Shock ☺️ Flashcards
What are the signs and symptoms of shock
- CV
- Resp
- Neuro
- Renal
- Psych
CV
- high HR, low BP => weak pulse
- clottability
Neuro
-SNS activation => pale, clammy
Resp
-increased RR, cyanotic
Renal
- oliguria, polydipsia
- acidosis, nausea
Psych
-anxiety, restless, confused, aggression, coma
Haemorrhagic shock
- compensatory mechanism
- management
Blood loss
Baroreceptors after 1/3 lost => VC, flow distribution to brain, heart
Systemic acidosis => chemoreceptors increase SNS stimulation
BP U50 => CNS ischemic response reinforce SNS
Renal hypoperfusion => RAAS, NA/A, ADH
-VC, BV, CARDIAC STIMULATION
Capillary hypotension => reabsorption, haemodilution
ABCDE -fluid replacement -blood -Hartmanns Address underlying cause
Decompensatory mechanism pathway for haemorrhagic shock
Hypotension => ischemia => hypoxia, acidosis, DIC
Lead to falling CO, decreased vascular tone
Increased permeability to tissue => loss of oncotic gradient
Also leads to multi-organ failure
What are the 4 stages of hypovolemic shock
- blood loss
- BP change
- pulse
- RR
- confusion
I (up to 15% loss)
- BP ok and alert
- pulse ok
- 14-20 RR
II (15-30% loss)
- BP ok and alert
- narrow pulse
- 20-30 RR
III (30-40% loss)
- hypotensive and confused
- narrow pulse
- 30-40 RR
IV (40%+ loss)
- hypotensive and confused
- narrow pulse
- 35+ RR
What are the effects of poor organ perfusion to the
- brain
- heart
- kidney
- tissue
Brain
-hypoxia => LOC
Heart
-decreased coronary flow => MI
Kidney
-Ischemia and low GFR => ATN
=> renal failure, oliguria, increased CR, acidosis
Tissue
-increased lactate prod and decreased clearance => acidosis
Septic shock
- criteria
- management
Infection that triggers systemic inflammatory response => 2+ elements -fever -high HR, RR -WBC out of range If also low BP => shocked
GIVE O2, ABx, fluids
TAKE blood cultures, urine, lactate
-if surgical patient => restore normal physiology before definitive management
Anaphylactic shock
- presentation
- dosage
Airway - swollen throat, tongue => hoarse voice, stridor
Breathing - wheeze, SOB
Circulation - low BP, high HR
-can also present with generalised itch, rash
IM Adrenaline in anterolateral thigh every 5mins
- U6 = 150ug
- 6-12 = 300ug
- 12+ = 500ug
Cardiogenic shock
- pathophysiology
- management
MAIN CAUSE - CVD, direct myocardial trauma
- Sustained low CO => stimulates SNS, baroreceptors, RAAS
- Does not increase CO => pulmonary, systemic edema
Treat underlying cause
Neurogenic shock
-how does this differ from spinal shock
Spinal shock - temporary loss of motor/sensory function due to spinal injury
SC injury above T5 - excessive PNS activity over SNS
- systemic VD => low BP, HR
- warm peripheries, cold trunk
A-E management
- IV fluids if needed
- atropine - bradycardia
- dobutamine - vasopressors
Obstructive shock
Cardiac tamponade
Pulmonary embolism
Tension pneumothorax
-high JVP, peripheral edema, SOB
ALL LEAD TO UNDERFILLED LV => LOW CO
- low CO, BP => cold extremities
- poor organ perfusion
Address underlying cause!
