Grayson Pals Chapter 4 Shock

Front 1

Inadequate delivery of oxygen and nutrients to the tissues relative to tissue metabolic demand.

Back 1

Shock

Front 2

Forms of shock that have a high cardiac output are?

Back 2

sepsis or severe anemia

Front 3

inadequate blood volume or inadequate oxygen-carrying capacity type of shock are?

Back 3

hypovolemic or hemorragic

Front 4

A type of shock due to inappropriately distributed blood volume.

Back 4

Distributive shock

Front 5

A type of shock due to impairment of heart contractility.

Back 5

cardiogenic

Front 6

A type of shock caused by restricted blood flow.

Back 6

obstructive shock

Front 7

A pathologic condition in which a region of the body or an organ is deprived of adequate oxygen supply

Back 7

Tissue hypoxia

Front 8

Tissue oxygenation depends on the amount of blood pumped per minute (cardiac output) and the _________?

Back 8

arterial content of that blood

Front 9

The causes of tissue fall into what 4 categories?

Back 9

*hypoxemic hypoxia
*anemic hypoxia
*ischemic hypoxia
*histoxic hypoxia

Front 10

Hypoxemic hypoxia results from?

Back 10

reduced arterial oxygen content

Front 11

Hypoxemic hypoxia is caused by?

Back 11

inadequate partial pressure of O2 (altitude)
Airway obstruction (severe)
Inadequate alveolar-capillary transfer
Intracardiac shunt ( congenital heart disease).

Front 12

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

Back 12

hypoxemic hypoxia

Front 13

_______ is caused by an abnomality in the O2 carrying capacity of the blood, Specifically a low hemoglobin concentration.

Back 13

Anemic hypoxia

Front 14

Anemic hypoxia can be caused by ____?

Back 14

Blood loss
excessive red blood cell destruction (hemolysis)
Deficient red blood cell production

Front 15

O2 may help improve symptoms by increasing the concentration in the blood with this type hypoxia.

Back 15

Anemic

Front 16

The treatment of anemic hypoxia is to restore the _____ and manage the underlying problem

Back 16

hemoglobin concentration

Front 17

_______ results from inadequate delivery of O2 to the tissues because blood flow is insufficient.

Back 17

ischemic hypoxia

Front 18

Hemoglobin concentration and oxygen saturation can be normal with this type of hypoxia.

Back 18

Ischemic

Front 19

Ischemic hypoxia is caused by any condition characterized by a low cardiac output, such as ______?

Back 19

hypovoemia
intense vasoconstriction
poor heart function
severe obstruction (pulmonary embolism, coarctation of the aorta)

Front 20

Treatment for ischemic hypoxia focuses the efforts on ____- and ______

Back 20

cardiac output and tissue perfusion

Front 21

_____ results from impaired cellular metabolic (mitochondrial) O2 use despite normal or increased O2 delivery.

Back 21

Histotoxic hypoxia (also called cytotoxic hypoxia)

Front 22

Causes of histotoxic hypoxia include?

Back 22

cyanide poisoning, carbon monoxide poisoning and methemoglobinemia.

Front 23

During histotoxic hypoxia cyanide poisoning inhibits a critical mitochondrial enzyme called _____?

Back 23

Cytochrome oxidase

Front 24

Septic shock is characterized by disordered _____?

Back 24

mitochondrial function

Front 25

The byproduct of anaerobic metabolism is _____?

Back 25

lactic acid

Front 26

Oxygen content of the blood is determined by ___________________ that is saturated with oxygen

Back 26

concentrationa and percent of hemoglobin.

Front 27

In children low cardiac output is most often the result of ____ rather than ____?

Back 27

low stroke volume

heart rate

Front 28

In children low cardiac output is most often the result of _____?

Back 28

heart rate

Front 29

Stroke volume is determined by these 3 factors.

Back 29

Preload: blood present in the ventricle before contraction.
Contractility: Strength of contraction.
Afterload: (resistance against the contracting ventticle)

Front 30

_____ is the most common cause of low stroke volume and therefore low cardiac output.

Back 30

inadequate preload

Front 31

Inadequate preload may be caused by a number of factors such as ___________ and will result in _____ shock.

Back 31

hemorrhage, severe dehydration, vasodilation.

Hypovolemic shock

Front 32

Preload is often estimated by ____?

Back 32

central venous pressure (CVP)

Front 33

As central venous pressure (CVP) increases, the amount of blood left in the heart at the end of diastole (end-diastolic volume) _____?

Back 33

increases

Front 34

At a steady state most of the blood volume about ___-% is in the veins

Back 34

70%

Front 35

An essential component of the treatment of cardiogenic shock is _____?

Back 35

afterload reduction

Front 36

The body's second line of defense is to ______?

