140 - Collapse/Sepsis Flashcards
What are the signs of shock?
Collapse Altered conscious level High HR Low Bp High Resp rate Poor peripheral perfusion Low urine flow
What type of shock is sepsis?
Maldistributive
What is the difference between Maldistributive shock and other forms of shock?
Maldistributive is a primary failure to control peripheral circulation, leading to cardiac and organ dysfunction.
Other forms of shock have reduced cardiac output and reduced O2 delivery which leads to a secondary failure to control peripheral circulation
How would you respond if someone presents with signs of shock?
ABCDE
15l/min O2
1.5L of Hartmann’s or saline (any crystalloid) or less amount of a colloid if you wanted.
Check for rash - ? Meningococcal Septicaemia
Antibiotics - if infection cause suspected - IV, broad range
What blood test would you expect to be raised in shock?
Lactate levels - due to anaerobic respiration of tissues
What is anaphylactic shock?
A severe type 1 hypersensitivity reaction to a previously met antigen/allegen.
What happens in anaphylaxsis?
Extreme response. Massive degranulation of mast cells, release of histamine, causes capillary leak and loss of vascular tone, can leave to systemic maldistributive shock.
Smooth muscle constricts - Bronchospasm
What could you give to someone having an anaphylactic shock?
Adrenaline - IM, 0.5mg, 1 in 1000 strength. IV only iven by expereinces anaesthetists with specialised access.
Bronchodilators - salbutamol
Steroids
Antihistamines
What are the different severities of sepsis?
SIRS - Systemic inflammatory response syndrome
Sepsis (SIRS + infection)
Severe Sepsis (Sepsis + hypoperfusion, low Bp of organ dysfunction)
Septic Shock ( Severe sepsis + refractory hypertension)
MODS (multiorgan dysfunction syndrome)
What bacterial mediators initiate the sepsis cascade?
Gram -ve bacteria - endotoxins - eg LPPS - lipopolysaccharide
gram +ve bacteria - toxins - eg enterotooxin, peptiidoglycans
When does a localised infection become systemic?
When the bacteria/infection gets into the bloodstream, where the immune cascade occurs and intravascular cytokine production leads to widespread endothelial injury.
Why does widespread endoothelial injury cause damage?
It means the endothelium is leaky, there is increased dilation and permiablity - causing hypotension.
What is the effect of sepsis on the CNS?
coma, confusion, encephalopathy
What is the effect of sepsis on the CVS?
hypotension, capillary leak, reduced peripheral vascular resistance.
What is the effect of sepsis on the Respiratory system?
ARDS - Acute respiratory distress syndrome.
Endothelium of alveolar capillaries are leaky - non cardiac oedema forms, causing reduced O2 uptake.
What is the effect of sepsis on the GI tract?
Loss of mucosal integrity, bacteria can leak through into the blood.
What is the effect of sepsis on the urinary system?
Kidney failure due to acute tubular necrosis
Anuria/oliiguria
What is the effect of sepsis on haematology?
30% have thrombocytopaenia
DIC - disseminated intravascular coagulation - clotting and bleeding occurs at the same time.
What is the effect of sepsis on endoocrine system?
Body is in a catabolic state - breaking things down
Increase in stress hormones
Steroid deficiency
deranged O2 metabolism
How do vasodilators work?
They cause vascular smooth muscle relaxation
How do arterial vasodilators work?
They cause a reduction in arterial vascular resistance - which reduces BP as BP = CO x SVR.
How do venodilators work?
Reduce Bp by reducing caridac output by reducing stroke volume returning to the heart. Most volume is stored in veins - so relaxing veins increases stroage, so less returns. BP = (HR x SV) x SVR.
Which type of vasodilator would you use in someone with heart failure?
Venodilator - as it reduces work load for heart by reducing stroke volume and cardiac output.
What are the 2 main types of vascular constictors?
Catecholamines and non-catecholamines
What is the synthetic catecholamine we use called?
Phenylephrine
What are the non-catecholamines we use to increase Bp?
vasopressiin, angotensin.
