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Associate Ambulance Practitioner > Shock > Flashcards

Shock Flashcards

1
Q

Shock

A

Shock is a clinical state in which the delivery of oxygenated blood (and the other nutrients such as glucose) to the body’s tissues is not adequate to meet metabolic demand.

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2
Q

Types of shock

A

Cardiogenic shock
Hypovolaemic shock
Obstructive shock
Distributive shock

Dissociative shock

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3
Q

Signs of hypovolaemic shoc

A

Pallor
Cool peripheries
Anxiety and abnormal behaviour
Increased heart rates and respiratory rates

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4
Q

Distributive shock

anaphylaxis

A

This kind of shock is caused by widespread dilation of the peripheral vascular system because of dilation in the arterioles and / or venules.
This in effect creates a larger container for the same blood volume, leading to decreased tissue perfusion.

In cases such as anaphylaxis and sepsis, the vessels become leaky, allowing fluid to escape into the tissue and so becoming removed from the general circulation.
Common causes of distributive shock include:

Anaphylaxis 
Sepsis 
Nervous system related causes such as a spinal cord injury (neurogenic shock)

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5
Q

Neurogenic shock

A

Neurogenic shock is circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation; seen in spinal cord injuries

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6
Q

Distributive shock
Clinical features

Nervous system
Circulatory system

A

Hypotension (BP often <80-90mmHg) with bradycardia

Warm peripheries or vasodilation in the presence of low blood pressure

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7
Q

Cardiogenic shock

A

This is due to a primary cardiac problem when the heart is unable to circulate sufficient blood to meet the body’s metabolic needs.

This is most common following a myocardial infarction, but can also be caused by acute heart failure or arrhythmia.

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8
Q

Cardiogenic shock

Clinical features

A

Central chest pain
Crushing or constricting in nature
Persist for >15 minutes
Pain may also present in the shoulders, upper abdomen, referred to neck, jaw and arms

Typically comes on over seconds and minutes rather than starting abruptly
Nausea/vomiting
Marked sweating
Breathlessness
Pallor
Combination of chest pain and haemodynamic instability
Feelings of impending doom
Skin that is clammy and cold to touch
Many patients do not have ‘classic presentation’ – some people especially the elderly and those with diabetes may not experience pain as the chief complaint.

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9
Q

Heart Failure Left Heart Failure

A

Blood flow ‘backs up’

Fluid from blood vessels leaks into lung tissue

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10
Q

Right Heart Failure

A

Blood flow ‘backs up’

Fluid from blood vessels leaks into body tissue

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11
Q

Cardiogenic shock

Causes

A

Causes

MI
COPD
PE
LHF
Valve disease
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12
Q

Cardiogenic shock

Clinical Presentation

A 
Tachypnoea
Crackles
Dullness to percussion
Reduced SpO2
Haemoptysis
Tachycardia
Peripheral oedema
Hepatomegaly
Ascites
Oliguria
Shortness of breath 
Dyspnoea
Orthopnoea
Fatigue
Paroxysmal nocturnal dyspnoea
Reduced exercise tolerance
Ankle swelling
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13
Q

Cardiogenic shock

Clinical sign

A

Pulmonary oedema – crackling on auscultation of lung
Productive cough – white/pink frothy sputum
Peripheral oedema
Raised JVP
Third heart sound (S3)

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14
Q

Obstructive shock

A

This is an uncommon cause of shock and is due to an obstruction of blood flow to/from the heart.

It can be caused by a tension pneumothorax, cardiac tamponade or a massive pulmonary embolism.

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15
Q

Cardiac tamponade

Obstructive shock

A

Cardiac tamponade – restriction of cardiac contraction, failing cardiac output, and shock, caused by the accumulation of blood in the pericardium

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16
Q

Beck’s Triad

A

Muffled heart sounds
Decreased blood pressure
Jugular vein distension

17
Q

Obstructive shock
Pulmonary embolism
Clinical signs

A 
Dyspnoea
Pleuritic chest pain
Substernal chest pain
Apprehension
Cough
Haemoptysis
Syncope
Resp rate >20bpm
Pulse rate >100 bpm
SpO2 <92%
Signs of deep vein thrombosis (DVT)
Unilateral swelling of lower calf
Warm, red, painful, tender calf
18
Q

Tension pneumothorax

Obstructive shock

A

Tension pneumothorax – air enters the pleural cavity on inspiration, but can not escape during expiration due to the presence of a one-way valve formed by a pleural defect.

