Shock

Question 1

What is shock? What is result?

Answer 1

state where the cardiovascular system cannot maintain adequate cellular perfusion ==> resuts in decreased tissue oxygenation nutrient flow –> cellular dysfunction –> diffuse tissue injury –> death

Question 2

components of tissue perfusion:

Answer 2

• cardaic fucntion: preload, afterload, contractility, HR, venous return
• arterial pressure
• vascular function: distribution of cardiac output, microvascular functions
• cellular function: oxygen delivery, energy gen and substrate utilization

Question 3

3 types of shock:

Answer 3

1) cardiogenic: severe myocardial dysfunction with severely reduced cardiac output (AMI)
2) hypovolemic: blood loss, severe burns (severe circulatory compromise)
3) distributive: many (*sepsis, drug OD, anaphylaxis, neurogenic, abn shunting of blood flow

Question 4

Characteristics of shock

Answer 4

• very low arterial SBP
• tachycardia
• oliguria: no urine production
• mental obtundation
• cool, mottled extremities

Question 5

Etiologies of cardiogenic shock: (dec LVEF)

Answer 5

• acute MI
• dilated cardiomyopathy
• valvular (acute MR, endocarditis)
• arrhythmia (v tach)

Question 6

most important indication of prognosis?

Answer 6

LEFT VENTRICULAR FUNCTION

Question 7

Etiologies of hypovolemic shcok (reduced circulating blood volume):

Answer 7

• blood loss (trauma, GI loss such as cholera)

- fluid depletion (vomit, diarrhea, burns)

Question 8

Etiologies of distributive shock (profound peripheral vasodilation):

Answer 8

-MOST COMMON IS SEPSIS**

Question 9

consequences of shock:

Answer 9

• myocardial dysfunction
• pulmonary ARDS
• rental ATN
• GI - hepatic injury (nutmeg liver) or inetstinal ischemia/injury
• CNS-post anoxic encephalopathy (no brain perfusion)

===> MULTIORGAN CONSEQUENCES!!!!

Question 10

Therapy for shcok:

Answer 10

go to the ICU!!

• monitor ECG
• IV meds/fluids - volume expansion
• ventilatory support
• O2 if needed
• vasopressors
• inotrpics (dobutamine)
• antibiotics

Question 11

What type of solution for fluid resuscitation?**

Answer 11

ISOTONIC