Recognition and management of shock trauma Flashcards
Explain why myocardial infarction often causes cardiogenic shock.
Myocardial infacrtion is caused by lack of oxygen entering the heart, (maybe) due to coronary artery blockage and damages the main pumping chamber (left ventricle). With oxygen rich blood circulating to that area of the heart, te heart muslces weaked and go into cardigenic shock.
Discuss the pathophysiology of hypovolaemic shock.
Can be caused by external fluid losses or by internal fluid shifts. The decrease in the intravascular volume in hypovolemic shock results in a decreased venous return of the blood to the heart, therefore decreasing ventricular filling. Decreased in ventricular filling, results in SV (amount of blood ejected from the heart) and decreased CO. When CO drops, BP drops and tissues cannot be adequately perfused.
Outline why anaphylactic shock is a medical emergency.
It causes damage to cell walls
Release of histamine vasodilation
Can cause death without prompt medical attention
Discuss the important causes of septic shock.
Is the most common type of circulatory shock and is caused by widespread infection.
sepsis
burns
pancreatitis
trauma
Describe how the systemic inflammatory response syndrome arises.
Presents clinically like sepsis except there is no identifiable source of infection. SIRS stimulates an overwhelming inflammatory immunological and hormonal response.
Ineffective tissue oxygen delivery
inappropriate vasodilation
cell death
Explain why treating the cause is important for all kinds of shock.
It is important to treat underlying cause to minimise further damages to the patient.
Describe why inflammation and clotting are triggered when the vascular endothelium is injured.
A chain reaction of pro-inflammatory and wound-healing responses is rapidly triggered. As part of the wound-healing response, a stable blood clot, consisting of aggregated platelets and a mesh of cross-linked fibrin protein, is formed to prevent excessive blood loss
Describe the mechanisms that result in decreased oxygen delivery to the tissues in multiple organ dysfunction syndromes.
Impaired oxygen and nutrient delivery to the tissues.
Disseminated Intravascular Coagulation (DIC), occurs when there is insufficient control of coagulation. This leads to:
• Formation of fibrin clots
• Consumption of platelets and coagulation proteins
• Occlusion of the microvasculature
• Reduction in cellular tissue oxygenation
Describe the clinical manifestations of Neurogenic shock
spinal shock: Dry, warm skin rather than cool moist skin. Bradycardia (slow HR) Hypotension SOB
Describe the clinical manifestations of Cardiogenic shock
Angina pain Arrhythmias Haemodynamic instability Low urine output Hypotensions Severe pulmonary congestion Oliguria Anxiety
Discuss the required management of patients suffering from cardiogenic shock.
Oxygenation Pain control Haemodynamic monitoring GTN Dobutamine Dopamine
Rapid A-E assessment obs invasive obs ECG ABGs Fuids Inatropes
With reference to the drug Adrenaline, outline the following:
a. Mechanism of action
b. Dose range
c. Physiological effect
d. Nursing considerations
Mechanism of Action: Sympathomimetic
α Agonist
β1 agonist
β2 agonist
Dose Range: 1 – 20 µg/min or higher
Physiological effect: Potent inotrope constrictor, increased Cardiac output, increased blood pressure, increased heart rate. Nursing considerations: • Tachycardia • Arrhythmia risk • Risk peripheral vascular compromise • Myocardial Work
What is Multi-Organ Dysfunction Syndrome (mods) and what causes it?
It is the failure of more the two or more organs in the body. Close related to sepsis, resulting from an uncontrolled inflammatory response tp severe illness or injury.
Infections
surgery
injury/ trauma
burns
