A&E 140 Collapse Flashcards

1
Q

What are the features of SIRS?

A

Temperature >38 or 90bpm
RR >20bpm
WBC >12x10^9/L <4x10^9/L

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2
Q

What is the definition of Sepsis?

A

SIRS in the presence of infection

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3
Q

What is severe sepsis?

A

Sepsis with evidence of organ hypo-perfusion

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4
Q

What are some evidences of organ hypoperfusion?

A

Hypoxaemia
Oliguria
Lactic acidosis
Altered cerebral function

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5
Q

What is septic shock?

A

Severe sepsis with hypotension (SYS <90mmHg)

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6
Q

What is one of the reasons for hypovolaemia in septic shock?

A

Vessels become leaky

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7
Q

Describe how tissue hypoxia can occur in septic shock

A

Microvascular changes resulting in reduced blood flow to organs, reduced oxygen extraction by tissues, intravascular coagulation

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8
Q

What causes endothelial damage in shock?

A

Pro-coagulation factors produced in response to cytokines or endotoxins

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9
Q

What is Anaphylaxis?

A

Severe systemic type 1 hypersensitivity reaction

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10
Q

What must happen prior to anaphylaxis to a particular antigen?

A

Sensitisation:
Antigen picked up with activation of Th2 cells and B cells which produce the IgE antibodies which bind to Fc receptors on mast cells

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11
Q

What occurs in anaphylaxis when the patient is reexposed to the antigen?

A

It cross links with IgE on mast cell surface

mast cell degranulation –> release inflammatory mediators

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12
Q

What is the body’s response in anaphylaxis?

A

Smooth muscle spasm, blood vessel dilatation and increased permeability = oedema
chemotaxis and tissue damage

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13
Q

Where two types of vascular dilators are there?

A

Arterial and venous dilators

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14
Q

What do venodilators affect?

A

BP by lowering stroke volume

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15
Q

How do arterial dilators decrease BP?

A

By decreasing the systemic vascular resistance

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16
Q

What is the common final pathway in the action of vascular dilators?

A

Nitric oxide/cGMP lowering intracellular calcium = smooth muscle relaxation

17
Q

What are the main vascular constrictors in the body

A

Adrenaline and noradrenaline

18
Q

What adrenergic receptors are there in the body?

A

alpha and beta receptors

19
Q

What other non-catecholamine vascular constrictors are there?

A

vasopressin and angiotensin

20
Q

Define hypovolaemic shock

A

Sharp decline in CO due to empty circulation

21
Q

Describe cardiogenic shock

A

Failure of the heart e.g. from ischaemic heart disease, pulmonary oedema, inflammation of heart muscle

22
Q

Describe obstructive shock

A

When there is blockage to the heart e.g. cardiac tamponade, pulmonary embolism or tension pneumothorax

23
Q

Describe maldistributive shock

A

Abnormal dilatation of small artieries

24
Q

What is the overall pathophysiology of shock?

A

Critically low oxygen delivery to mitochondria

25
Q

What features are required for adequate oxygen delivery to tissues?

A

Intact respiratory and vascular system, heart and haemoglobin rich blood

26
Q

What are the most frequent microorganism causing sepsis

A

staph aureus from soft tissue/skin infection

E.coli from urinary tract