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CLASP: Sudden Death 2018/19 > 4: Physiology and treatment of shock > Flashcards

4: Physiology and treatment of shock Flashcards

1
Q

What is shock?

A

Inadequate perfusion of the vital organs

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2
Q

What happens if shock isn’t promptly treated?

A

Organ failure

Death

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3
Q

What are the five different types of shock?

A

Hypovolaemic

Cardiogenic

Septic

Anaphylactic

Neurogenic

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4
Q

Septic, anaphylactic and neurogenic shock are also known as ___ shock.

Why?

A

distributive

Problem is with the distribution of fluid, not the volume

So the blood is there, it’s just not in the right place

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5
Q

Which types of shock are also known as distributive shock?

A

Septic

Anaphylactic

Neurogenic

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6
Q

What is hypovolaemic shock?

A

Inadequate organ perfusion caused by an insufficient blood volume

typically the shock caused by massive haemorrhage

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7
Q

What are some causes of hypovolaemic shock apart from bleeding?

A

Excessive vomiting

Burns

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8
Q

How is hypovolaemic shock managed?

A

Assuming all else OK (oxygenated, warm, U&Es):

IV fluids

Blood

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9
Q

How does blood pressure change in hypovolaemic shock?

A

1. Initially stays the same because tachycardia compensates (CO=HRxSV)

2. Reduced when patient exhausted

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10
Q

What is cardiogenic shock?

A

Inadequate organ perfusion caused by the failure of the heart to act as a pump

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11
Q

What are some causes of cardiogenic shock?

A

MI

Heart failure

PE

Cardiac tamponade

Severe valvular disease

Arrhythmias e.g VF, VT

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12
Q

In hypovolaemic shock, the skin is cool and pale.

How does it appear in cardiogenic shock?

A

Flushed and swollen

because blood collects inferiorly (heart isn’t working)

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13
Q

How is cardiogenic shock managed?

A

Assuming all else OK (heart rhythm, oxygen, U&Es etcccc)

Inotropes - dobutamine - increases force of contractility i.e SV

Vasopressors - adrenaline - increases TPR, increasing blood pressure

Then treat underlying cause

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14
Q

What is the pathophysiology of anaphylactic shock?

A

1. Allergens enter bloodstream and bind to B cells, which produce IgE antibodies

2. IgE antibodies bind to mast cells and cause them to degranulate…

3. …releasing histamine, cytokines

4. Histamine causes widespread vasodilation > hypotension. Cytokines recruit WBCs, causing widespread inflammation (pruritus, SOB, urticaria, oedema)

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15
Q

How is anaphylactic shock managed?

A

IV adrenaline

Causes vasoconstriction (improving BP and perfusion) + bronchodilation (improving oxygenation)

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16
Q

Below which BP is a patient thought to be hypotensive?

A

90/60 mm Hg

though in reality you should just compare it to whatever they were before and use common sense, say 25-30% decrease

17
Q

How do you calculate MABP?

A

MABP = 2(diastolic BP) + systolic BP all over 3

18
Q

What is the minimum MABP needed to perfuse the vital organs?

A

60 mm Hg

19
Q

What is the pathophysiology of septic shock?

A

WBCs encounter pathogen - inflammation, vasodilation and leaky vessels > hypotension

20
Q

What is the SEPSIS 6 bundle?

A

Give oxygen, fluids and antibiotics

Take lactate, urine output and sample for culture

21
Q

Apart from SEPSIS 6, what other drug should patients in septic shock be given?

A

Vasopressor e.g adrenaline

22
Q

What skin changes occur in septic shock?

A

Initially warm

Then cold

23
Q

What is neurogenic shock?

A

Inadequate organ perfusion caused by spinal cord anaesthesia or injury

More specifically loss of sympathetic function (branch from spinal nerves), causing unopposed parasympathetic vasodilation and bradycardia

24
Q

How do you tell neurogenic shock apart from other types of shock?

A

BRADYCARDIA

Hx suggestive spinal cord injury (e.g RTA, fall from height)

25
Q

Why does neurogenic shock cause bradycardia and not tachycardia?

A

In other types of shock, tachycardia is compensation for hypotension

But in neurogenic shock the sympathetic supply to heart is cut off, so parasympathetic (bradycardia) unopposed

26
Q

How is neurogenic shock managed?

A

Suss out cause (might be irreversible)

Vasopressor - adrenaline - causes vasoconstriction, ups heart rate and force of contraction

27
Q

What is the mnemonic for remembering the reversible causes of cardiac arrest?

A

4 Hs

4 Ts

28
Q

What are 4 Hs which cause reversible cardiac arrest?

A

Hypoxia

Hypothermia

Hypovolaemia

HypERkalaemia

29
Q

What are 4 Ts which cause reversible cardiac arrest?

A

Cardiac tamponade

Tension pneumothorax

Thrombosis

Toxins

30
Q

What are the 4 Hs and 4 Ts of reversible cardiac arrest?

A

Hypoxia, hypovolaemia, hypothermia, hyperkalaemia

Tension pneumothorax, tamponade, thrombosis, toxins

31
Q

What metabolic disturbance can cause cardiac arrest?

A

Hyperkalaemia

CLASP: Sudden Death 2018/19 (8 decks)

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