Term
|
Definition
|
|
Term
|
Definition
hemorrhage
trauma of burns
MI
pulmonary embolism
sepsis |
|
|
Term
|
Definition
systemic hypoperfusion due to reduced CO and VO
hypotension, impaired tissue perfusion, cellular hypoxia
initially cellular injury is reversible but over time it becomes irreversible |
|
|
Term
|
Definition
cardiogenic
hypovolemic
septic
neurogenic
anaphylactic |
|
|
Term
| what causes cardiogenic shock |
|
Definition
| myocardiacal pump failure |
|
|
Term
| what are 2 examples of cardiogenic shock |
|
Definition
|
|
Term
| what are 5 signs of cardiogenic shock |
|
Definition
hypotension
weak rapid pulse
cool, clammy, cyanotic |
|
|
Term
| what are the two areas of dysfunction in cardiogenic shock |
|
Definition
systolic dysfunction
diastolic dysfunction |
|
|
Term
| what is the progression of systolic dysfunction in cardiogenic shock |
|
Definition
ventricular ischemia, structural compormize, or dysrhythmia causes
systolic dysfunction which causes
decrease in SV which causes
decrease in CO which causes
cellular oxygen delivery decrease |
|
|
Term
| what is the progression of diastolic dysfunction in cardiogenic shock |
|
Definition
decreased filling in diastole causes
pulmonary hypertension and edema which causes
decreases oxygenation of blood which causes
tissue hypoxia |
|
|
Term
| what is the caue of hypovolemic shock |
|
Definition
| loss of blood or plasma volume |
|
|
Term
| what are three examples of causes of hypovolemic shock |
|
Definition
|
|
Term
| what are 5 signs of hypovolemic shock |
|
Definition
hypotension
weak rapid pulse
cool, clamy, cyanotic |
|
|
Term
| what is the MOA of hypovolemic shock |
|
Definition
relative or absolute hypovolemia leads to
decreased BV, venous return, SV, CO which causes
decreased cellular oxygen delivery |
|
|
Term
|
Definition
| shock caused by systemic microbe infection |
|
|
Term
| what usually causes septic shock |
|
Definition
| gram negative endotoxin producing bacilli |
|
|
Term
| how do microbes cause septic shock |
|
Definition
| LPS released when cell wall is degrated from inflammatory response |
|
|
Term
| why is antibiotic treatment difficult in septic shock |
|
Definition
| antibiotics could make things worse initially by breaking up LPS |
|
|
Term
|
Definition
| shock caused by systemic microbe infection |
|
|
Term
| what usually causes septic shock |
|
Definition
| gram negative endotoxin producing bacilli |
|
|
Term
| how do microbes cause septic shock |
|
Definition
| LPS released when cell wall is degrated from inflammatory response |
|
|
Term
| why is antibiotic treatment difficult in septic shock |
|
Definition
| antibiotics could make things worse initially by breaking up LPS |
|
|
Term
| what are 6 microbes that commonly cause septic shock |
|
Definition
E. coli
salmonella
shigella
pseudomonas
neisseria
haemophilus |
|
|
Term
| explain the progression of septic shock |
|
Definition
| infection > systemic inflammatory response syndrome > sepsis > severe sepsis > septic shock |
|
|
Term
| what are 4 signs of septic shock |
|
Definition
skin is initially warm and flushed due to peripherial vasodilation
electrolyte imbalance
metabolic acidosis
decreased urine output |
|
|
Term
| what are the three main venues septic shock causes damage through |
|
Definition
endothelial damage
release of inflammatory cytokines and acute phase reactants
CNS endocrine activation |
|
|
Term
| how does endothelial damage contribute to the symptoms of septic shock (3) |
|
Definition
increased capillary permeability
microemboli
activation of the coagulation system |
|
|
Term
| what inflammatory cytokines cause damage iin septic shock (4) |
|
Definition
|
|
Term
| what acute phase reactants cause damage in septic shock (3) |
|
Definition
complement,
prothrombin
plasminogen |
|
|
Term
| how do cytokines and acute phase reactants cause problems in septic shock |
|
Definition
myocardial depression
vasodilation/hypotension and increased permeability causes decreased contractin and CO
microemboli |
|
|
Term
