Shock & Sepsis Flashcards
(23 cards)
What is cardiogenic shock and what is it defined as?
Failure of the pump action of the heart, leading to a decrease in cardiac output and reduced perfusion to the tissues and organs. Despite there being an adequate volume of fluid, the tissues/organs become hypoxic.
- Sustained hypotension (systolic <90mmHg for >30minutes)
- Decreased urine output (<30ml/hour)
What is cardiogenic shock most commonly caused by? What are the other causes?
MI Arrhythmias PE Tension pneumothorax Cardiac tamponade Myocarditis Aortic dissection
What are the signs of cardiogenic shock?
Pale mottled skin with weak peripheral pulses Hypotension Oliguria Altered mental state Raised JVP Tachycardia
If the cause of cardiogenic shock is MI, how do you manage this?
Prompt reperfusion therapy is vital (PCI/ thrombolysis)
How do you investigate a patient with cardiogenic shock?
ECG U&E Troponin ABG CXR Pulmonary pressures (LAP) high
How do you monitor a patient in cardiogenic shock?
CVP BP ABG ECG Urine output Cardiac telemetry
What is the management of cardiogenic shock?
1) Oxygen. Sats of 94-98%. (If COPD sats of 88-92%)
2) Diamorphine 1.25-5mg IV
3) Investigations and monitoring
4) Correct arrhythmias/U&E abnormalities/acid-base
5) Clinical assessment of filling pressure (JVP/pulse/BP)
6) Underfilled = plasma expander, 100mL every 15min IV
Overfilled = Inotropic support e.g. dobutamine
How do you work out MAP?
CO x SVR
How do you work out CO?
SV x HR
What is the management of hypovolaemic shock?
Large bore IV access 2 cannulas Check ECG rate and rhythm Identify and treat underlying cause Raise the legs Give fluid bolus 10-15mL/kg crystalloid via large peripheral line If shock improves, repeat
What are the investigations of hypovolaemic shock?
Hb, U&E, LFT Blood gases (may show metabolic acidaemia from poor perfusion) Urine output CVP ECG for rate and rhythm
What are the classes of haemorrhagic shock?
1 = <15%. <750mL. Normal/anxious
2 = 15-30%. 750-1500mL. Anxious/hostile
3 = 30-40%. 1500-2000mL. Anxious/confused
4 = >40%. >2000mL. Confused/unresponsive
What are the three stages of hypovolaemic shock?
1) Compensated shock: Baroreceptor reflexes result in an increase in myocardial activity, tachycardia and vasoconstriction. They maintain cardiac output and BP (release renin, aldosterone etc)
2) Decompensated. Failure of vasomotor reflexes resulting in increased capillary permeability and thrombosis. Lactic acidosis
3) Irreversible shock. Failure of vital organs with no chance of recovery
What procedure can be used for haemorrhage in shock?
Resuscitative endovascular balloon occlusion of the aorta (REBOA)
Introducing a balloon in the femoral artery into the aorta which is then inflated and cuts off the blood supply above the haemorrhaging point
What is the management of haemorrhagic shock?
Stop bleeding
If still shocked despite 2L crystalloid or Class 3 shock:
Crossmatch blood
Give FFP with red cells
Consider tranexamic acid
What is the management of hypovolaemic shock due to heat exhaustion?
Tepid sponging and fanning
Resuscitate with 0.9% saline and hydrocortisone 100mg IV
Lorazepam may be used to stop shivering
Stop cooling when core temperature <39 degrees
What is the definition of sepsis?
Life threatening organ dysfunction caused by a dysregulated host response to infection
What is the definition of septic shock?
Sepsis in combination with;
Either lactate >2mmol/L despite adequate fluid resuscitation
OR the patient is requiring vasopressins to maintain MAP >65mmHg
What is the management of sepsis in adults?
1) Assess: consider sepsis in anyone with infective signs, altered mental state, feeling generally unwell,
2) Assess: PMH, capillary refill, mottled skin, conscious level, lactate, temperature, ECG, HR, BP, urine output/cultures
3) Assess risk: high/moderate-high/low
4) Treatment: broad spectrum ABx within 1hr.
Give fluids within 1hr if SBP <90, AKI or lactate >2. Give
500mL crystalloid boluses with 0.9% saline
Oxygen
Noradrenaline as a vasopressor to maintain MAP >65
PEEP for ARDS
What is the SIRS criteria, sepsis criteria and severe sepsis criteria?
Temp >38 or <36
HR > 90
RR > 20
WBC > 12 000 or <4 000
If an infective source is present then that is the criteria for sepsis
If there is lactic acidosis or SBP <90 then that is the criteria for severe sepsis
What is ARDS (acute respiratory distress syndrome)?
Respiratory failure characterised by widespread inflammation in lungs
SOB, rapid breathing and skin discolouration occurs
Sepsis may cause this
Impairs the lungs ability to exchange O2 and CO2
Mechanical ventilation may be needed
What is the Sepsis 6?
1) Give O2 to keep sats >94%
2) Take blood cultures
3) Give IV ABx
4) Give a fluid challenge
5) Measure lactate
6) Measure urine output
What is the qSOFA score?
A score used to see if patients with infection are at risk of heightened mortality:
RR >22
BP <100
Altered mentation
