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NSB236 > Week 1 - Shock > Flashcards

Week 1 - Shock Flashcards

1
Q

What is shock?

A
  • A state of insufficient perfusion and oxygen delivery to vital organs and tissues throughout the body
  • Life-threatening
  • Signs and symptoms vary in patients
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2
Q

Stages of shock.

A
  1. Compensatory
  2. Progressive
  3. Irreversible
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3
Q

3 types of dysfunction in shock.

A
  1. Pump dysfunction (cardiogenic and obstructive shock)
  2. Pipe dysfunction (anaphylactic, neurogenic and septic shock)
  3. Tank dysfunction (hypovolaemic shock)
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4
Q

Name 2 categories of infection/sepsis risk factors.

A
  1. Patient

2. Treatment

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5
Q

Patient-related infection risk factors include:

A
  • Burns
  • Trauma
  • Malnutrition
  • Leukaemia
  • > 70 age
  • Debilitating disease (eg. COPD)
  • Pregnancy
  • Sleep deprivation
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6
Q

Treatment-related infection risk factors include:

A
  • Immunosuppressant drugs
  • Artificial airways
  • Surgery
  • Immobility
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7
Q

Common infection sites for bacteria include:

A
  • Lungs
  • Abdomen
  • Skin and soft tissue
  • Urinary tract
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8
Q

What is the pathophysiology of sepsis?

A
  1. Infection
  2. Inflammatory response
  3. Increased capillary permeability
  4. Complement system activation
  5. WBC and inflammatory mediator release
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9
Q

What is the pathophysiology of SEVERE sepsis?

A
  • Intrinsic and extrinsic coagulation - thrombosis and bleeding
  • Bleeding worsens and intravascular coagulation can occur
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10
Q

SIRS symptoms:

A
  • Temp >38 or <36
  • RR >20
  • HR >90
  • WBC >12x10^9/L
  • Normal BP
  • Normal U/O
  • Normal SaO2
  • Normal breathing pattern
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11
Q

SIRS diagnosis must include:

A

> 2 notable symptoms.

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12
Q

Sepsis diagnose must include:

A

Any combination of notable symptoms.

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13
Q

Sepsis symptoms:

A
  • Confusion
  • Hyperthermia or hypothermia
  • HR >90
  • Low BP
  • Low U/O
  • Low SaO2
  • Tachypneic (RR >20)
  • Organ dysfunction (raised liver/renal enzymes)
  • Presence of infection
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14
Q

3 main effects of sepsis on the cardiovascular system:

A
  1. Vasodilation
  2. Maldistribution
  3. Myocardial depression
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15
Q

What is the hyper dynamic phase of sepsis?

A
  • Early phase of sepsis

* Body moderately compensates

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16
Q

What is the hypodynamic phase of sepsis?

A
  • Later phase of sepsis

* Compensatory mechanisms starting to fail

17
Q

What is the effect of sepsis on the liver?

A
  • Causes damage to hepatocytes due to hypoperfusion resulted in decreased metabolism of substances which manifests as jaundice.
  • Decreases coagulation as lover cannot produce coagulation factors, leading to increased risk of bleeding.
18
Q

What is the effect of sepsis on the kidneys?

A
  • Hypoperfusion resulting in decreased U/O
  • Metabolism of drugs and vitaminK
  • Causing hyperkalaemia
19
Q

What is the effect of sepsis on temperature?

A

Can cause hyper/hypothermia in hypodynamic phase.

20
Q

What is the effect of sepsis on ECG?

A
  • Sinus tachycardia
  • Ventricular ectopy
  • Decreased CO
21
Q

What is the effect of sepsis on LOC?

A

Early signs include:
• decrease LOC from systemic infection
• poor cerebral blood from maldistribution causes decrease LOC

22
Q

Name the types of shock.

A
  • Cardiogenic
  • Obstructive
  • Hypovolemic
  • Anaphylactic
  • Septic
  • Neurogenic
23
Q

Common cause of cardiogenic shock.

A
  • Heart failing as a pump

* Intrinsic factors

24
Q

Common cause of obstructive shock.

A
  • Heart failing as a pump

* Extrinsic factors

25
Q

Common cause of hypovolemic shock.

A

Loss of circulating volume eg. Blood clot, burns, heart being squeezed.

26
Q

Common cause of anaphylactic shock.

A
  • Widespread vasodilation (response to antigen)

* Patient would feel warm

27
Q

Common cause of septic shock.

A

Widespread vasodilation (response to infection).

28
Q

Common cause of neurogenic shock.

A

Widespread vasodilation (injury to nervous system).

29
Q

Monitoring a patient with shock.

A

ABCDE approach

A - secure airway
B - RR, monitor O2sats
C - manual assessment of arterial pulse for rate, rhythm, bounding or thready
D - GCS or AVPU
E - renal function
E - temp measurement, observe skin colour, capillary refill, lab and diagnostic tests

30
Q

Management of hypovolaemic shock.

A
  • IV fluid (crystalloid) resus to restore circulating volume
  • identify and correct cause
  • colloid/blood as required
  • adrenaline/noradrenaline for vasoconstriction (raise BP)
31
Q

Management of cardiogenic shock.

A
  • High O2 therapy
  • Inotropes eg adrenaline
  • Vasodilator eg GTN
  • Pain control eg IV morphine
32
Q

Management of septic shock.

A

Goals to achieve
• CVP (8-12mmhg)
• MAP (>65mmhg)
• U/O (>0.5mL/kg/hr)

NSB236 (5 decks)

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