| what CNS and neuroendocrine activation occurs in septic shock |
|
Definition
selective vasoconstriction
hypermetabolic state that increases oxygen demand |
|
|
Term
| what are the overall results on the body in septic shock |
|
Definition
combination of vasodilation and constriction
increased permeability
increased cell demand
microemboli
all lead to poor distribution of blood volume which decreases delivery of oxygen to tissues |
|
|
Term
| what causes neurogenic shock |
|
Definition
| anasthetic accident or spinal cord injury causes loss of vascular tone and peripherial pooling of blood |
|
|
Term
| what is the MOA of neurogenic shock |
|
Definition
loss of sympathetic tone initiates parasympathetic response which decreased HR and CO
loss of sympathetic tone causes vasodilation which decreases BP, venous return, SV, CO and thus O2 delivery to tissues |
|
|
Term
| what causes anaphylatic shock |
|
Definition
| IgE mediated hypersensitivity causes vasodilation and increased vascular permeability |
|
|
Term
| what are the three stages of shock |
|
Definition
nonprogessive
progressive
irreversible |
|
|
Term
| what are the activated compensatory mechanisms in the nonprogressive stage of shock |
|
Definition
baroreceptor reflex
catecholamines
fever
sympahtetic stimulation
ADH
RAAS |
|
|
Term
| what does fever in the nonprogressive stage of shock lead to |
|
Definition
|
|
Term
| explain the sympathetic response in nonprogresive shock |
|
Definition
| anterior pituitary releases ACTH which tells adrenal cortex to release glucorticouds which increases blood sugar to meet metabolic need |
|
|
Term
| how is ADH activated, what does it do |
|
Definition
| low BP activates causing ADH release from pituitary which increases water reabsorption in kidney increasing BV |
|
|
Term
|
Definition
| decreased flow to kidney causes renin secretion initiating RAAS which releases angiotensin causing adrenal cortex to release aldosterone which causes reabsorption of Na and water to increase BV |
|
|
Term
| what is the overall affect of the compensatory mechanisms in the nonprogressive stage of shock |
|
Definition
tachycardia
peripherial vasoconstriction
renal conservation of blood
increased BMR to give more energy to organs
anaerobic metabolism |
|
|
Term
| why is there anaerobic metabolism in nonprogressive shock |
|
Definition
| energy made is not supplied by enough O2 so it is made through carb breakdown |
|
|
Term
| what are the signs of the progressive stage of shock (6) |
|
Definition
heart cannot make enough CO for the body
BP falls and patient becomes cold and clammy (hot in septic shock)
urine output is absent
pulses are fast and week
respiration falls
loss of conciousness |
|
|
Term
| what classifies the irreversible stage of shock |
|
Definition
cardiac, hepatic, renal, respiratory, pancreatic, GI, hematological, neurological failure
no response to treatment
death is imminent |
|
|
Term
| what is the morphology of shock in the brain (2) |
|
Definition
|
|
Term
| what is the morphology of shock in the heart (3) |
|
Definition
coagulative necrosis
subendocardial hemorrhage
contraction band necrosis |
|
|
Term
| what is the morphology of shock in the kidney (4) |
|
Definition
tubular necrosis
oliguria
anuria
electrolyte imbalance |
|
|
Term
| what is the morphology of shock in the lungs |
|
Definition
only has symptoms in sepsis or trauma which causes alveolar damage
aka shock lung |
|
|
Term
| what is the prognosis of shock |
|
Definition
varies with origin and duration
80-90% young healthy people with hypovolemic shock survive
75% of people with cardiogenic shock associated with MI or sepsis from gram negative bacilli die |
|
|
Term
| what is multiorgan dysfunction syndrome |
|
Definition
| dysfunction of physiological effects of shock |
|
|
Term
| what are the 5 effects in multiorgan dysfunction syndrome |
|
Definition
cardiac depression
respiratory disreess
renal failure
disseminated intravascular coagulation
organ failure |
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