Cardiac Output and Shock Quiz

Pulmonary embolism, cardiac tamponade, and tension pneumothorax.

Beta blockers and calcium channel antagonists.

Traumatic injuries to the heart, such as a flail mitral valve, and ventricular septal rupture.

<p>Carbon monoxide and cyanide.</p> Signup and view all the answers

<p>The four categories of shock caused by volume loss are hemorrhagic shock, traumatic shock, gastrointestinal losses, and dehydration from insensible losses. The category, 'body cavity', is also caused by volume loss.</p> Signup and view all the answers

<p>Two types of shock that require both fluid replacement and vasopressor support are septic shock and anaphylactic shock.</p> Signup and view all the answers

<p>Five conditions that lead to pump dysfunction are myocardial ischemia, coronary artery thrombosis, arterial hypotension with hypoxemia, cardiomyopathy, and acute myocarditis.</p> Signup and view all the answers

<p>Third-space sequestration can lead to shock because the body fluids become trapped or sequestered in tissues, causing a decrease in the volume of circulating fluids, similar to volume loss caused by hemorrhage.</p> Signup and view all the answers

<p>Atrial fibrillation with a rapid ventricular response makes it difficult for the heart to effectively pump blood, leading to low cardiac output. This reduced blood flow can result in shock by causing insufficient oxygen transport to the body's organs and tissues.</p> Signup and view all the answers

<p>Identifying the underlying cause of shock is crucial because treating only the symptoms might not address the root issue, which could lead to worsening conditions and complications. Treating the root cause ensures a more effective and sustainable resolution.</p> Signup and view all the answers

<p>A heart rate greater than 100 beats per minute is one of the physiological signs used to diagnose shock.</p> Signup and view all the answers

<p>Arterial hypotension lasting for at least 30 minutes is a significant indicator of shock.</p> Signup and view all the answers

<p>Patients experiencing shock may exhibit an altered mental status, such as confusion, disorientation, or lethargy, due to inadequate oxygen supply to the brain.</p> Signup and view all the answers

<p>Low urine output, less than 0.5 mL/kg/h, indicates reduced blood flow to the kidneys, a key feature of shock.</p> Signup and view all the answers

<p>Both arterial base deficit less than -4 mEq/L and lactate level greater than 4 mM/L indicate a disturbance in acid-base balance, which is a characteristic of shock caused by poor tissue perfusion.</p> Signup and view all the answers

<p>Regardless of the cause of shock, a majority of the listed criteria should be met to confirm a diagnosis.</p> Signup and view all the answers

<p>A respiratory rate greater than 20 breaths/min or a PaCO2 less than 32 mm Hg suggests hyperventilation, which is a compensatory mechanism the body uses in shock to try to improve oxygen supply.</p> Signup and view all the answers

<p>Identifying the cause of shock is crucial for providing effective treatment and improving patient outcomes.</p> Signup and view all the answers

<p>Shock is a life-threatening condition caused by widespread circulatory system failure, resulting in inadequate oxygenation and nourishment of the body. This leads to disrupted mitochondrial energy transfer and the formation of toxic chemicals.</p> Signup and view all the answers

<p>Urine output is a reliable indicator of vital organ perfusion. A urine output less than 0.5 mL/kg/h suggests severe renal hypoperfusion, potentially indicating shock.</p> Signup and view all the answers

<p>The three major categories are fluid-responsive, vasopressor-responsive, and combination-responsive shock.</p> Signup and view all the answers

<p>Hemorrhagic shock is effectively treated with a balanced transfusion approach using packed red blood cells, fresh frozen plasma, and platelets.</p> Signup and view all the answers

<p>A base deficit more negative than -4 mEq/L suggests shock, indicating metabolic acidosis due to inadequate tissue perfusion and oxygenation.</p> Signup and view all the answers

<p>Prompt initiation of balanced fluid resuscitation, vasopressor support, and antimicrobial therapy significantly improves outcomes in patients with septic shock.</p> Signup and view all the answers

<p>Base deficit and serum lactate levels are two crucial laboratory values used to evaluate shock. A base deficit more negative than -4 mEq/L or a serum lactate level greater than 4.0 mmol/L indicates shock.</p> Signup and view all the answers

<p>The primary goal of emergent resuscitation is to restore tissue oxygenation and prevent a vicious cycle of systemic inflammation, organ dysfunction, and death.</p> Signup and view all the answers

<p>The historical categories of shock are: distributive, hypovolemic, cardiogenic, and obstructive.</p> Signup and view all the answers

<p>Cardiogenic shock arises when more than 40% of the myocardium becomes dysfunctional, usually due to factors like ischemia, inflammation, toxins, or immune injury.</p> Signup and view all the answers

<p>Neurogenic shock is traditionally characterized by bradycardia (slow heart rate), contrasting with the tachycardia (fast heart rate) often seen in other shock types like hemorrhagic or septic shock.</p> Signup and view all the answers

<p>Acute traumatic injury, such as spinal cord injuries, is a frequent cause of neurogenic shock. This kind of injury disrupts the sympathetic and parasympathetic nerve inputs from the spinal cord to the heart and periphery, interrupting normal nerve regulation of blood vessels.</p> Signup and view all the answers

