11. Shock Flashcards
Define shock.
When the cardiovascular system is unable to provide adequate substrate for aerobic cellular respiration.
Give 7 signs/symptoms of shock.
- Pale.
- Sweaty.
- Cold.
- Pulse is weak and rapid.
- Reduced urine output.
- Confusion.
- Weakness/collapse.
What can cause hypovolemic shock?
- Loss of blood e.g. acute GI bleeding, trauma, post-op, splenic rupture.
- Loss of fluid e.g. dehydration, burns, vomiting, pancreatitis.
Classification of shock: describe the vital signs in class 1 e.g. blood loss, pulse, blood pressure, pulse pressure, respiratory rate and urine output.
- 15% blood loss.
- Pulse < 100 bpm.
- Blood pressure - normal.
- Pulse pressure - normal.
- Respiratory rate: 14 - 20.
- Urine output > 30ml/h.
Classification of shock: describe the vital signs in class 2 e.g. blood loss, pulse, blood pressure, pulse pressure, respiratory rate and urine output.
- 15-30% blood loss.
- Pulse > 100 bpm.
- Blood pressure - normal.
- Pulse pressure - decreased.
- Respiratory rate: 20 - 30.
- Urine output: 20 - 30ml/h.
Classification of shock: describe the vital signs in class 3 e.g. blood loss, pulse, blood pressure, pulse pressure, respiratory rate and urine output.
- 30-40% blood loss.
- Pulse > 120 bpm.
- Blood pressure - decreased.
- Pulse pressure - decreased.
- Respiratory rate: 30 - 40.
- Urine output: 5 - 15ml/h.
What can cause cardiogenic shock?
- Cardiac tamponade.
- Pulmonary embolism.
- Acute MI.
- Fluid overload.
What is septic shock?
A systemic inflammatory response associated with an infection (bacterial endotoxins).
What is anaphylactic shock?
An intense allergic reaction associated with massive histamine release = haemodynamic collapse. The patient may be breathless, wheezy and have a rash.
What is the treatment for anaphylactic shock?
Adrenaline and supportive therapy e.g. O2 delivery, fluid replacement.
Give 2 signs of ARDS.
- Impaired oxygenation.
- Bilateral pulmonary infiltrates.
- No cardiac failure.
Describe the pathophysiology of ARDS in 3 stages.
- Exudative phase: increased vascular permeability leads to a platelet, fibrin and clotting factor rich exudate.
- Proliferative phase: fibroblast proliferation.
- Fibrotic phase.
Give 4 extra-pulmonary causes of ARDS.
- SEPSIS!
- Trauma.
- Shock.
- Drug reaction.
- Pancreatitis.
Give 3 pulmonary causes of ARDS.
- Pneumonia.
- Smoke inhalation.
- Near drowning.
Give 5 signs of anaphylactic shock.
- Breathlessness.
- Wheeze.
- Rash.
- Swollen lips/tongue.
- Low BP.
- Chest tightness.
Why might someone with anaphylactic shock have a low BP?
- Vasodilation.
2. Increased vascular permeability.
State two common allergens responsible for causing anaphylactic shock.
- Seafood.
- Nuts.
- Grains.
Give 3 clinical features of shock.
- Low blood pressure.
- Rapid pulse.
- Low urine output.
- Pallor.
- Sweating.
what is shock?
acute circulatory failure with inadequate or inappropriately distributed tissue perfusion - prolonged oxygen deprivation leads to necrosis, organ failure and death
list the different types of shock
hypovolaemia, cardiogenic, sepsis, anaphylaxis, neurogenic shock
give 3 causes of hypovolaemia shock
haemorrhages - GI bleed, trauma, AAA dissection etc.
fluid loss - burns, diarrhoea, intestinal obstruction.
give 3 causes of cardiogenic shock
(= pump faillure).
ACS, arrhythmias, aortic dissection, PE, tension pneumothorax, cardiac tamponade, endocarditis
give 3 signs of hypovolaemic shock
pale grey skin, slow capillary refill, sweating, weak pulse, tachycardia
name 2 precipitating factors of anaphylactic shock
penicillin, contrast, latex, dairy, nuts, insect stings
describe the clinical features of anaphylactic shock
onset within 5-60mins of exposure.
warm peripheries, hypotension, urticarial, angio-oedema, wheezing, upper airway obstruction.
how would you manage septic shock?
take blood cultures before abx - then co-amoxiclav and tazocin IV
how would you manage anaphylactic shock?
remove cause. O2. IM adrenaline. IV chlorphenamine and hydrocotisone.
how would you manage hypovolaemic shock?
raise legs. fluid bolus - repeat if shock improves.
