Pathophysiology of Shock- CardioRush

Early treatment improves outcome
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Early treatment improves outcome
Why is it important to recognize shock early?
False (occur in the later stages when it doesn't respond to treatment as well)
True or false: the classic signs of shock usually occur in the early stages when it is easiest to treat
Tachycardia, increased pulse rate, tachypnea, pale/cool skin, MM pallor, delayed CRT, weak or abnormal pulses, muscle weakness, pupillary dilation, abnormal sensorium
What are the classic signs of shock to recognize?
O2 deficits to the tissues
What is the main issue that is causing what we see as shock?
Reduced tissue perfusion, impaired O2 delivery, inadequate cellular O2 utilization or energy production
What are some things that characterize severe hemodynamic and metabolic dysfunction in shock?
CO and PaO2
What 2 things does the delivery of O2 to tissue depend on?
HR, SV
What are the 2 things that can change CO?
Preload, afterload, myocardial contractility
What things influence stroke volume?
SNS
When an animal is in shock, is SNS or PSNS tone higher?
Majority Hgb bound, minimal dissolved
What are the 2 ways O2 travels in blood?
Inadequate blood volume, cardiac performance, vascular tone, defect in tissue O2 utilizationWhat are the major mechanisms for lack of O2 delivery to tissues that result in shock, from most to least common?Etiology, volume status, descriptiveWhat are some common ways to classify shock?Recognize low BP, cause SNS activation, leads to higher HR, vasoconstrictionWhat do the baroreceptors do to compensate during shock?Low perfusion in shock, increase renin release to activate RAAS, filter and produce less urine to conserve volumeWhat do the kidneys do to compensate during shock?SNS activation results in NE and epi release, releases aldosterone to increase fluid retentionWhat do the adrenal glands do to compensate during shock?Vasoconstriction response to non critical tissuesWhat cause the mucous membranes to be pale in shock?SNS activationWhat causes the eyes to dilate in shock response?Low circulating volume, lots of SNS tone causes snappy pulsesWhat causes the femoral pulse to be weak or absent in shock?Decreased perfusion, switch to anaerobic metabolism, produce lactic acid, may lead to lactic acidosisWhat is the response of muscles to compensate in shock?Tachypnea to compensate for acidosis, may have ARDS as a result to shock in catsWhat is the response of the lungs to compensate in shock?Decreased perfusion, possible ulceration, liver doesn't clear toxins as easily, may cause bacteria to enter systemic circulationWhat is the response of the GI tract to compensate for shock?TrueTrue or false: the coagulation cascade can be affected in shock and result in DICTNF, interleukin 1 PAFWhat are some inflammatory cytokines released in shock?Prostaglandins, leukotrienes, bradykinin, DAMPs, radical formationWhat is released during cell death in shock?Bradycardia, hypothermia, hypoglycemiaWhat is the common presentation of shock in cats?Fluid usually in excess, ANP/BNP elevated, jugular vein distended, diuretic indicated while fluids are NOTHow is cardiogenic shock treated differently from hypovolemic shock?False (small, transient bacteria is common and the body is able to handle it well)True or false: bacteremia always results in infectionSystemic inflammatory response syndromeWhat is SIRS?Recognize an animal is near shockWhat is the purpose of SIRS?SepsisWhat is the term for SIRS and documented or strongly suspected infection?EndotoxemiaWhat is the term for endotoxin in the bloodstream?Severe sepsisWhat is the term for sepsis with organ dysfunction?Multiple organ dysfunction syndromeWhat is MODS?Septic shockWhat is the term for severe sepsis with hypotension that is unresponsive to adequate fluid resuscitation?Abnormal temperature, abnormal HR, tachypnea, Leukocytosis, leukopenia or significant left shiftWhat are the 4 criteria for SIRS?2-3How many of the 4 SIRS criteria must be present to say the animal has SIRS?Presence of organ dysfunction in 2 or more systemsWhat is required for an animal to be in MODS?Maintain BP, maintain perfusion, maintain