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Shock Flashcards

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1
Q

what is the pathophysiology of shock?

A

MAP below necessary = slow flow to organs (thrombus formation) = inadequate perfusion for cellular metabolic requirements (= acidosis and lactate)

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2
Q

what are the consequences of inadequate perfusion in shock?

A

o Systemic Acidosis (pH < 7.35), further worsening global enzyme function and cellular performance
o Microcapillary thrombus with patchy tissue injury and even large vessel thrombus with organ infarction
o Eventual cellular necrosis results in mortality

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3
Q

what are the 3 main windows for recognition in shock?

A

Skin = mottling
Brain = GCS <15
Kidney = Urine Output <0.5ml/kg/h
4th? - side stream dark field microscopy of sublingual microcirculation

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4
Q

how can shock be confirmed?

A

lactate levels

>2mmol/L

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5
Q

what is the management of shock?

A

Rapid assessment

Fluid challenge

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6
Q

what are the features of A/B history in a shock ABCDE?

A

Dyspnoea
Cough
Allergies

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7
Q

what are the features of C history in a shock ABCDE?

A

Chest/Abdo pain, oliguria, medication

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8
Q

what are the features of D history in a shock ABCDE?

A

confusion

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9
Q

what are the features of E history in a shock ABCDE?

A

trauma, fever, vomiting, haematemesis, melena, diarrhoea, urinary sx

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10
Q

what are the features of examination of A/B in a shock ABCDE?

A

Hyper-resonance
Oedema
Consolidation

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11
Q

what are the features of examination of C in a shock ABCDE?

A

Peripheries cool or warm, JVP distension, murmur

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12
Q

what are the features of examination of D in a shock ABCDE?

A

Neurological signs

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13
Q

what are the features of examination of E in a shock ABCDE?

A 
PR Exam
Dehydration
Oedema
Trauma
Fever
Abdo Exam
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14
Q

what action may be required for A/B in ABCDE of shock?

A

pneumothorax&raquo_space;> needle thoracocentesis

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15
Q

what action may be required for C in ABCDE of shock?

A

Hypovolaemia»>fluid challenge

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16
Q

what action may be required for E in ABCDE of shock?

A

Sepsis»>antibiotics

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17
Q

what investigations are required in A/B in ABCDE of shock?

A

ABG

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18
Q

what investigations are required in C in ABCDE of shock?

A

ECG, Bloods, Echo/CT

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19
Q

what investigations are required in D in ABCDE of shock?

A

Xrays/CT

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20
Q

what investigations are required in E in ABCDE of shock?

A

Sugar, urine, swabs, FAST/CT

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21
Q

what are the 4 different types of shock?

A

Cardiogenic
Distributive
Obstructive
Hypovolaemic

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22
Q

what is the pathophysiology of cardiogenic shock

A

Reduced SV + HR = reduced CO and MAP.

Compensatory increase in SVR

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23
Q

What are the causes of Cardiogenic shock?

A

HR - arrhythmia, poisoning

SV - MI, cardiomyopathy, valve failure

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24
Q

what are the clinical features of cardiogenic shock?

Study These Flashcards
A

cool, clammy hands (peripheries)

