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PAR2022 - Trauma > Week 3 > Flashcards

Week 3 Flashcards

1
Q

define shock?

A

failure of the circulatory system leading to inadequate organ perfusion and tissue oxygenation

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2
Q

Define perfusion?

A

the ability of the cardiovascular system to provide tissues with adequate blood supply to meet their functional demands and to effectively remove the associated metabolic waste products

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3
Q

what are the 4 types of shock?

A
  • hypovolaemic
  • distributive
  • cardiogenic
  • obstructive
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4
Q

What are the two main causes of hypovolaemic shock?

A
  • haemorrhage

- Dehydration

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5
Q

What type of shock is sepsis a combination of?

A

hypovolaemic
distributive
cardiogenic

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6
Q

What is the main cause of distributive shock?

A

Neurogenic shock

-spinal injuries

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7
Q

What is the main cause of cardiogenic shock?

A

Ischaemia
Valve dysfunction
arrhythmias

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8
Q

What is the main cause of obstructive shock?

A

Pulmonary embolus

Tension pneumothorax

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9
Q

What are keys signs of cardiac tamponade?

A
  • muffled heart sounds
  • Jugular Vein Distension
  • Higher DBP and lower SBP starting to narrow BP
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10
Q

what systems regulate perfusion?

A

Neural:
- ANS (baro and chemo receptors)

Hormonal:
- Renin-angiotensin-aldosterone, adrenal glands

Spenic discharge
Fluid shifts

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11
Q

Where are baroreceptors located?

A

Corotid bifurcations and aortic arch

  • monitor strech on vessel walls
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12
Q

What do chemoreceptors measure?

A

O2, Co2 and H+

Want to blow off co2

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13
Q

what hormones are used in regulating perfuson?

A

adrenaline and noradrenaline
Renin-angiotensin
ADH anti diuretic

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14
Q

How much blood does the spleen hold and how much can it release during shock?

A

300mls.

Can release 2/3 of it to increase blood vol.

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15
Q

What are the types of perfusion fluids?

A

Intravascular - in the vessels
Interstitial - between the cells
Intracellular - in the cells

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16
Q

what is the formula for BP?

A

SVR X CO

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17
Q

What is the formula for CO?

A

HR X SV

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18
Q

What is the formula for SV?

A

EDV - ESV

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19
Q

What kind of shock affects the System vascular resistance?

A

Anaphylactic shock
Neurogenic shock
Septic shock

20
Q

What kinf od shock affects the end diastolic vol?

A

obstructive

hypovolaemic

21
Q

What kind of shock affects end systolic volume

A

cardiogenic

22
Q

What is included in the lethal triad?

ON EXAM

A

Coagulopathy
Acidosis
Hypothermia

23
Q

What is coagulopathy?

A

a condition in which the bloods ability to clot is impaired

24
Q

Aerobic respiration generates how many ATP?

A

38

25
Q

Anaerobic respiration in hypoperfusion generates how many ATP?

A

2 + 2 lactic acid

26
Q

What are key characteristics of hypovolaemic shock?

A

most common cause of shock
Loss of RBCs impairs oxygen transport
Shock in trauma is hypovolaemic until proven otherwise

27
Q

What are key characteristics of Distributive shock?

A

Decreased systemic vascular resistance due to vasodilation

- spinal cord injury os most common cause

28
Q

What are key characteristics of Cardiogenic shock?

A

Intrinsic - blunt trauma causing muscle damage or dysrhythmia
Extrinsic - pericardial tamponade/tension pneumothorax

29
Q

What are injuries associated with haemorrhagic shock?

A

Traumatic aortic rupture
Haemothorax
Abdominal organ injury
Fractures

30
Q

What type of injury is usually associated with neurogenic shock?

A

spinal cord injury above T4 - T6

  • loss of sympathetic tone
  • blood vessels dilate
  • blood return to heart decreases and cardiac output drops
  • Perfusion and tissue oxygenation are usually maintains
  • skin remians pink and dry
31
Q

What are injuries associated with cardiogenic shock?

A
  • Pneumothorax
  • pericardial tamponade (becks triad - low arterial BP, JVD, muffled heart sounds)
  • Blunt injury to heart - dysrhytmias and ruptures
32
Q

Wjat are the 3 stages of shock?

A

Compensated
Uncompensated
Irreversible

33
Q

What VS do the stages of shock look at ?

A

Same as PSA

HR/BP/Skin/CS

34
Q

What are the VS seen in compensated shock?

A

HR - mild tachy
CS - Lethargy, confusion, combative
Skin - Decreased cap refil, CPC
BP - normal/slightly elevated

35
Q

What are the VS seen in uncompensated shock?

A

HR - Tachy
CS - Confused/unconscious
Skin - Decreased cap refil/cold extremeties/cyanosis
BP - decerased

36
Q

What are the VS seen in irreversible shock?

A

HR - bradycardia/severe arrythmias
CS - coma
Skin - Decreased cap refill/cold extremities/cyanosis
BP - Hypotension +++

37
Q

How much blood is lost in the 4 classifications of shock?

A

Stage 1 = <15% (750mls)
Stage 2 = 15-30% (750 - 1500mls)
Stage 3 = 30-40% (1500 - 2000mls)
Stage 4 = >40% (>2000mls)

38
Q

What is the HR expected to see in the different stage sof shock?

A

Stage 1 = <100
Stage 2 = >100
Stage 3 = >120
Stage 4 = >140

39
Q

What is the treatment for hypovolaemic shock as per AV CPG’s?

A
  1. manage potential mimics (tension pnuemothorax, significant pain, environmental)
  2. If SBP over 70 - tolerate hypotension for 2 hours, perpare for deterioration, consult with clinician
  3. if SBP under 70
    - Normal Saline 250ml IV
    repeat 250 as required (max 2000mls)

Titrate to 70SBP

40
Q

What is the fluid treatment for traumatic head injury?

A 
Nomal saline (max 40ml/kg)
aim for SBP >120

If SBP <120 after 40ml/kg consult clinician
If consult unavailable provide additional 20ml/kg

41
Q

What is the ventilation treatment for traumatic head injury?

A

if ventilation required
6-7ml/kg
Spo2 = >95%
EtCO2 = 30 - 35

42
Q

what is the purpose of fluid resuscitation?

A

to replace lost intravascular volume in the setting of hypotension due to hypovolaemia

  • normalise tissue perfusion by improving preload
43
Q

What types of fluids do we use?

A

Crystalloids:

  • Hartmann’s Isotonic crystalloid (similar concentration to extracellular fluid)
  • Isotonic normal saline

Colloids:
- Large protein type molecules in water or solution

44
Q

What VS do you aim for with hypovolaemia?

A

HR <100

SBP >70

45
Q

What can happen if we give too much fluid?

A

Haemodilution - dilutes clotting factors and decreases oxygen carrying capacity

Raise BP - may dislodge clots and increase internal bleeding

Tissue oedema may occur as fluid moves to interstitial space

46
Q

what are the best veins for venipuncture?

A

ARM:

  • Medial cubital vein
  • Medial Cephalic vein

UPPER ARM:
- Cephalic vein

HAND:

  • Digital dorsal veins
  • Dorsal metacarpal vein
  • Dorsal venous network
  • Cephalic vein
  • Basilic vein
47
Q

What veins do we have to be careful of with venepuncure?

A

Basilic veins (nerve and artery underneath)

PAR2022 - Trauma (12 decks)

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