Shock

Question 1

Products of anaerobic metabolism?

Answer 1

Ethanol and lactate

Question 2

What can cause shock?

Answer 2

• anaemia
• hypoxaemia
• cardiovascular disturbance

Question 3

3 causes of CV shock?

Answer 3

> blood pressure 
- systemic vascular resistance 
> stroke volume 
- preload
- after load
- contractility
> heart rate and rhythm

Question 4

Clinics, signs of shock

Answer 4

• HR
• pulse quality
• mm colour
• capillary refil
• extremity /body temperature
• mentation

Question 5

What can different heart rates tell you about the patient?

Answer 5

>normal 
-dogs 60-120
- cats 160-200
> tachycardia 
- compensation 
> bradycardia
- decompensation shock 
- cats (do whatever they want!!)

Question 6

Ddx tachycardia

Answer 6

• hypoxaemia
• anaemia
• pain
• tachyarythmias

Question 7

Ddx bradycardia

Answer 7

Bradyarrythmia, ^ ICP

Question 8

Use of ECG for shock?

Answer 8

• diagnose cause

- monitor

Question 9

What makes the pulse quality change? Which pulses should be felt?

Answer 9

Difference between systolic and diastolic BP
- femoral pulse (palpate alongside auscultation)
- metatarsal (medial aspect)
> can be increased or decreased in shock

Question 10

How can mm appear in shock? CRT? Ddx?

Answer 10

> pale
- anaemia, hypoxaemia 
> injected
- gingivitis 
> CRT CAN BE ^\v

Question 11

How may temperature differ in shock?

Answer 11

> decreased extremity in mild to mod
decreased whole body
- common in cats
- means very severe in dogs

Question 12

Levels of mentation

Answer 12

• obtained
• stupendous (painful stimulus only)
• comatose (not even pain)
  Ddx : NEURO 1* dz

Question 13

4 types of shock

Answer 13

> hypovolaemic
- preload too low 
> vasodilatory
- low systemic vascular resistance 
- LOOKS INJECTED MM (cf others look pale) 
> obstructive 
- not enough return to RA
> cardiogenic
- arrythmias

Question 14

3 types of vasoconstrictive shock? Causes?

Answer 14

> hypovolaemic 
- dehydration 
- VD+
- haemorrhage
- 3rd spacing
- PU
> obstructive
- GDV
- pericardial, effusion 
- pneumothorax 
> cardiogenic 
- arrythmias
- systolic dysfunction

Question 15

What must be remembered about stages of shock.

Answer 15

Only typical ^HR etc. In compensation stage, as they become decompensated HR DECREASES. Serious.

Question 16

How is vasoconstrictive shock classified?

Answer 16

>mild
- pulse quality can be ^/v
- CRT can be quick
- Cats HR can ^/v
- mild obtundation
> moderate 
- pule quality always v
- cats v body temp (dogs likely only extremities until decomp) 
- moderate obtundation
> severe/decompensated
- bradycardia
- cats HR can ^/v
- stuperous

Question 17

How will hypovolaemic shock present? Further diagnostics?

Answer 17

> PE
- dehydration
- pleural effusion 
- abdo distension
- rectal palpation 
> ultrasound 
- free fluid

Question 18

Tx hypovolaemia shock

Answer 18

IVFT

- control haemorrhage

Question 19

Presentation and further diagnostics of obstructive shock?

Answer 19

• distended abdo
• v heart and lung sound s
  > radiographs and ultrasound chest

Question 20

Tx obstructive shock

Answer 20

• receive obstruction

+- IVFT

Question 21

PE findings and further diagnostics cardiogenic shock?

Answer 21

• auscultation heart and lungs
• jugular distension
  > ECG
  > cardiac ultrasound
• LA:aorta (large LA shows cardiogenic shock risk)
• contractility
• pericardial effusion

Question 22

Normal LA:Ao ratio

Question 23

Tx cardiogenic shock?

Answer 23

NO FLUIDSS!!!!

• antiarrhythmics
• positive inotropes

Question 24

What are the different types of ventricular arrythmias?

Answer 24

• VPCs

- accelerated idioventricular rhythm (HR 180)

Question 25

When can ventricular arrythmias occour?

Answer 25

- cardiogenic shock - hypovoameic shock - obstructive shock - vasodilatory shock > challenging to tx as may or may not require fluid to tx underlying cause

Question 26

Types of vasodilatory shock?

Answer 26

- SIRS (systemic inflammatory response syndrome) - sepsis - anaphylaxis - anaesthesia

Question 27

How does vasodilatory shock present differently to vasoconstrictive? Stages?

Answer 27

``` > mild - pulse bounding - CRT quicker - mm injected > moderate > decompensated ```

Question 28

What causes SIRS?

Answer 28

- severe trauma | - immune mediated disease

Question 29

PE vasodilatory shock and further diagnostics

Answer 29

Signs > mild and moderate - pulse quality increased (cf. vasoconstrictive where likely decreased) - mm colour injected dogs, cats injected if mild but otherwise pale (mod severe) - very quick CRT until decompensated then slow - extremities warm until decompensated then ^ or v Reasons for shock

Question 30

Tx vasodilatory shock

Answer 30

- IVF (careful can overload leaky vessels) | - vasopressors to improve systemic vascular resistance (adrenaline, vasopressin, DA)

Question 31

Other markers of shock?

Answer 31

> lactate should be under 2.5mmol/l - can be use to check response to treatement > blood pressure - mild-mod shock may be normal - severe shock may be too difficult to find a pulse!! *dont waste time, check 6 perfusion parameters) - normal systolic 90-160mmHg, mean 60-120mmHg

Question 32

Can multiple types of shock be present in one animal?

Answer 32

Yes! | - eg. GDV with arrythmia, septic peritonitis, obstructive and V+ -> hypovolaemia

Question 33

What is shock?

Answer 33

Inadequate oxygen delivery to cells -> inadequate cellular energy production, cellular dysfunction and organ dysfunction