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Shock Flashcards

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1
Q

Types of hemorrhage

A
  1. Overt/Visible hemorrhage
  2. Concealed/Covert hemorrhage
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2
Q

M/C type of shock

A

Hypovolemic/Hemorrhagic shock

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3
Q

Types of Hemorrhage in surgery

A
  1. Primary: During surgery
  2. Reactionary: Within 24 hours
  3. Secondary: After 7-14 days
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4
Q

Classification of Hypovolemic shock

A

Class I
Class II: Mild/Compensated
Class III: Moderate/Decompensated
Class IV: Severe

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5
Q

% of blood loss in each class of Hypovolemic shock

A

I: 0-15%
II: 15-30%
III: 31-40%
IV: >40%

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6
Q

Mental status in each class of Hypovolemic shock

A

I: Normal
II: Thirsty and anxious
III: Confused
IV: Comatose

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7
Q

Management of each class of Hypovolemic shock

A

I: Oral fluids
II: IV crystalloids
III: IV crystalloids + colloids (3:1 ratio)
IV: Massive blood transfusion

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8
Q

Management of Hypovolemic shock

A
  1. Dynamic fluid response
  2. Hemorrhage resuscitation
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9
Q

What is Dynamic fluid response?
Just study

A

After 1 litre of fluid (IV bolus) administration
There are 3 types of responders:
1. Responders
2. Transient responders
3. Non-responders

Response:
1. Responder: Sustained
2. Transient responder: Reversed in 15-20 mins d/t ongoing loss
3. Non-responder: Ongoing loss

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10
Q

What is Hemorrhage resuscitation?

A

Ongoing losses:
1. Responders: Prioritise perfusion -> Perfusion targeted resuscitation
2. Transient/non-responders: Prioritise coagulation -> Damage control resuscitation

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11
Q

Indicators of Fluid resuscitation in shock

A
  1. PCWP: Measures left heart pressure; best indicator, more accurate
  2. CVP: Measures right heart pressure; M/C used indicator
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12
Q

Best clinical indicator of adequate fluid resuscitation in shock

A

Urine output

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13
Q

Indices of Shock

A
  1. Shock index
  2. Rate over pressure evaluation (ROPE)
  3. Modified shock index
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14
Q

What is Shock index?

A

SI = HR/Systolic BP
>0.9 = Inc mortality rate

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15
Q

What is ROPE?

A

ROPE= Pulse rate/Pulse pressure
>3 = Decompensated hemorrhagic shock

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16
Q

What is Modified shock index?

A

Modified SI = HR/Mean arterial pressure
Best index

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17
Q

End points of resuscitation

A

Systemic perfusion:
To normalise:
1. Mixed Venous Oxygen Saturation (MVOS): Best indicator
2. Base deficit
3. Serum lactate

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18
Q

What is Massive blood transfusion?

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A

Replacement of entire circulating volume in 24 hours
>10 units of blood in 24 hours
>4 units of blood in 1 hour

19
Q

Complications of Massive blood transfusion

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A

Mostly d/t citrate toxicity
1. Hypothermia
2. Hypocalcemia
3. Metabolic alkalosis
4. Hypomagnesemia
5. Hyper K&raquo_space; Hypo K (D/t RBC lysis in stored blood)
6. Coagulopathy: M/C cause of death after transfusion -> Prevented by 1:1:1 transfusion (RBC:Platelet:FFP)

20
Q

Complications of Blood transfusion

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A
  1. Transfusion related acute lung injury (TRALI)
  2. Transfusion associated cardiac overload (TACO)
  3. Transfusion reactions
21
Q

What is Transfusion related acute lung injury?

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A

M/C cause of death after transfusion
Ab against HLA Ag -> Non- cardiogenic pulmonary edema
Occurs within 6 hours of blood transfusion
Implicated donors:
1. Multiparous women
2. FFP donors

22
Q

What is Transfusion associated cardiac overload?