cardiac filling pressuresWhat are the main priorities of the cardiovascular system when it needs to conserve resources?False (BP is the main priority of the CV system, so when it falls, disease is already progressed)True or false: blood pressure is one of the first things to fall when the animal is in shockHemorrhage, GI losses, reduced fluid intake, diuresis, third spacing, addison'sWhat are some causes loss of circulating blood volume leading to hypovolemic shock?TrueTrue or false: variable amounts of blood loss result in variable outcomes30-40%What percentage of blood must be lost for shock to possibly be irreversible and fatal despite treatment?Increased SNS discharge, signals for vasocontriction, increased HR, increased stroke volume, contractilityWhat are the short term events that follow hemorrhage to compensate?RAAS, ADH, capillary filtration pressure decreasesWhat are the more long term events for compensation following hemorrhage?Cardiac tamponade, ruptured chordae tendinae, severe arrhythmia, myocardial infarction, PTE, tension pneumothoraxWhat are some possible causes of cardiogenic shock?ToxinsWhat mainly triggers septic shock: toxins or bacteria themselves?SepticWhat is one of the most difficult forms of shock to treat?Cold (warm progresses to cold)Which is worse: warm or cold shock?Inadequate circulating BV, poor contractile function, loss of vasomotor tone, metabolic alterations cause reduced O2 utilization abilityWhat are some distributive aspects of septic shock?Vasodilation, bronchoconstriction, coagulopathy, edema, airway obstruction, vomiting/diarrhea, ataxia, hypotensionWhat does the IgE mediated release of substances from mast cells and basophils cause?Anesthesia, CNS disease, trauma, ischemia to vasomotor centersWhat are some causes of neurogenic shock?O2, determine and remove inciting cause, FLUIDS (always except cardiogenic shock)What are some general things to do to treat shock?False (Fluids NOT indicated in cardiogenic shock)True or false: even if the heart is the problem, fluids are always indicated in shockCrystalloids, colloidsWhat are the 2 general categories of fluids?Replacement, maintenance, hypertonicWhat are the 3 types of crystalloids?Similar make up to bloodWhat are the general features of replacement fluids?Inexpensive, easy to administer, limited persistence in intravascular space, many choices of electrolytes, few adverse reactions (unless too much is given)What are the benefits of crystalloids?Large animals, head traumaWhat are some reasons we would use hypertonic saline?Hyperosmolarity, hemolysis, hypernatremia, hyperchloremia, hypotension, VPCsWhat are some potential side effects of hypertonic saline use?Hetastarch, dextrans, gelatin, albuminWhat are some examples of colloids?Smaller volume needed, greater persistance in intravascular space, maintains intravascular colloid osmotic pressureWhat are some oft he benefits of colloids?Expensive, possible renal tox, coagulopathy, anaphylactic reactions, not cleared quickly, no survival benefit over crystalloidsWhat are the potential disadvantages of colloids?Whole blood, packed RBCs, fresh frozen plasma, cryoprecipitateWhat are some common blood products given?Low PCV, active bleed, clotting factors, protein, plateletsWhat are some reasons we would give blood products?VasoconstrictionWhat is the action of pressors?Blood volume ok, heart or vascular tone abnormalWhen are pressors used in shock?ReplacementWhat are the most common type of fluids given?Capillary leak, hypoalbuminemiaWhat situations are fluid overloads more common?False (it is associated with worse outcome)True or false: fluid overload is not associated with a worse outcome, so it is better to give too much rather than too little fluidsGenerally not helpful, lower doses may be used in late, pressor dependent shockWhat is the current thought on using mega high doses of corticosteroids early in shock?Within 1 hourWhen should you administer antibiotics upon presentation with septic shock?CardiogenicWhat type of shock are diuretics indicated in?Delayed initiation of abx use, wrong abx chosenWhat are the things in septic shock that reduces survival?NEWhat is the preferred vasopressor in septic shock?