<p>Impaired perfusion, characterized by inadequate blood flow to tissues, is a common consequence of both cardiogenic and neurogenic shock. This mirrors the reduced perfusion seen in hemorrhagic shock, highlighting the shared downstream effects of different shock types.</p> Signup and view all the answers

<p>The presence of abnormal cardiac enzymes or signs of ischemia on an EKG can point towards cardiogenic shock, distinguishing it from other shock types that may present with similar symptoms.</p> Signup and view all the answers

<p>Treatment for shock involves reversing the underlying cause of shock (e.g., controlling bleeding or resolving the source of infection), and providing supportive care to manage the complications of decreased tissue perfusion and potential organ failure.</p> Signup and view all the answers

<p>The location of the spinal cord injury and the complex interplay between disrupted sympathetic and parasympathetic nerve activity can result in a wide range of heart rate responses, making it difficult to rely solely on bradycardia to diagnose neurogenic shock.</p> Signup and view all the answers

<p>Cardiogenic shock shares common circulatory and metabolic alterations with hemorrhagic shock, and it can be triggered by factors like infection or hemorrhage, further blurring the distinctions between different shock types.</p> Signup and view all the answers

<p>Despite seeming promising, clinical trials have not consistently demonstrated the effectiveness of anti-inflammatory therapies for sepsis. This highlights the need for further research to determine their true value in treating sepsis.</p> Signup and view all the answers

<p>Shock is a multifaceted condition, and its underlying causes and physiological consequences can vary significantly depending on the type of shock. Understanding the complexity of shock is crucial for selecting appropriate and effective treatment strategies.</p> Signup and view all the answers

<p>Relative hypovolemia develops due to increased venous capacitance and capillary leak, which leads to fluid shifting from the intravascular space to the extravascular space. This reduces the effective circulating blood volume, contributing to hypotension and organ dysfunction characteristic of septic shock.</p> Signup and view all the answers

<p>Septic shock directly suppresses myocardial function. The mechanism involves a complex interplay of inflammatory mediators and direct myocardial damage. These factors lead to decreased cardiac contractility and reduced ejection fraction, ultimately impairing the heart's ability to pump blood effectively.</p> Signup and view all the answers

<p>While necessary to address hypotension, aggressive fluid resuscitation in septic shock can cause greater injury to end-organs than the initial hypotension. Overly rapid fluid administration can exacerbate capillary leak, leading to increased interstitial fluid accumulation and tissue edema, which can further compromise organ function.</p> Signup and view all the answers

<p>LPS, a component of the outer cell membrane of gram-negative bacteria, is a potent inflammatory trigger. It activates the immune system, leading to a cascade of inflammatory responses that contribute to the development of septic shock. These responses include the release of cytokines, activation of complement, and coagulation pathways, which contribute to systemic inflammation and organ dysfunction.</p> Signup and view all the answers

<p>Septic shock can lead to kidney injury through acute spasm of the preglomerular arterioles and acute tubular necrosis. Spasm of the preglomerular arterioles restricts blood flow to the glomeruli, reducing filtration and leading to decreased urine output. Acute tubular necrosis occurs due to direct damage to the renal tubules, impairing their ability to reabsorb fluids and electrolytes, resulting in further deterioration of kidney function.</p> Signup and view all the answers

<p>Systemic inflammation, a hallmark of septic shock, amplifies the initial insult. The release of inflammatory mediators like cytokines and chemokines by immune cells causes widespread tissue damage, further impairing organ function. This leads to a vicious cycle of inflammation, tissue injury, and organ dysfunction, exacerbating the severity of septic shock.</p> Signup and view all the answers

<p>The three primary effects that need to be addressed during resuscitation of septic shock are hypovolemia, cardiovascular depression, and systemic inflammation. Hypovolemia, both absolute and relative, reflects the loss of effective circulating blood volume. Cardiovascular depression results from direct myocardial suppression. Systemic inflammation is a widespread inflammatory response that further complicates the condition.</p> Signup and view all the answers

<p>Early impairment of cardiac contractility is significant because it underscores the rapid progression of septic shock. This early decrease in pump function contributes to hypotension and reduced tissue perfusion, further exacerbating the cascade of events that leads to organ dysfunction. Therefore, early recognition and appropriate interventions to restore hemodynamic stability are crucial in managing septic shock effectively.</p> Signup and view all the answers

<p>A base deficit more negative than -4 mEq/L or a serum lactate level greater than 4.0 mmol/L.</p> Signup and view all the answers

<p>Less than 0.5 mL/kg/h.</p> Signup and view all the answers

<p>A worsening base deficit, increasing lactate level, and low urine output. (B)</p> Signup and view all the answers

<p>With blood products using a balanced transfusion approach (packed red blood cells, fresh frozen plasma, and platelets).</p> Signup and view all the answers

