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Flashcards in Week 10 Deck (15):
1

Shock is

a syndrome characterised by tissue ischemia from decreased perfusion and impaired cellular metabolism

Generalized state of hypoperfusion
Inadequate substrate delivery
Catecholamines and other responses
Anaerobic metabolism
Cellular dysfunction
Cell death

2

How to recognise shock

Alteration in LOC, anxiety
tachypnea, shallow respirations
tachycardia
hypotension
decreased urine output
cold, diaphoretic skin

3

Hypovolaemic shock

‘Low Volume of Blood’
Can be any fluid.
Caused by :
Bleeding – internal/external
Diarrhoea / vomiting
Dehydration

4

Treatment for hypovolaemic shock

Oxygen
Fluid replacement
Stop further loss

5

How to locate the bleeding

Physical examination
diagnostic adjuncts to the primary survey, including chest x-ray, chest tube insertion, DPL, FAST (focused assessment ultrasonography in trauma), CT scan, pelvic x-ray

6

What to do to stop bleeding

apply direct pressure
operation
reducing pelvic volume
splint fractures
restore volume - Vascular access (catheter, sites), Warmed fluids (type)
Monitor response
prevent hypothermia

7

How to evaluate a positive response to treatment

CNS: Improved level of consciousness
Renal:  urinary output
Skin: Warm, capillary refill
Respirations: Improved rate and depth
Vital signs: Return to normal

8

Mild hypovolaemic shock

Responder
750mL BVL (15-30%)
slightly anxious
urine output 30mL/hr
heart rate <100/min
normal blood pressure
treated with crystalloid

9

Moderate hypovolaemic shock

Transient or non responder
1500-2000mL BVL (30-40%)
respirations 30-40/min
confused, anxious
urine output 5-15mL/hr
heart rate >120/min
decreased pulse pressure
decreased blood pressure
treated with crystalloid, blood, operation

10

Severe hypovolaemic shock

Non responder
>2000mL BVL (>40%)
confused, lethargic
urine negligible
respirations >35/min
heart rate >140/min
decreased pulse pressure
decreased blood pressure
treat with rapid fluids, blood, operation

11

What are the pitfalls of shock

Equating BP with cardiac output
Hemoglobin, hematocrit levels
Age extremes
Hypothermia
Athletes
Pregnancy
Medications
Pacemaker

12

The two types of shock are

External (haemorrhage/severe diarrhoea/vomiting/massive urination)

Internal (fluid shift into extravascular/interstitial space/third spacing – peritonitis/burns/ascites)

13

Management of hypovolaemic shock

Medical management:
Treat underlying cause
Fluid/blood replacement
Redistribution of fluid
Pharmacologic therapy

Nursing management:
Haemodynamic monitoring
Maintaining arterial/venous lines/equipment
Patient assessment/vital signs/fluid balance
Oxygen
Safety/comfort/reassurance
positioning

Airway support:
Maximal oxygenation/ventilatory support
Vasoactive medication therapy:
Restore vasomotor/improve cardiac function
Adrenaline/vasopressin/dopamine

Fluid replacement
Restore intravascular volume
Nutritional support

14

Fluid replacement

Crystalloids: (electrolyte solutions) - 0.9% saline (normal saline)/ Hartmans (CSL)
Colloids: (plasma proteins) – albumin/gelofusine/haemaccel
Blood components (primarily for hypovolaemic shock)
Large bore cannulae x 2 (16g) at ~ 1000ml/5 mins each via hand pump/pressure bag driven/rapid infusors
CVC/intraosseus

15

Nutritional therapy

Nutritional support needed to meet increased metabolic, energy requirements prevent further catabolism, due to depletion of glycogen
Support with parenteral or enteral nutrition

Administration of glutamine:
Amino acid essential in injury/burns/trauma