Haemorrhage & Shock Flashcards Preview

Cardiovascular > Haemorrhage & Shock > Flashcards

Flashcards in Haemorrhage & Shock Deck (26):
1

What is meant by circulatory shock?

When the cardiovascular system is unable to provide adequate oxygen & nutrients for aerobic cellular respiration

2

What are the signs of shock?

Pale, cold, sweaty, mottled skin
Pulse is weak and rapid
Pulse pressure is reduced
Low BP
Slow capillary refill
Tachypnoea
Urine output is reduced
Confusion
Weakness
Collapse
Coma

3

What are they types of shock?

Hypovolaemic shock

Cardiogenic shock

Distributive shock

Anaemic shock

Cytotoxic shock

4

What is hypovolaemic shock?

Severe blood or fluid loss meaning the heart can't pump enough blood around the body

5

What causes hypovolaemic shock?

Blood loss:
- acute GI bleed
- Peri/post operative
- Splenic rupture

Fluid loss:
- Dehydration
- Burns
- Pancreatitis

6

There are 3 classes of shock: what are they & how are they defined?

CLASS I: MILD
Up to 15% blood loss
Pulse less than 100bpm
BP normal
Resp rate 14-20
Urine = >30ml/hr
Mental state: mildly anxious

CLASS II: MODERATE
15-30% blood loss
Pulse above 100bpm
BP normal
Resp rate 20-30
Urine = 20-30ml/hr
Mental state: anxious

CLASS III
30-40% blood loss
Pulse above 120
BP low
Resp rate 30-40
Urine = 5-15ml/hr
Mental state: confused

7

What is cardiogenic shock?

Inadequate tissue perfusion caused by cardiac dysfunction

8

What causes cardiogenic shock?

MI
Arrhythmia
PE
Tension pneumothorax
Anything that causes pump failure

9

What is distributive shock?

Abnormal distribution of blood flow in the smallest blood vessels results in inadequate supply of blood to the body's tissues and organs.

1. Septic
2. Anaphylactic
3. Neurogenic

10

What are the 3 types of distributive shock?

1. Septic
2. Anaphylactic
3. Neurogenic

11

How does sepsis cause shock?

Infection

Causes blood flow in capillaries to be low in some and high in others

Endothelial cells in vessels become less responsive to vasoconstrictors, and produce an excess of NO

Coagulation cascade is disrupted which leads to DIC

RBCs develop a tendency to clump together inhibiting blood flow through vessels

12

What is DIC?

Disseminated intravascular coagulation

Widespread activation of coagulation cascade, formation of loads of blood clots in small vessels

Leads to the compromise of blood flow to tissue and organs

13

How does anaphylaxis cause shock?

Massive histamine release causes systemic vascular dilatation, causing a huge drop in BP

14

What is neurogenic shock?

Injury to the CNS which causes loss of vascular tone, so blood flow is altered

15

What is cytotoxic shock?

Shock caused by poisoning, eg. with cyanide

16

How would you manage septic shock?

Take cultures before antibiotics if time

Give antibiotics ASAP

Adrenaline

Supportive care

17

How would you manage anaphylactic shock?

Give adrenaline (epipen)

Secure airway, give oxygen

Give saline to get BP up

18

How would you manage cardiogenic shock?

Treat the cause

MI = revascularisation, thrombolysis

19

How would you treat hypovolaemic shock?

Give fluids

If haemorrhagic, give blood

20

What are other symptoms of anaphylactic shock?

Breathlessness
Wheeze
Rash
Erythema
Angio-oedema

21

Why does shock cause low BP?

Blood/fluid loss

Reduction in ventricular filling = fall in stroke volume & BP

22

Why does shock cause oliguria?

reduced renal perfusion, reduced glomerular filtration

23

What does ARDS stand for?

Acute respiratory distress syndrome

24

What is ARDS?

Widespread inflammation in the lungs triggered by trauma, sepsis, etc.

Inflammation causes alveolar capillary membrane injury

Leading to impaired gas exchange in the lungs, so the body does not get enough oxygen

25

What are the clinical features of ARDS?

Cyanosis
Tachypnoea
Tachycardia
Bi-lateral fine inspiratory crackles

26

There are 3 phases in ARDS. What are they?

Exudative phase: accumulation of excessive fluid, protein & inflammatory cells in lungs

Proliferative phase: connective tissue & other structural elements proliferate in response

Fibrotic phase: scarring