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week 3 > shock, haemorrhage and wounds > Flashcards

shock, haemorrhage and wounds Flashcards

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1
Q

what is the definition of shock

A

A life-threatening, generalised form of acute circulatory failure with inadequate oxygen delivery and utilisation by cells

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2
Q

what are important features about shock

A

not a specific diagnosis
requires urgent intervention

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3
Q

what normally leads to shock

A

Decreased blood perfusion of tissues
Inadequate blood oxygen
Increased oxygen demand from tissues
- overlap

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4
Q

what are the clinical parameters of shock

A

heartrate + respiratory rate is up
blood pressure can start to drop
glasgow coma score -> concious level starts to drop

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5
Q

what are the biochemical markers of shock

A

blood tests that find elevated levels of lactate + urine output

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6
Q

what is lactate a sign of ?

A

someone who is hypoperfused

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7
Q

what is the SOFA score

A

related to scoring of sepsis

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8
Q

what are the four subcategories of shock

A

obstructive
distributive
cardiogenic
hypovolemic

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9
Q

what is distributive shock

A

failure of Vaso regulation -
problem with control of vasculature as peripheral
Severe peripheral vasodilation
blood circulation is dilated and uncontrolled

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10
Q

what is the main reason for distributive shock is

A

septic shock

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11
Q

briefly describe septic shock

A

the toxic effect of inflammatory response (large number of cytokines)
-> leads to many dilated blood vessels in peripheral system

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12
Q

what are two other types of distributive shocks

A

anaphylaxis and neurogenic

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13
Q

explain anaphylaxis

A

significant allergic reaction which triggers large release of biochemical mediators. for example histamine from mast cells

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14
Q

what does anaphylaxis lead to

A

gross peripheral vasodilation

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15
Q

explain what neurogenic shock is

A

spinal cord injury - problem with autonomic nervous system and vagal tone problems

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16
Q

explain hypovolaemic shock

A

reduction in your circulating blood volume -> loss of intravascular volume

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17
Q

what are the two subcategories of shock

A

haemorrhage
+
non haemorrhage

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18
Q

what are examples of haemorrhage causes

A

trauma
GI bleeding -> eg stomach ulcers

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19
Q

what are examples of non-haemorrhage bleeding

A

burns -> tissue loss / tissue damage
diabetes complications -> diabetic ketoacidosis which causes huge amounts of volume loss

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20
Q

explain cardiogenic shock

A

problems with the heart.
in particular the pump in the heart is failing

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21
Q

what can cause cardiogenic shock

A

heart attack
myocardial infarction

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22
Q

what are problems related to cardiogenic loss

A

arrhythmias -> irregular rhythms of the heart
mechanical problems -> valves of the heart are affected

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23
Q

explain obstructive shock

A

barriers to cardiac flow or filling

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24
Q

what are problems related to obstructive shock

A

pulmonary embolism (clots)in the vasculature of the lungs
cardiac tamponade
tension pneumothorax

