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CSI > Acutely Unwell Adult > Flashcards

Acutely Unwell Adult Flashcards

1
Q

What is shock?

A

State of hypo-perfusion
Tissues do not receive adequate blood supply
Cellular and tissue hypoxia

‘Life threatening, generalised form of acute circulatory failure with inadequate oxygen delivery’

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2
Q

What force is relevant in blood vessels?

A

Capillary hydrostatic pressure

Changes throughout the capillary from venous to arterial end

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3
Q

What movement happens at the arterial end?

A

Fluid exits capillary since hydrostatic pressure > blood coloidal osmotic pressure

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4
Q

What movement happens at the venous end?

A

Fluid re-enters capillary since hydrostatic pressue < blood coloidal osmotic pressure

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5
Q

What is the capillary hydrostatic pressure at the venous end?

A

18mmHg

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6
Q

What is the capillary hydrostatic pressure at the arterial end?

A

35mmHg

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7
Q

What is the net filtration pressure at the arterial end?

A

+10mmHg

35mmHg-25mmHg

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8
Q

What is the net filtration pressure at the venous end?

A

-7mmHg

25mmHg-18mmHg

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9
Q

In shock where is the fluid lost to?

A

Interstitium

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10
Q

Explain distributive shock

A 
Inflammation
Increased vascular permeability 'leakier' 
Colloid osmotic pressure decreases
Decreased venous reabsorption
Fluid loss to the interstitum
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11
Q

Explain hypovolaemic shock

A

Loss of circulating blood volume

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12
Q

Explain cardiogenic shock

A

Failure of the pump

Problem with output - ‘delivery of blood’

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13
Q

Explain obstructive shock

A

Problem with output - ‘delivery of blood’

Obstruction within the circulatory system

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14
Q

Describe the pathophysiology of burns

A

Burn
Tissue damange
Clot formation and firbin
Necrotic cells release permeability factors
White cells can invade space
White cells in turn release permeability factors
White cells release cytokines
Eventual recruitment of fibroblasts promoting angiogenesis

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15
Q

Why do burns cause distributive shock?

A

Large number of permeability factors that are released at the site of damage

But these factors end up in the blood stream

Becomes a systemic problem as these factors invade healthy tissue

Overall blood vessels become leakier and more fluid is lost to the interstitum

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16
Q

Why is it called distributive shock?

A

Redistribution of fluid from in vessels to interstitum

‘Fluid moved to other spaces’

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17
Q

Why does blood become more viscous in shock?

A

Fluid loss but blood cells remain

18
Q

Why do burns cause hypovolaemic shock?

A

Normally skin acts as protective barrier to water loss

Dermis becomes exposed and more evaporation occurs

19
Q

Why do burns cause cardiogenic shock?

A

Cardiac stress
Heart responds to the volume of blood in it
Release of cytokines also contribute to cardiac stress

20
Q

Which type of shock contributes the most in burns?

A

Distributive is by far the largest

Other two components are important

21
Q

What in a patient’s history indicates need for fluid resus?

A 
Previous limited intake
Thirst
Abnormal losses (trauma/bleeding)
Comorbidities
Vomiting and Diarrhoea
22
Q

What in the clinical examination indicates need for fluid resus?

A 
Tachycardia (>90)
Low BP (<100mmHg)
Capillary refill (>2s)
JVP
Postural hypotension
Poor skin turgor
Dry mucous membranes
23
Q

What can cause a volume shift?

A

Sepsis
Anaphylaxis
Neurogenic shock

24
Q

What metrics on monitoring can indicate fluid resuss?

A

NEWS
Fluid balance charts
Weight

25
Q

What formula is used to calculate how much fluid is given to burn patients?

A

Parkland formula
4ml x TBSA (%) x body weight (kg)
Over 24 hours

26
Q

How do you calculate TBSA burn?

A

Wallace’s rule of 9s
18% front chest
9% for each arm

27
Q

How do you determine when you give the fluid?

A

50% in the first 8 hours

50% in the next 16 hours

28
Q

What are three commonly used fluids?

A

5% dextrose
Ringers Lactate (Hartmann’s)
0.9% Saline

29
Q

How are the volumes distributed across the body?

A

66% is intracellular
33% is extracellular

of the 33% that is extracellular:
75% is found in the interstitial fluid
25% is found intravascularly

30
Q

If you give 1L of dextrose how much fluid will go to the different compartments and why?

A

666ml Intracellular
250ml Interstitial
83ml Intravascular

5% dextrose can go into cells
So when equilibirum is reached the distribution of fluid given matches the body’s fluid % distribution

31
Q

If you give 1L of saline how much fluid will go to the different compartments and why?

A

Sodium transporter ensures the Sodium does not enter cells
Nothing enters cells so entire fluid is deposited extravascularly
750ml in interstitial fluid
250ml to the blood
0ml into cells

32
Q

If you give 1L of Ringer’s lactate how much fluid will go to the different compartments and why?

A

100ml intracellular
675ml interstitial fluid
225ml intravascular

Some fluid goes into cells, Ringer’s has slightly lower osmolality than cells. Goes from high to low until equilibrium is reached

Remaining distributes with a 75:25 ration extracellulary between interstitial and intravascular

33
Q

Which fluid is most commonly used?

A

Saline
Cheaper
In practise Ringer’s is not a whole load better

34
Q

Why would colloid solution in theory be great for shock?

A

Increase plasma protein in the capillary
Which would draw fluid back in
Does not work in practice
Associated with allergic responses

35
Q

What is the skin layer affected in an epidermal burn?

A

Epidermis

36
Q

What is the skin layer affected in an superficial partial thickness burn?

A

Upper dermis

37
Q

What is the skin layer affected in an deep partial thickness burn?

A

Extends into the deep dermis
Affecting the vascular plexus
Not all of the dermis is affected

38
Q

What is the skin layer affected in a full thickness burn?

A

has extended through the entire
thickness of the dermis and
no dermal tissue remains
(Third degree)

39
Q

What are some psychological impacts of burns?

A 
Flashbacks
Dissociation
Avoidance
Insomnia
Hyperarousal
Hypoarousal
40
Q

How can these problems be dealt with?

A

CBT
Anti-depressants
Sleeping pills/Other methods

CSI (17 decks)

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