Back 36

shunt blood away from nonvital organs.

Front 37

When systemic vascular resistance is increased the diastolic blood pressure _____?

Back 37

increases

Front 38

In this type of shock hypotension is an early sign rather than a later sign of shock.

Back 38

Septic shock

Front 39

The 4 basic types of shock are?

Back 39

Hypovolemic
Distributive
Cardiogenic
Obstructive

Front 40

The most common type of shock in children worldwide?

Back 40

Hypovolemia

Front 41

The leading cause of hypovolemic shock?

Back 41

fluid loss due to diarrhea

Front 42

During hypovolemic shock Preload is _____ Contractility is _____ and afterload is _____?

Back 42

Decreased

Normal or increased

Increased

Front 43

Distributive shock is characterized by _____?

Back 43

inappropriate distribution of blood volume with inadequate organ and tissue perfusion.

Front 44

The most common forms of distributive shock are?

Back 44

septic
anaphylactic
neurogenic

Front 45

There is an abnormal reduction in systemic vascular resistance resulting in abnormal distribution of blood flow in this type shock.

Back 45

Distributive

Front 46

There is a loss of plasma from distributive shock caused by _____?

Back 46

increased capillary permemability

Front 47

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.

Back 47

Anaphylactic

Front 48

This type of shock is characterized by a generalized loss of vascular tone, most often following a high cervical spine injury.

Back 48

Neurogenic

Front 49

Central venous oxygen saturation may be normal or even increased in ______ because of the inappropriate blood flow to the organs.

Back 49

septic

Front 50

In distributive shock preload is ______, contractility is ______ and afterload is _____.

Back 50

normal or decreased

normal or decreased

variable

Front 51

Wide pulse pressure is characteristic of _______.

Back 51

Distributive shock.

Front 52

High cardiac output and low systemic vascular resistance are often observed in ______ shock.

Back 52

distributive

Front 53

Low cardiac output, and high systemic vascular resistance is typically seen in _____ shock.

Back 53

hypovolemic, cardiogenic, and obstructive shock.

Front 54

Findings consistent with distributive shock include?

Back 54

Hypotension with a wide (warm shock) or narrow (cold shock) pulse pressure.
Bounding peripheral pulses
warm flushed skin of pale skin with vasoconstriction.

Front 55

_____ shock is the most common form of distributive shock.

Back 55

Septic

Front 56

_____ shock is caused by infectious organisms of their byproducts.

Back 56

Septic

Front 57

Endotoxins of septic shock stimulate the immune system and trigger _________?

Back 57

release or activation of inflammatory mediators.

Front 58

_____ produce vasodilation and increase capillary permeability in septic shock.

Back 58

Cytokines

Front 59

The pathophysiology of the septic cascade include _______________?

Back 59

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.

Front 60

Uncontrolled activation of _________ can lead to organ failure in septic shock.

Back 60

inflammatory mediators

Front 61

Clinical characteristics of pediatric sepsis are ___________?

Back 61

Systemic inflammatory response syndrome (SIRS)
Sepsis
Severe sepsis
Septic shock (the 4 S's_

Front 62

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.

Back 62

core temp >38.5 c or < 36 c
Tachycardia (over 1/2 to 4 hr)
Mean respiratory rate
Leukoyte count elevated or depressed.

Front 63

Sepsis id defined as SIRS in the presence of , or as a result of, suspected or proven ____?

Back 63

infection

Front 64

Severe sepsis is defined as?

Back 64

Sepsis + cardiovascular or respiratory distress syndrome. or Sepsis + 2 or more other organ failures.

Front 65

Respiratory failure as a sign of organ dysfunction in sepsis is characterized by?

Back 65

PaO2/FiO2 <300
PaCO2 > 65mm Hg or 20 mm Hg above baseline.
Proven need for O2 greater than 50%
need for mechanical ventilation

Front 66

Septic shock is defined as?

Back 66

(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

Front 67

Because capillary permeability is increased providers should anticipate the development of ______ during volume resuscitation.

Back 67

pulmonary edema

Front 68

____ is often needed to restore adequate blood pressure in septic shock.

Back 68

vasopressor therapy

Front 69

In septic shock myocardial dysfunction may develop and is an indication for _____?

Back 69

inotropic therapy

Front 70

In septic shock, if adrenal dysfunction is present or suspected _____ therapy is indicated.

Back 70

Cortisol

Front 71

Anaphylactic shock is characterized by?

Back 71

Venodilation, systemic vasodilation, and increased capillary permeability combined with pulmonary vasoconstriction.

Front 72

The vasoconstriction acutely increases right heart work and may add to the _____?

Back 72

hypotension.

