Shock

Question 1

What does normal tisse perfusion rely on?

Answer 1

Cardiac function
Capacity of vascular bed
Circulating blood volume

Question 2

What is used as a surrogate to measure normal perfusion?

Answer 2

Blood pressure/MAP

Question 3

What are 5 classifications of shock?

Answer 3

Hypovolaemic
Cardiogenic
DIstributive
Obstructive
Endocrine

Question 4

What can cause hypovolaemic shock?

Answer 4

Acute haemorrhage
Severe dehydration
Burns

Question 5

What does hypovolaemic shock affect?

Answer 5

Volume depletion Decreased SVR
Reduces CO (reduced preload)

Question 6

What can cause cardiogenic shock?

Answer 6

Pump failure
Ichaemia induced myocardial dysfunction
Cardiomyopathies
Valvular problems

Question 7

If cardiogenic shock is due to an MI what does that suggest?

Answer 7

> 40% of the Left ventricle is involved

Question 8

What is obstructive shock?

Answer 8

Mechanical obstruction to normal cardiac output to an otherwise normal heart

Question 9

What can cause obstructive shock?

Answer 9

PE
Air embolusm
Tamponade
Tension pneumothorax

Question 10

What is distributive schocl caused by?

Answer 10

Disruption of normal vascular autoregulation and profound vasodilation

Question 11

What are the causes of distributive shock?

Answer 11

Sepsis
Anaphylaxis
Acute liver failure
Spinal cord injuries
Poor perfusion

Question 12

What are some endocrine causes of shock?

Answer 12

Severe hypothyroidism
Addisonian crisis
Thryotoxicosis

Question 13

What is the main cause of shock/

Answer 13

Septic (62%)

Question 14

What is the neuroendocrine response to shock?

Answer 14

Release f pituitary hormones
Release of cortison
Release of glucagon

Question 15

What is a basic vibe of the pathophysiology of shock?

Answer 15

Poor perfusion
Inflammatory cascafe
Vicious cycle of vasoconstriction and oedema

Question 16

What causes the inflammatory resooinse/

Answer 16

Pathological process (sepsis)
Persistent hypoperfusion

Question 17

What follows the inflammatory response?

Answer 17

Secondary immune suppression

Question 18

What is involved in the inflammatory respinse?

Answer 18

Activation of leukocytes
Cytokine release
pAF
Adhesion molecules
etc

Question 19

What haemodynamic changes occur in shock?

Answer 19

Vascular changers (Vaso-)
Maldistibution of blood flow
Microcirculatory abnormalities
Innapropriate activation of coagulation system
Reperfusion injuries

Question 20

What are the clinical features of shock?

Answer 20

Hypotension
Signs of myocardial failure
Raised JVP
Pulsus parodoxus
Pyrexia
Vasodilatation
Rapid cap refill
Erythema 
Bronchospasm Oedema

Question 21

What is class one hypovolaemia?

Answer 21

<15% blood loss

Question 22

What is class 2 hypovolaemia?

Answer 22

15-30%

Question 23

What is class 3 hypovolaemia/

Answer 23

31-40% blood loss

Question 24

What is class 4 hypovolaemia?

Answer 24

> 40% blood loss

Question 25

What can be seen on examination in hypovolaemic shock?

Answer 25

Pale
Cold skin
Prolonged cap refill
Disturbed conciousnes

Question 26

What should be monitored in hypovolaemic shock

Answer 26

BP
Central venous pressure
Pulmonary artery pressure
Cardiac output

Question 27

What is used to monitor cardiac output?

Answer 27

Thermodulution with PA catheter
Pulse contour analysis
Doppler ultrasonography

Question 28

What is the management of shock?

Answer 28

Prompt diagnosis
ABCDE
Wide bore IV access
Recussitate
Treat cause

Question 29

How is oxygen dosage measured?

Answer 29

COx (1.39xHbxSpO2) + 0.003PaO2

Question 30

What is a fluid challende?

Answer 30

300-500ml over 10-20 minutes

Look for target (Increased MAP, Increased urine etc)

Question 31

What are the types of fluid?

Answer 31

Crystalloid
Colloids
Bloods

Question 32

What drugs can be used in shock?

Answer 32

Adrenaline
Noradrenaline
Vasopressin
Dopamine
Dobutamine