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6. Cardiovascular System > 11. Shock > Flashcards

11. Shock Flashcards

1
Q

Define shock.

A

When the cardiovascular system is unable to provide adequate substrate for aerobic cellular respiration.

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2
Q

Give 7 signs/symptoms of shock.

A
  1. Pale.
  2. Sweaty.
  3. Cold.
  4. Pulse is weak and rapid.
  5. Reduced urine output.
  6. Confusion.
  7. Weakness/collapse.
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3
Q

What can cause hypovolemic shock?

A
  1. Loss of blood e.g. acute GI bleeding, trauma, post-op, splenic rupture.
  2. Loss of fluid e.g. dehydration, burns, vomiting, pancreatitis.
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4
Q

Classification of shock: describe the vital signs in class 1 e.g. blood loss, pulse, blood pressure, pulse pressure, respiratory rate and urine output.

A
  1. 15% blood loss.
  2. Pulse < 100 bpm.
  3. Blood pressure - normal.
  4. Pulse pressure - normal.
  5. Respiratory rate: 14 - 20.
  6. Urine output > 30ml/h.
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5
Q

Classification of shock: describe the vital signs in class 2 e.g. blood loss, pulse, blood pressure, pulse pressure, respiratory rate and urine output.

A
  1. 15-30% blood loss.
  2. Pulse > 100 bpm.
  3. Blood pressure - normal.
  4. Pulse pressure - decreased.
  5. Respiratory rate: 20 - 30.
  6. Urine output: 20 - 30ml/h.
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6
Q

Classification of shock: describe the vital signs in class 3 e.g. blood loss, pulse, blood pressure, pulse pressure, respiratory rate and urine output.

A
  1. 30-40% blood loss.
  2. Pulse > 120 bpm.
  3. Blood pressure - decreased.
  4. Pulse pressure - decreased.
  5. Respiratory rate: 30 - 40.
  6. Urine output: 5 - 15ml/h.
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7
Q

What can cause cardiogenic shock?

A
  1. Cardiac tamponade.
  2. Pulmonary embolism.
  3. Acute MI.
  4. Fluid overload.
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8
Q

What is septic shock?

A

A systemic inflammatory response associated with an infection (bacterial endotoxins).

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9
Q

What is anaphylactic shock?

A

An intense allergic reaction associated with massive histamine release = haemodynamic collapse. The patient may be breathless, wheezy and have a rash.

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10
Q

What is the treatment for anaphylactic shock?

A

Adrenaline and supportive therapy e.g. O2 delivery, fluid replacement.

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11
Q

Give 2 signs of ARDS.

A
  1. Impaired oxygenation.
  2. Bilateral pulmonary infiltrates.
  3. No cardiac failure.
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12
Q

Describe the pathophysiology of ARDS in 3 stages.

A
  1. Exudative phase: increased vascular permeability leads to a platelet, fibrin and clotting factor rich exudate.
  2. Proliferative phase: fibroblast proliferation.
  3. Fibrotic phase.
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13
Q

Give 4 extra-pulmonary causes of ARDS.

A
  1. SEPSIS!
  2. Trauma.
  3. Shock.
  4. Drug reaction.
  5. Pancreatitis.
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14
Q

Give 3 pulmonary causes of ARDS.

A
  1. Pneumonia.
  2. Smoke inhalation.
  3. Near drowning.
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15
Q

Give 5 signs of anaphylactic shock.

A
  1. Breathlessness.
  2. Wheeze.
  3. Rash.
  4. Swollen lips/tongue.
  5. Low BP.
  6. Chest tightness.
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16
Q

Why might someone with anaphylactic shock have a low BP?

A
  1. Vasodilation.

2. Increased vascular permeability.

17
Q

State two common allergens responsible for causing anaphylactic shock.

A
  1. Seafood.
  2. Nuts.
  3. Grains.
18
Q

Give 3 clinical features of shock.

A
  1. Low blood pressure.
  2. Rapid pulse.
  3. Low urine output.
  4. Pallor.
  5. Sweating.
19
Q

what is shock?

A

acute circulatory failure with inadequate or inappropriately distributed tissue perfusion - prolonged oxygen deprivation leads to necrosis, organ failure and death

20
Q

list the different types of shock

A

hypovolaemia, cardiogenic, sepsis, anaphylaxis, neurogenic shock

21
Q

give 3 causes of hypovolaemia shock

A

haemorrhages - GI bleed, trauma, AAA dissection etc.

fluid loss - burns, diarrhoea, intestinal obstruction.

22
Q

give 3 causes of cardiogenic shock

A

(= pump faillure).

ACS, arrhythmias, aortic dissection, PE, tension pneumothorax, cardiac tamponade, endocarditis

23
Q

give 3 signs of hypovolaemic shock

A

pale grey skin, slow capillary refill, sweating, weak pulse, tachycardia

24
Q

name 2 precipitating factors of anaphylactic shock

A

penicillin, contrast, latex, dairy, nuts, insect stings

25
Q

describe the clinical features of anaphylactic shock

A

onset within 5-60mins of exposure.

warm peripheries, hypotension, urticarial, angio-oedema, wheezing, upper airway obstruction.

26
Q

how would you manage septic shock?

A

take blood cultures before abx - then co-amoxiclav and tazocin IV

27
Q

how would you manage anaphylactic shock?

A

remove cause. O2. IM adrenaline. IV chlorphenamine and hydrocotisone.

28
Q

how would you manage hypovolaemic shock?

A

raise legs. fluid bolus - repeat if shock improves.

6. Cardiovascular System (24 decks)

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