25
What is the management of cardiogenic shock?
Arrhythmia - Drugs +/- cardioversion Poisoning - Drugs +/- dialysis MI - drugs +/- PCI Cardiomyopathy/Valve Failure - Drugs +/- surgery
26
what is the pathophysiology of distributive shock?
Vasodilation leads to reduced SVR and MAP. | CO increases to compensate (via increased HR and SV)
27
what are the 2 types of causes of distributive shock?
Inflammatory | Neurogenic
28
what are the causes of inflammatory distributive shock?
Sepsis SIRS - pancreatitis and Burns Anaphylactic shock
29
what are the causes of neurogenic distributive shock?
Spinal cord damage | Iatrogenic
30
what is the clinical features of distributive shock?
warm red peripheries, bounding hyperdynamic circulation
31
what is the management of inflammatory distributive shock?
Sepsis - Antibiotics +/- noradrenaline SIRs - supportive Anaphylaxis - adrenaline
32
what is the management of neurogenic distributive shock?
Spinal cord - neurosurgery | Iatrogenic - support +/- vasopressors
33
what is the pathophysiology of hypovolaemic shock?
Reduced blood volume = Lower venous return to the heart = reduced SV = reduced CO and MAP increased HR and SVR to compensate
34
what are the clinical features of hypovolaemic shock?
signs of haemorrhage, dehydration, tachycardia, cool clammy peripheries
35
what are the causes of haemorrhage in hypovolaemic shock?
Trauma - overt haemorrhage, pelvic fracture, long bone fracture, abdominal visceral, intrathoracic GI bleeding Post op bleeding
36
what are the causes of dehydration in hypovolaemic shock?
1. GI loss (diarrhoea, vomiting, stoma, starvation) 2. Epithelial loss (burns) 3. renal/cellular loss (Addisonian crisis, diabetic ketoacidosis)
37
what is the management of haemorrhage hypovolaemic shock?
``` temporising measures (pressure, splint, binding, sengstaken) Find and stop bleeding (surgery, endoscopy) Cross match, blood, blood products ```
38
what is the management of dehydration hypovolaemic shock?
1. Fluid electrolytes 2. specialist unit care 3. Steroids/insulin
39
what is the pathophysiology of obstructive shock?
Obstruction to cardiac outflow (otherwise similar to cardiogenic shock) – leading to backflow
40
what are the causes of obstructive shock?
cardiac tamponade tension pneumothorax PE
41
what are the clinical features of obstructive shock?
raised JVP, distended neck veins
42
what are the causes of cardiac tamponade in obstructive shock?
Trauma | Aortic Dissection
43
what are the causes of Tension pneumothorax in obstructive shock?
Trauma | Pleural Pathology
44
what are the causes of PE in obstructive shock?
Stasis
45
what is the management of cardiac tamponade in obstructive shock?
Pericardiocentesis +/- Thoracotomy +/- Surgery
46
what is the management of tension pneumothorax in obstructive shock?
Thoracentesis + Thoracostomy +/- surgery
47
what is the management of PE in obstructive shock?
Anticoagulation +/- Thrombolysis or direct lysis
48
what is the 1st stage of the major haemorrhage protocol?
Call blood bank and state Major haemorrhage
49
what is the 2nd step of the major haemorrhage protocol?
Send urgent blood samples Blood bank issues blood Resus Patient
50
What blood products does the blood bank issue in major haemorrhage protocol?
4 units red cells 4 units FFP 1 unit platelets
51
What is the Resus approach in major haemorrhage protocol?
``` ABCDE Large bore IV access IV fluids Call for senior help Transfuse red cells/FFP/platelets ```
52
what should occur after bleeding is controlled in the major haemorrhage protocol?
notify blood bank to stand down
53
what is the 3rd stage of major haemorrhage protocol if bleeding continues after initial transfusion?
Repeat blood samples Transfuse further RVC and FFP at 2:1 ratio (1:1 if trauma) Cryoprecipitate if fibrinogen <1g/L Consider further platelets
54
how should blood results be maintained in major haemorrhage protocol?
Hb>80g/L APTT and PT ratio <1.5 Platelets >50x10^8/L Fibrinogen >1.5g/L
55
what is the specific feature of management in post partum haemorrhage?
fibrinogen replacement early
56
what is the specific feature of management in trauma haemorrhage?
tranexamic acid
57
what is the specific feature of management in variceal bleeding haemorrhage?
coagulopathy before bleed, predispose and make it difficult to stop
58
what is the specific feature of management in ruptured AAA haemorrhage?
surgical emergency

Haematology (13 decks)

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