<p>Ill appearance or altered mental status, heart rate &gt;100 beats/min, respiratory rate ≥20 breaths/min or PaCO2 &lt; 32 mm Hg, arterial base deficit &lt; -4 mEq/L or lactate level &gt; 4 mM/L, urine output &lt; 0.5 mL/kg/h, arterial hypotension &gt; 30 min duration, continuous (C)</p> Signup and view all the answers

<p>Septic shock, anaphylactic shock, central neurogenic shock, and drug overdose. (D)</p> Signup and view all the answers

<p>Immediate relief (e.g., thrombolysis for pulmonary embolism, pericardiocentesis for tamponade).</p> Signup and view all the answers

<p>Carbon monoxide, methemoglobinemia, hydrogen sulfide, and cyanide. (D)</p> Signup and view all the answers

<p>Hypovolemia, cardiovascular depression, and systemic inflammation. (A)</p> Signup and view all the answers

A severe infection leading to dangerously low blood pressure and organ failure.

A blockage in a pulmonary artery usually due to blood clots.

Pressure on the heart due to fluid accumulation in the pericardial space.

A type of shock caused by loss of blood volume due to hemorrhage.

A condition where blood flow to the heart is reduced, causing heart muscle damage.

A severe allergic reaction that can lead to shock and life-threatening symptoms.

Irregularities in heartbeats that can affect heart function.

Fluid loss that cannot be seen, such as through skin and respiration.

Occurs when over 40% of myocardium is dysfunctional due to ischemia or injury.

Shock caused by disrupted spinal cord signals to the heart and blood vessels.

Ischemia, inflammation, toxins, or immune injury impair heart function.

Shortness of breath, abnormal cardiac enzymes, EKG ischemia, low fever.

Peripheral vasodilation and bradycardia; heart rate varies with injury.

Shows left or right ventricular dysfunction early in cardiogenic shock.

Both shocks show impaired perfusion and can mimic hemorrhagic shock effects.

Focus on reversing shock causes and supportive care for organ failure.

Steroids in shock treatments have inconsistent clinical trial outcomes.

Typically results from acute traumatic injuries affecting spinal signals.

Changes in awareness or cognitive function in patients with shock.

Heart rate over 100 beats per minute indicating potential shock.

Respiratory rate exceeds 20 breaths/min or PaCO2 is low (below 32 mm Hg).

Deficit less than -4 mEq/L indicates metabolic acidosis in shock.

Lactate level greater than 4 mM/L indicates tissue hypoperfusion in shock.

Less than 0.5 mL/kg/h indicates inadequate kidney perfusion in shock.

Low blood pressure lasting more than 30 minutes is a sign of shock.

A component of the outer membrane of gram-negative bacteria contributing to sepsis.

Liver damage seen as elevated transaminase levels in septic shock.

Kidney injury often resulting from septic shock's effects on arterioles.

A condition of decreased blood volume in the body affecting blood pressure.

Direct suppression of heart muscle function during septic shock.

Body-wide inflammatory response triggered by septic shock.

Constriction of small blood vessels in kidneys leading to injury.

Potential harm to organs during efforts to restore blood volume.

Shock can occur even when arterial blood pressure is normal.

A base deficit < -4 mEq/L or lactate > 4.0 mmol/L indicates shock.

Normal urine output is 1.0 mL/kg/h; < 0.5 mL/kg/h suggests severe renal hypoperfusion.

Worsening base deficit, high lactate, and low urine output indicate worsening shock.

Balanced blood transfusion with red cells, plasma, and platelets is key.

Early fluid resuscitation, vasopressors, and antibiotics improve septic shock outcomes.

Shock is a state of circulatory failure to provide adequate oxygen.

Shock is historically classified into distributive, hypovolemic, cardiogenic, and obstructive.

Rescue efforts to restore tissue oxygenation during shock.

Shock caused by obstruction of blood flow.

Physical damage to heart structures affecting function.

Air trapped in the pleural space leading to lung collapse.

Total amount of blood pumped by the heart per minute.

Fluid loss not easily perceived, like through skin.

Indicator of tissue hypoperfusion, elevation suggests shock.

A measure indicating metabolic acidosis, significant in shock.

Measurement of kidney perfusion; low output suggests hypoperfusion.

Based on mental status, heart rate, etc. for clinical evaluation.

Adding fluid to the body to treat hypovolemic shock.

Medications used to elevate blood pressure in shock.

Medications to improve heart contractility in shock.

Irregular heart rhythm that can complicate shock response.

Displacement of the valve affecting heart function.

Toxic effects from exposure, treated with specific antidotes.

Severe toxicity requiring immediate antitodal treatment.

Narrowing of the aorta obstructing blood flow.

Shock caused by significant physical injuries.

Shock resulting from severe blood loss due to trauma.

Clot formation on artificial heart valves leading to shock.

Heart abnormalities present at birth affecting blood flow.

Hypertrophic obstructive cardiomyopathy affecting heart function.

Urine output measurement as a shock severity indicator.

Disruption of cellular metabolism from poisons.

High death rates associated with severe shock conditions.

Various microbes can induce systemic inflammatory shock.

Body’s defense reaction leading to complications in shock.

Signs like urine output that reflect kidney health in shock.