Shock Flashcards
(19 cards)
What are the signs of hypoperfusion?
Mottled skin Urine output <0.5ml/kg/hr Serum lactate >2mmol/L Reduced GCS Pallor Cool peripheries Tachycardia Slow cap refill Tachypnoea Oliguria
Give some causes for hypovolaemia
Bleeding - trauma, ruptured AAA, GI bleed
Fluid loss:
- vomiting
- burns
- third space losses - pancreatitis, heat exhaustion
Give some causes for cariogenic shock
ACS
Arrhythmia
Aortic dissection
Acute valve failure
Give some secondary causes for pump failure
PE
Tension pneumothorax
Cardiac tamponade
What can cause a reduction in systemic vascular resistance and lead to shock?
Sepsis
Anaphylaxis
Neurogenic - spinal cord injury, epidural or spinal anaesthesia
Endocrine failure - Addison’s disease, hypothyroidism
Other - drugs - anaesthetics, antihypertensives, cyanide poisoning
What is key in the assessment of a patient in shock?
2 large bore cannulas ECG - rate and rhythm Signs of ischaemia Check JVP - if raised, likely cariogenic shock Check abdomen - trauma, AAA, GI bleed
How are hypovolaemic shock’s treated?
Treat underlying cause
Raise legs
10-15ml/kg crystalloid bolus - if no improvement after 2 boluses then consider ITU
How is haemorrhagic shock managed?
Stop bleeding ASAP
If still shocked after 2L crystalloid or if Class III/IV shock, crossmatch blood:
- FFP with red cells (1:1 ratio)
- aim for platelets >100 and fibrinogen >1 - give platelets and cryoprecipitate
- Tranexamic acid 2g IV
How is shock due to heat exposure managed?
Tepid sponging and fanning
Avoid ice and immersion
Rhesus with IVI - 0.9% saline ± 100mg IV hydrocortisone
Lorazepam 1-2mg IV or chlorpromazine 25mg IM/IV for shivering
Stop cooling when core temp <39 degrees
What is used to categorise haemorrhagic shock into classes?
Blood loss Heart rate Systolic BP Pulse pressure Cap refill Resp rate Urine output Cerebral function
What constitutes a class I haemorrhagic shock?
<750ml or <15% blood loss
Normal HR, systolic BP, pulse pressure, cap refill, reps rate, urine output and cerebral function
What constitutes a class II haemorrhagic shock?
750ml - 1500ml or 15-30% blood loss HR >100bpm Normal Systolic BP Narrow pulse pressure >2s cap refill 20-30 breaths per min 20-30ml/hr Urine output Anxious/hostile
What constitutes a class III haemorrhagic shock?
1500-2000ml or 30-40% blood loss HR 120-140 Low systolic BP Narrow pulse pressure Cap refill >2s >30 breaths per min 5-20 ml/hr urine output Anxious/confused
What constitutes a class IV haemorrhagic shock?
>2L or 40% blood loss HR >140 Unrecordable systolic BP V narrow/absent pulse pressure Absent cap refill >35 breaths per min Negligible urine output Confused/unresponsive
How do you manage anaphylactic shock?
Adrenaline 0.5mg (0.5ml 1:1000) - can repeat every 5 mins
Chlorphenamine - 10mg IV
Hydrocortisone - 200mg IV
Can give IV fluid boluses as req.
What are some mimics of anaphylaxis?
Carcinoid tumours
Phaeochromocytoma
Systemic macrocytosis
Hereditary angioedema
What is involved in the further management of anaphylaxis?
Admit to ward and monitor ECG
Measure serum tryptase for 1-6hrs post
Continue chlorphenamine 4mg/6hr PO if still itching
Suggest Medic Alert bracelet
Teach about self-injection - 0.3mg epipen
Skin prick test
How does anaphylaxis present?
Sudden onset and rapidly progressive
- pruritis and urticarial rash
- laryngeal oedema = stridor and hoarse voice
- wheeze and SOB
- hypotension and tachycardia
After the acute event, what needs to happen for an anaphylaxis patient?
Admit and observe for 6-12 hours
Measure serum tryptase levels which may be raised for 12 hours
