embolism - cardiac tamponade -cardiac tumor -tension pneumothorax |
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Hemorrhagic, Trumatic, Burn, and Surgical Shock are all classified as what type of shock?
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Hypovolemic
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Hypotension, rapid thready pulse, cold clammy skin, tachycardia,and tachypnia are symptoms of what type of shock?
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hypovolemic shock
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What causes acidosis in hypovolemic shock?
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inadequate perfusion of tissue increases anaerobic glycolysis which leads to build up of lactic acid. This is followed by a decrease in peripheral vascular response to catecholamines => myocardial depression and depression of cerebral function which can lead to coma
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What are compensatory mechanisms to hypovolemic shock?
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Low blood pressure => stimulates baroreceptors which cause VASOCONSTRICTION to the limb resulting in increased perfusion to heart and limb but cold and clammy skin
Hypovolemia => increases sodium and H20 retention by increasing angiotensin, catecholamines, epo, vasopressin, ACTH, and aldosterone. Low O2 in blood => stimulates chemoreceptors which leads to tachypnia and tachycardia. |
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Cerebral Ischemia and Myocardial ischemia which lead to further decrease in blood pressure and increase in shock are sing of what type of shock?
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refractory shock
- patient shows no response to treatment Also, patient has endothelial damage with increases cytokines => Acute respiratory distress syndrome. |
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A sudden increase in vascular bed capacitance associated with systemic vasodilation and PERIPHERAL POOLING is associated with what type of shock?
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vasogenic shock
- acute disparity between volume of blood and capacity of the vascular system |
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Loss of vascular tone and peripheral pooling of blood due to spinal cord injury, anesthetic accident, or syncope is classified as what type of vasogenic shock?
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Neurogenic shock
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T/F cold and clammy skin is a sign of vasogenic shock
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FALSE!
cold and clammy skin is a sign of HYPOVOLEMIC shock. warm skin is a sign of VASOGENIC shock, |
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How does allergic reaction cause a decrease in blood pressure?
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allergic reactions increase histamine which increase vasodilation ==> decreased BP.
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What causes peripheral pooling?
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peripheral pooling is caused by vasodilation due to chemical mediators and cytokines following tissue destruction, allergic reaction, or bacterial infection
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What is cardiac temponade?
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cardiac temponade is fluid accumulation in the pericardium. It is associated with obstructive shock.
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What causes tension pneumothorax?
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tension pneumothorax is caused by a rupture in the lungs that disrupts the negative pressure in the lungs => lungs collapse and mediastenum shifts => blocks blood vessels => obstructive shock
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What is the leading cause of death in ICUs in the US ?
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sepsis and septic shock
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Use of catheters, invasive procedures, prosthetic devices, and immunosuppresive and cytotoxic drugs increase the risk of what type of shock?
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septic shock
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What causes sepsis?
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sepsis results from spread of severe bacterial infection caused mostly by endotoxin of gram - bacillu and the rest by toxins of gram +.
- LPS activates chemokine and cytokine production |
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What is Systemic Inflammatory Response Syndrome?
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SIRS is an exaggerated generalized inflammatory reaction, a hypermetabolic state, that can lead to multiple organ failure (septic shock)
- SIRS results from systemic release of TNF, IL-1, 6, and PAF |
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What are conditions that indicate poor prognosis of a patient?
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hypothermia and leukopenia
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What are the compensatory mechanisms for sepsis?
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- tachycardia
- tachypnia - fever - increased WBC count |
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What are the sings and symptoms of sepsis syndrome?
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-decreased perfusion
- peripheral vasodilation - hypoxemia - increased lactate - oliguria (decreased urine) - decreased mental status |
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How does infection lead to shock?
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Infection => Bacterimia, endotoxins, exotoxins => Active inflammatory cells => release mediators => activation of complement, kinin and coagulation systems => vasodilation, myocardial depression, organ disfunction => SHOCK
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What morphology is seen in the following organs ..
Heart? Brain? Lungs? GIT? Liver? |
Heart - focal or widespread myocardial necrosis
Brain - ischemic encephalopathy Lungs - diffuse alveolar damage (Shock Lung) GIT: patchy mucosal hemorrhages and necroses (hemorrhagic enteropathy) Liver: fatty change, central hemorrhagic necrosis |
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A clinical presentation of hypotension, weak rapid pulse, tachypnia, cold and clammy skin (or warm if sepsis) are indicative of what?
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SHOCK
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T/F: Prognosis of shock is very bad if 3 or more organs fail
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true, 80-100% mortality
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increased bilirubin, increased AST, and increased alkaline phosphatase are signs of failure of what organ?
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Liver
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