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Trauma > SHOCK > Flashcards

SHOCK Flashcards

1
Q

What is shock defined as?

A

Shock is defined as a clinical state of under delivery of O2 and essential nutrients to the cells and tissues in the body. Inadequate supply/utilisation of this leads to anaerobic glycolysis the activation of complex cellular and immune mediated pathways and cellular damage

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2
Q

What are the factors affecting tissue oxygen delivery? (4 things)

A

1) the ability of lungs to take up oxygen
2) the oxygen carrying capacity of blood
3) Haemoglobin concentration
4) Blood flow

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3
Q

What is the definition of cardiac output?

A

Volume of blood injected by each ventricle per minute therefore cardiac output equates to volume of blood injected with each beat multiplied by heart rate

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4
Q

What is the cardiac output equation?

A

Cardiac output = stroke volume x heart rate

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5
Q

What can cardiac output be affected by?

A

Preload/myocardial contractility/afterload/heart rate/systemic blood pressure

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6
Q

What is preload?

A

The volume of blood in the ventricle at the end of diastole

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7
Q

Starlings law

A

The greater the preload the greater the consequent stroke volume

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8
Q

What inotropes both positive and negative?

A

Positive inotropes produce greater contraction for a given length. for example adrenaline noradrenaline dopamine which are naturally produced

Negative inotropes reduce contractility for example antiarrhythmics and anaesthetic agents

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9
Q

What is afterload?

A

This is the resistance faced by ventricular myocardium during contraction

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10
Q

What happens during diastole as heart rate increases?

A

Ventricular filling is shortened meaning a smaller Stroke volume and a fall in cardiac output

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11
Q

Describe the important facts of tissue oxygen consumption

3

A

1) tissues only use 20 to 25% of oxygen available
2) For resting healthy male the total consumption of oxygen per minute is between 100 and 160 mils per minute per metre squared

3Normally increased oxygen demands is increased by the increased delivery of oxygen usually from arise in cardiac output

4) VO2 or total consumption of oxygen per minute decreases because delivery of oxygen DO2 is falling

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12
Q

What are the causes of shock in trauma? (5)

A

Hypervolaemic/cardiogenic/neurogenic/septicaemic/anaphylactic

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13
Q

Three pathophysiological entities which will result in shock are?

A

Reduced Venus return

Impaired cardiac function

Reduced vascular tone

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14
Q

Hypovolaemic shock

A

Reduced Venus return

Causes haemorrhage burns and crush injury

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15
Q

Cardiogenic shock

A

Impaired cardiac function

Causes - cardiac contusion/Tamponade/ischaemic heart disease/antiarrhythmic drugs/underlying cardiomyopathy

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16
Q

Neurogenic shock

A

Reduced vascular tone

Spinal lesion above T6 can impair sympathetic nervous system outflow

17
Q

Septicaemic shock

A

Result of establish systemic infection

Causes by trans-location of bacteria across gut wall /infection of wounds/aspiration/gastrointestinal perforation

18
Q

Anaphylactic shock

A

Antigen induced IgE mediated release of vasoactive substances histamine causes generalised vasodilation

Venus return and tone for which increases vascular permeability which means fluid gets into the extravascular space

19
Q

Blood on the floor and for more what are these?

A

External

Chest

Abdomen and retroperitoneum

Pelvis

Long bone fractures

20
Q

What are the systolic blood pressure is with the presence of a radial/femoral/carotid pulse?

A

Radial is systolic of 80+

Femoral pulse is systolic of 70+

And carotid pulse is systolic of 60+

BP of 80 systolic is enough to maintain a essential central organ perfusion

21
Q

Indicatorss of shock

A

Increased risk rate

Tachycardia early sign due to sympathetic response

Vasoconstriction leading to increased diastolic blood pressure without full of systolic leading to narrow pulse pressure equals early signs of shock

Sweating/Pale/distressed/Refill greater than two seconds

I fall in blood pressure will only take place when there is no further compensation it’s a late sign of shock

22
Q

What are the limitations to estimation of hypovolaemia? (7)

A

Elderly (sympathetic drive is reduced)

Prescribed drugs (b blockers night tacky)

Pacemakers (keep pulse steady)

Athletes (larger blood volume, hr 50 bpm)

Pregnancy

Hypothermia (dec BP HR AND RR)

Tissue damage

23
Q

What are the three types of response to fluids resuscitation?

A

Responders

Transient responders- initial good response then deteriorate

Non-responders- no improvement

24
Q

Summarise the management of a hypervolaemic patient

A

Warmed crystalloid fluid

Urgent surgical assessment

Vigourous fluid resus

Aim blood pressure systolic of 80 until the source of bleeding is controlled

25
Q

Extra assessment and monitoring which may be needed in shock

A

Regular blood gas analysis

Urine output

Coulags abnormality is due to clotting factors being diluted by IV fluids FFP

26
Q

Extra – the commonest cause of shock and trauma is?

A

Haemorrhage

27
Q

Extra – summary of things needed to do to help manage shock

A

Administer IV fluids

Establish present and location of bleed

Surgery

Aim blood pressure 80 systolic

Initial fluid is Hartmans warmed and then blood is the second fluid

28
Q

First category of physiological changes in shock?

A

Less than 15% volume loss

RESPeRATE within normal ranges heart rate less than 100

Capillaries feel normal blood pressure normal pulse pressure normal mental state normal

29
Q

Second category of physiological changes in shock?

A

15 to 30% volume lost

RESPeRATE 20 to 30

Heart rate hundred to 120

Delaying capillary refill raised diastolic blood pressure low pulse pressure feeling anxious

Fluid for a placement with crystalloid

30
Q

Third category of physiological changes in shock?

A

30 to 40% volume loss

Resp rate 30 to 40/heart rate 120 to 140/delay in capillary refill/low diastolic and systolic blood pressure/low pulse pressure/anxious and confused mental state

Use crystalloid and blood to replace fluid

31
Q

4thcategory of physiological changes in shock?

A

Above 40% volume loss

Rest rate above 35/heart rate above 140/delay in cap refill/very low diastolic and systolic blood pressure/low pulse pressure/negligible urine output/confused and drowsy mental state

Crystalloid and blood for fluid replacement

Trauma (5 decks)

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