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25
what is cardiac tamponade
large amount of blood in the pericardial space (around the heart) -> restricts the pumping of the heart
26
what is tension pneumothorax
build up of air around the lungs - causes the lung to collapse
27
how would you treat distributive shock
fluid -> optimise circulatory status vasopressers -> drugs that improve peripheral vasodilation antibiotics
28
how do we treat hypovolaemic shock
fluid, giving blood try to stop the loss of fluid in general
29
how do we treat cardiogenic shock
combination of different types of medicine fluid vasopressers inotropes cardiologist
30
what are inotropes
drugs that positively improve cardiac output
31
how do we treat obstructive shock
improve obstruction -> putting hole in chest to relieve pressure preventing clots -> thrombolysis
32
what can make recognition of shock more complicated
people on medication
33
what is blood
majority plasma 55% 45% cells
34
explain in blood sample where plasma, WBC, RBC are ?
35
what is plasma made up of
90% water 7% plasma proteins other substance
36
of the 45% of blood that is cell how many are rbc
99% RBC rest WBC and platelets
37
why is blood important
Oxygen transport Clotting Healing & Infection Transport system Homeostasis
38
explain oxygen transport
Oxygen transport from the lungs via haemoglobin to tissues and returns carbon dioxide
39
explain clotting
Clotting and haemostasis via platelet aggregation and the coagulation cascade
40
explain blood as a transport system
Transport of nutrients and hormones to all tissues of the body, and waste products to the kidneys, lungs and other organs for excretion
41
explain the role of blood in homeostasis
Homeostasis or regulation of the pH and electrolyte composition of body fluids
42
what happens when we lose blood
Intravascular volume loss -> decreased cardiac output -> impaired tissue oxygenation ->end-organ dysfunction -> death!
43
in order to maintain cardiac output and compensate for a lack of volume what occurs ?
the heart will increase heart rate blood is shunted from visceral/ non vital organs to provide heart with enough blood for vital organs
44
what can happen if shunting of blood occurs for too long
those organs such as kidney, liver, skin will die
45
how are the components of blood lost
they are all lost equally
46
decreased perfusion can lead to what
lactic acidosis
47
lactic acidosis has a negative effect on what
clotting -> more bleeding, more shunting and increased heart rate
48
what can lactic acidosis lead to a drop in
a drop in body temperature (hyopthermia)
49
what does hypothermia lead to ?
more clotting more bleeding more acidosis -> trauma triad of death
50
describe class I shoch
up to 750ml blood loss 15% of blood lost pulse rate less than 100 blood pressure is normal resp rate : 14-20 urine output is more than 30mls/ hour mental status is normal
51
describe class II shock
750ml to 1500ml of blood lost 15-30% of blood lost pulse rate more than 100 blood pressure is normal resp rate is 20-30 urine output is 20-30 mls/hr mild anxiety
52
describe class III shock
1500 to 2000ml lost 30-40% of blood lost pluse rate more than 120 blood pressure decreased resp rate is 30-40 5-15mls per hour mental status is anxious
53
explain class IV shock
blood loss is more than 200ml total % of blood is more than 40% pulse rate is more than 140 blood pressure is decreased resp rate is more than 40 urine output is negligible mental status is confused
54
what is the order of importance on how to assess the patient
check: Catastrophic haemorrhage control Airway with C-Spine Control Breathing with oxygenation Circulation with haemorrhage control Disability Exposure
55
what are additional procures that can be carried out
Emergency Imaging Secondary Survey Definitive Treatment -> where are they going after Trauma Team
56
in trauma case what do we need to check for ?
Airway obstruction? Fractures? Swelling? Blood? Snoring? Stridor? Visible obstruction? Unconscious?
57
how would you deal with airway obstruction
Adjuncts- open up airway intubation - tube into throat into larynx where there is inflated balloon
58
how is a patient breathing assessed
RR + 02 sats
59
where would we see signs of trauma in breathing
Air entry is subdued abnormal Chest movement Crepitus if they are in Pain (huge)
60
trauma to chest can lead to what
Haemopneumothorax - air/blood around/in lung Fractures (flail chest) -> problems with ventilation Cardiac tamponade Contusions
61
how can blood be removed from the wrong place eg the lung
intercostal drain which expands lungs and removes blood
62
what would be signs of hemorrage ?
is he agitated tachycardic blood pressure low/high is it hard for them to breathe
63
in trauma cases what cavities cause the most severe blood loss
Chest/Abdo/Pelvis/Limb fractures (long bones)
64
how can we asses signs of hemorrhage
Investigations CT scan, FAST scan, ultrasound
65
how is the bleeding normally controlled in haemorrhage patients
going theatre
66
what is important if someone is hypovolemic or bleeding
to put cannula in and get vascular access
67
what is intraosseous access
using drill to push needle into bone usually tibia deliver 50/100 mils per hour 35.21
68
what is an important step in haemorrhage control ?
stopping the bleeding
69
how can stop bleeding quickly
apply pressure elevate tourniquets
70
what are surgical ways to stop bleeding
Suture, clamp, pack
71
what are other medical ways to stop dressing ?
Specialised dressings (quickclot) -> has clotting capabilities
72
what is the idea of embolization ?
interventional cardiology -> through the use of CT scanning, we can identify vessels that are bleeding and actually embolism or cauterise them
73
what is the purpose of giving blood?
to resemble what is being lost
74
in terms of blood what is given immediately, in 15 mins and should in 35 mins
o negative group specfic in 15 mins full crossmatched given in 35 mins
75
what is the importance of tranexamic acid
Tranexamic acid is an antifibrinolytic i.e. stops the breakdown of clot. Improved mortality in trauma.
76
explain an abrasion wound
Superficial/Deep Dragging against an irregular surface Clean debris Dress Bleeding not usually an issue Theatre to scrub
77
what normally leads to abrasion
Loss usually of the superficial epithelium due to scraping. Some skin is missing!
78
explain laceration
Blunt force trauma Skin splitting/tearing , tissue bridging, irregular edges and levels of depth Has legal/forensic implications Irrigate, clean
79
how to close laceration
Glue, Steristrips, Staples, Sutures
80
what is most common complication of laceration
infection
81
explain incised wounds
Sharp or penetrating trauma Slash/stab type Clean edges, uniform shape Stabs look less dramatic but beware depth Investigate for underlying damage (ATLS)
82
what is a puncture wound
. A type of incisional wound but unlike the slash type wound previously often has a smaller entry are and greater depth.
83
what is a degloving wound
Skin and its blood supply are torn off -> severing its blood supply Major trauma Limbs/digits Often associated more severe injuries
84
explain bites wounds
Usually a small entry wound Possibly deep penetration Foreign body contamination
85
what normally causes bite wounds
Animal Human Blood borne viruses
86
what can heal bite wounds
Antibiotics, Tetanus, Vaccines
87
what is the % of cat and dog bites that get infected
. 80% will get infected if not treated. Approx 5% of dog bites will.

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