Front 73

In anaphylactic shock hypotension is caused by ______; hypovolemia is caused by _____?

Back 73

vasodilation

capillary leak and intravascular volume loss.

Front 74

Neurogenic shock, including spinal shock, results from an injury to the head or spine that disrupts the _______ innervation of the vessels and the heart.

Back 74

sympathetic nervous system

Front 75

The cause of neurogenic shock is usually is _____ but may also result from head injury or injury to the thoracic spine above the ___ spine.

Back 75

a cervical spine injury

Sixth thoracic

Front 76

In neurogenic shock, The sudden loss of sympathetic nervous system signals to the smooth muscle in the vessel walls result in _____?

Back 76

uncontrolled vasodilation

Front 77

Primary signs of neurogenic shock are?

Back 77

*hypotension with a wide pulse pressure.
*normal heart rate or bradycardia.
*may have increased respiratory rate or diaphragmatic breathing.

Front 78

Neurogenic shock is differentiated from hypovolemic shock by?

Back 78

In neurogenic shock, hypotension occurs without compensatory tachycardia or peripheral vasoconstriction because sympathetic innervation of the heart is also disrupted

Front 79

Hypovolemic shock is differentiated from neurogenic shock by?

Back 79

Hypovolemic shock is typically associated with hypotension, a narrow pulse pressure from compensatory tachycardia.

Front 80

Cardiogenic shock is a condition of inadequate tissue perfusion resulting from _____

Back 80

myocardial dysfunction

Front 81

Cardiogenic shock can be caused by ________?

Back 81

pump failure, congenital heart disease, myocarditis, cardiomyopathy, arrhythmias, sepsis, poisoning or drug toxicity, injury.

Front 82

Cardiogenic shock is characterized by ______?

Back 82

decreased cardiac output, marked tachycardia, and high systemic vascular resistance.

Front 83

In cardiogenic shock the preload is _____, contractility is _____, and the afterload is _____.

Back 83

variable

Decreased

Increased

Front 84

Crdiogenic shock is often characterized by sequential compensatory and ____ mechanisms.

Back 84

pathologic

Front 85

In cardiogenic shock compensatory increases in systemic vascular resistance to _____?

Back 85

redirect blood flow to the heart and brain.

Front 86

Cardiogenic shock increases both _____ and _____ which increases left ventricular work and O2 consumption.

Back 86

heart rate and left ventricular afterload.

Front 87

In cardiogenic shock as afterload increases, ______ decreases.

Back 87

stroke volume

Front 88

Cardiogenic shock increases venous tone, which increases _________ and _______ pressures.

Back 88

central venous (right atrial) and pulmonary (left atrial). and renal fluid retention.

Front 89

Type - specific signs that distinguish cardiogenic shock are.

Back 89

Increased respiratory effort
Signs of congestive heart failure
Cyanosis

Front 90

For cardiogenic shock the pulse oxietry may be ___ id there is pulmonary edema.

Back 90

low

Front 91

Increased respiratory effort often distinguishes _____ shock from hypovolemic shock. Hypovolemic shock is characterized by _________.

Back 91

cardiogenic

quiet tachypnea

Front 92

In children with cardiogenic shock volume resuscitation should be given ______.

Back 92

gradual with smaller (5 to 10 mL/kg)

Front 93

Obstructive shock is caused by?

Back 93

impaired cardiac output caused by physical obstruction to blood flow.

Front 94

Types of obstructive shock include?

Back 94

cardiac tamponade
tension pneumothorax
ductal dependent congenital heart lesions.
massive pulmonary embolism

Front 95

Early clinical presentation of obstructive shock may be indistinguishable from ________?

Back 95

severe hypovolemic

Front 96

Obstructive shock may reveal signs of ____ or ____ that would not be consistent with hypovolemic shock.

Back 96

systemic or pulmonary venous congestion

Front 97

If untreated, cardiac tamponade will result in cardiac arrest characterized by _________.

Back 97

pulseless elecrical activity

Front 98

Distinguishing signs of cardiac tamponade are?

Back 98

muffled or diminished heart sounds.
pulsus paradoxis
distended neck veins

Front 99

Pulmonary embolism results in a vicious cycle of events, including?

Back 99

vent/perfusion mismatc
systemic hypoxemia
increased PVR
left shift of the septum
Rapid fall in end-tidal CO2

Front 100

Ductal-dependant are ?

Back 100

Cardiac abnormalties (usually present in the 1st week)

Front 101

Ductal dependant lesions include?

Back 101

Cyanotic (pulmonary blood flow)

left ventricular (systemic blood flow)

Front 102

Left sides lesions include?

Back 102

coarcation of the aorta
interrupted aortic arch
aortic stenosis
hypoplastic left heart syndrome