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National Diploma > Shock > Flashcards

Shock Flashcards

1
Q

What are the different types of shock?

A 
Hypovolemic
Cardiogenic
Anaphylactic
Septic
Spinal
Obstructive
Hypoadrenal
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2
Q

What is hypovolemic shock?

A

Inadequate blood volume within the blood vessels.

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3
Q

What are common causes of hypovolemic shock?

A

External bleeding
Internal bleeding
Vomiting and diarrhoea
Burns

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4
Q

What is cardiogenic shock?

A

Due to inadequate cardiac output as a result of a heart problem. The most common cause is acute myocardial infarction. Usually left ventricular dysfunction.

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5
Q

What is anaphylactic shock?

A

Due to mediators released in response to a severe allergic reaction. Rapid onset multi organ, generalised hypersensitivity syndrome. Histamines cause blood vessels to vasodilate and leak resulting in decreased blood pressure.

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6
Q

What is septic shock?

A

Due to systemic inflammatory state secondary to the immune response to an infection. Causes vasodilation and capillary leak as well as impaired cardiac function.

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7
Q

What is spinal shock?

A

Due to the loss of sympathetic nervous system following spinal cord injury. Results in vasodilation and capillary leak

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8
Q

What is obstructive shock?

A

Due to pulmonary embolism causing inadequate right ventricular function or tension pneumothorax causing inadequate right ventricular filling. These cause pressure on blood vessels which obstruct blood flow and cause shock.

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9
Q

What is hypoadrenal shock?

A

Due to inadequate circulating levels of cortisol. Cortisol usually enhances the vasoconstrictive effects of adrenaline. A lack of it results in vasodilation.

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10
Q

What is congential adrenal hypoplasia?

A

Small adrenal glands - don’t produce enough cortisol. More at risk of hypoadrenal shock.

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11
Q

What can cause vasodilation?

A

Histamines
Toxins released by bacteria
Parasympathetic nervous system (of loss of SNA)

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12
Q

What are the three stages of shock?

A

Compensated
Decompensated
Irreversible

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13
Q

What are the compensatory mechanisms the body uses when in shock?

A 
Increased HR
Increased contractility
Increased resp rate
Increased breathing
Diversion of blood
Constriction of blood vessels
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14
Q

What happens in decompensated shock?

A

The SNS cannot ensure constant delivery of oxygenated blood. Tissues begin to release toxic metabolites. These cause vasodilation.
Heart rate cannot maintain perfusion and so blood pressure begins to fall.

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15
Q

What are the signs of shock?

A 
Tachycardia
Cold, clammy skin
Prolonged capillary refill
Tachypnoea
Narrowed pulse pressure (diff between systolic and diastolic)
Hypotension
Confusion/altered LOC
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16
Q

What are signs of decreased perfusion?

A

Rapid pulse
Prolonged cap refill time as blood is diverted from the peripheries
Pale, cold, clammy skin

17
Q

What are signs of decompensated shock?

A 
Confusion
Lethargy
Rapid, deep, gasping breaths
Prolonged cap refill
Cold extremities
Mottled skin
Dropping blood pressure
18
Q

What are signs of irreversible shock?

A

Decreased level of consciousness
Decreasing respiration rate
Cold, mottled skin
No peripheral pulse

19
Q

What cells release inflammatory mediators such as histamine?

A

Mast cells and basophils

20
Q

What are the respiratory signs of anaphylaxis?

A

SOB
Chest or throat tightness
Wheeze
Stridor

21
Q

What are the cardiovascular signs/symptoms of anaphylaxis?

A 
Shock
Hypotension
Fainting
Collapse
Altered level of consciousness
22
Q

What are the gastrointestinal signs/symptoms of anaphylaxis?

A

Persistent or severe nausea/vomiting
Cramping abdominal pain
Explosive diarrhoea

23
Q

What are the skin signs/symptoms of anaphylaxis?

A

Urticaria
Itch
Flush
Swollen lips/tongue

24
Q

What is urticaria?

A

Rash that has patches of skin which are red, raised and itchy

25
Q

What is shock?

A

The global reduction of blood flow (perfusion) to the tissues and organs of the body. It results in the accumulation of metabolites (including acids) in the tissues and organs which causes cellular and organ dysfunction.

26
Q

What is loratadine?

A

A potent long-acting, non-sedating anti-histamine selective peipheral H1 receptor antagonist

27
Q

What is the action of loratadine?

A

It blocks the action of histamine by binding to histamine receptor sites. Specifically the H1 receptor sites

28
Q

What does histamine binding to H1 receptors have a role in?

A 
Bowel movements
Sleep regulation
Itching and pain 
Systemic vasodilation
Separation of endothelial cells
Bronchospasm (asthma)
29
Q

How many known histamine receptors are there?

A

4

30
Q

Why do we use loratadine?

A

For patients who have minor allergic reactions that are confined to skin involvement only
Or for a prominent itch after treatment for anaphylaxis, provided the systemic signs and symptoms have all resolved

31
Q

Why is loratadine non-sedating?

A

Because it has a higher affinity for peripheral H1 receptors so does not have as much of an effect on central H1 receptors which control sleep

32
Q

How long does loratadine take to work?

A

Onset occurs rapidly after oral administration

Symptomatic relief usually occurs 10-20 minutes after administration

33
Q

What are the contraindications for loratadine?

A

Universals

Restricted to over 1 YOA (not a contraindication)

34
Q

What dose of loratadine do we give?

A

> 12 years - 10mg

1-11 years 5mg

35
Q

What are the side effects of loratadine?

A

Fatigue
Sedation
Headache
Dry Mouth

36
Q

When may patients be administered loratadine and not requrie immediate referral to a doctor?

A 
No signs of systemic involvement
No signs of spreading inflammation
No facial or intra oral swelling
No signs of blistering or peeling
No adrenaline has been administered
37
Q

What is an allergy?

A

Where the immune system has a hypersensitivity to normally harmless environmental substances. This causes the degranulation of mast cells and the release of histamine and other inflammatory mediators

38
Q

What are signs and symptoms of an allergic reaction?

A 
Inflammation of conjuctiva (red eyes)
Conjunctival swelling
Tears
Itchy eyes
Headache
Facial Pain
Sneezing
Nasal Congestion
Runny nose
Coughing
Bronchospasm
WheezingSOB
Upper airway swelling (Stridor)
Dilation of blood vessels
Swelling
Increased capillary permeability
Fluid loss
Abdo pain
Bloating
Vomiting
Diarrhoea
Itchy skin
Warm red skin
Urticaria (red raised itchy bumps)

National Diploma (15 decks)

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