This leads to increasing intra-pleural pressure on the effected side of the chest, worsening the lung collapse and causing diaphragmatic depression.

In severe cases, and dependent on mediastinal distensibility, the can compress the contralateral lung.

19
Q

Obstructive shock
Clinical signs
Tension pneumothorax

A 
Pleuritic chest pain (sharp pain, worse on breathing in and out)
Air hunger
Respiratory distress
Tachypnoea
Tachycardia
Failing SpO2
Agitation
On the same side of the injury:
Hyper-expansion
Hypo-mobility
Decreased breath sounds
Pre-terminal
Decreasing respiratory rate
Hypotension
Decreasing level of consciousness
20
Q

Obstructive shock

A

Respiratory conditions
Cardiovascular conditions
Chest injuries

21
Q

Dissociative shock

A

This occurs when the oxygen-carrying capability of the blood is affected because of inadequate numbers of red blood cells available to carry sufficient oxygen (anaemia).

22
Q

Dissociative shock

A

Blood consists of 55% plasma and 45% red cells, white cells and platelets.

Ambulance Care Practice p220

Oxygen is carried in the blood in chemical combination with haemoglobin as oxyhaemoglobin (98.5%) and in solution in plasma (1.5%)

23
Q

Dissociative shock

Signs and symptoms of anaemia

A

Tachycardia
Palpitations or angina pectoris
Breathlessness on exertion
Can also occur when competing molecules take up space on the red blood cells that would normally be used to carry oxygen, such as in cases of carbon monoxide poisoning.

24
Q

Dissociative shock

Clinical presentation

A

Disorientation
Decreased consciousness
The supposed cherry red skin discoloration is rarely seen in practice

25
Q

Sickle Cell Disease

Dissociative shock

A

Sickle cell disease is a red blood cell disorder characterised by haemolysis and vaso-occlusion.

SCD is a multi-organ disease, leading to a range of symptoms and complications often termed ‘sickle cell crisis.

Pain is often a presenting symptom.

26
Q

Sickle Cell Disease
Dissociative shock
Clinical presentation

A

Severe pain, most common in the long bones and/or joints of the arms and legs, but also in the back and abdomen
Stroke
High temperature

Difficulty in breathing, reduced SpO2, cough and chest pain may indicate acute chest syndrome
Pallor
Tiredness/weakness
Dehydration
Headache 
Priapism
27
Q

Dissociative shock

A

Cardiovascular system

28
Q

Sepsis

A

Sepsis is a clinical syndrome caused by the body’s immune and coagulation systems being switched on by an infection.
Sepsis with shock is a life-threatening condition that is characterised by low blood pressure despite adequate fluid replacement, and organ dysfunction or failure.

29
Q

Sepsis

Pathophysiology

A

The local inflammatory response is not contained.

Cytokines are signalling chemicals which co-ordinate the inflammatory response. A cytokine storm creates a systemic inflammatory response.

SIRS is not always related to infection and can be caused by ischemia, inflammation or trauma.

30
Q

Sepsis screening and treatment

A

tools

31
Q

Anaphylaxis

A

Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death.
Its hallmark is rapidly developing life-threatening airway/breathing/circulation problems (in any combination) and it is usually associated with skin and mucosal changes.

32
Q

Anaphylaxis

A

Envenomation typically causes cardiac arrest within 15 minutes, and food takes on average around 30 minutes

33
Q

Anaphylaxis

Clinical Presentation

A 
Urticaria
Itching
Angio-oedema
Petechial or purpuric rash
Dyspnoea
Clinical Presentation
Wheeze
Stridor
Hypoxia
Hypotension
Abdominal pain
Diarrhoea/vomiting

JRCALC p 155

34
Q

Anaphylaxis

A

Administration of medication - Intramuscular injections

Associate Ambulance Practitioner (63 decks)

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