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A

Volume overload: Facial puffiness, pedal edema, breathlessness
Chest X ray: Normal
Treatment: Diuretics (Lasix)

23
Q

What are Transfusion reactions?

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A

Febrile non-hemolytic transfusion reactions:
1. M/C, caused by graft-versus-host response
2. Leucoreduction filter: Dec in febrile reactions

24
Q

Other types of Shock

Study These Flashcards
A
  1. Cardiogenic
  2. Neurogenic
  3. Anaphylactic
  4. Septic:
    > Warm
    > Cold
25
What is Obstructive shock?
Mechanical impairment of Cardiac filling (Type of cardiogenic shock) E.g. 1. Tamponade 2. Pulmonary embolism
26
What is Distributive shock?
Blood redistributes to peripheries Warm shocks: 1. Anaphylactic 2. Warm septic 3. Neurogenic
27
What is MVOS?
% of oxygen that returns to the heart after being utilised in body Only increases in warm septic shock/distributive shock
28
What is Systemic Inflammatory Response Syndrome (SIRS)?
Mediated by IL-1,6, TNF- ALPHA 2 or more of foll criteria: 1. Temp >38 deg C or <36 deg C 2. HR >90 beats/min 3. Resp rate >20 breaths/min or PaCO2 <4.3 kPa 4. WBC >12000 cells/mm3, <4000 cells/mm3 or >10% immature forms
29
What is Sepsis?
SIRS + known foci of infection
30
What is Septic shock?
Sepsis leading to hypotension not responding to fluids
31
What is MODS?
Failure of >=2 organ systems
32
Quick Sequential Organ Failure Assessment Score (qSOFA)
1. Hypotension systolic BP <100 mmHg 2. Altered mental status 3. Tachypnea RR >22/min Score of >=2 criteria suggests poor outcome
33
Sepsis bundle completed within 3 hours
1. Measure lactate levels 2. Obtain blood cultures 3. Give antibiotics 4. Administer IV fluids
34
Sepsis bundle completed within 6 hours
1. Give vasopressors (Maintain MAP >=65 mmHg) 2. In persistent arterial hypotension -> Measure MVOS 3. Re measure lactate (If initial levels inc)
35
Sepsis six Just study
Mnemonic: Give 3 and Take 3 Within 1 hour: Give 3: 1. IV fluids 2. IV antibiotics 3. Oxygen Take 3: 1. Blood culture 2. Urine output 3. Serum lactate
36
What is MVOS?
% of oxygen that returns to the heart after being utilised in the body Only increases in warm septic shock/distributive shock
37
What is Systemic Inflammatory Response Syndrome (SIRS)?
Mediated by IL-1,6 and TNF-ALPHA 2 or more of the following criteria: 1. Temperature >38 deg C or <36 deg C 2. HR >90 beats/min 3. RR >20 breaths/min or PaCO2 <4.3 kPa 4. WBC >12000 cells/mm3, <4000 cells/mm3, or >10% immature forms
38
What is Sepsis?
SIRS + Known foci of infection
39
What is Septic shock?
Sepsis leading to hypotension not responding to fluids
40
What is MODS?
Failure of >=2 organ systems
41
Quick Sequential Organ Failure Assessment Score (qSOFA)
1. Hypotension: Systolic BP <100 mmHg 2. Altered mental status 3. Tachypnea: RR >22/min Score of >=2 suggests a poor outcome
42
Sepsis bundle completed within 3 hours
1. Measure lactate levels 2. Obtain blood cultures 3. Give antibiotics 4. Administer IV fluids
43
Sepsis bundle completed within 6 hours
1. Give vasopressors (Maintain MAP >=65 mmHg) 2. In persistent arterial hypotension -> Measure MVOS 3. Re measure lactate (If initial levels inc)
44
Sepsis six Just study
Mnemonic: Give 3 & Take 3 Give 3: 1. IV fluids 2. IV antibiotics 3. Oxygen Take 3: 1. Blood culture 2. Urine output 3. Serum lactate

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