Acutely Unwell Patient Flashcards
What is shock?
A descriptive term used to describe the state that results when circulatory insufficiency leads to inadequate tissue perfusion and thus inadequate oxygen delivery to tissues - this shortage of oxygen means aerobic metabolism cannot occur, resulting in organ dysfunction.
What are the broad causes of shock? (5)
Hypovolaemic (e.g haemorrhagic, dehydration)
Distributive (e.g sepsis, anaphylaxis)
Obstructive (e.g pulmonary embolism, tension pneumothorax)
Cardiogenic (e.g myocardial infarction)
Neurogenic (e.g cervical spinal cord injury)
What signs indicate hypovolaemic shock?
Signs of shock plus history or examination evidence of bleeding or fluid loss, cool peripheries and a good response to fluid or blood resuscitation.
What signs indicate distributive shock?
Signs of shock plus peripheral vasodilation (warm, dilated peripheries) and history of recent worsening infection or known exposure to allergen. Patient may be febrile, and may or may not respond to fluid resuscitation (as hypotension is not the underlying cause).
What presentation can indicate obstructive shock?
Signs of shock plus signs of a problem inside the thorax that is impeding cardiac output, such as tension pneumothorax, cardiac tamponade or massive pulmonary embolism.
[Serious pathology can be present without all the classical examination findings; echocardiography is useful in these cases.]
What are two signs indicative of cardiac tamponade?
Dilated neck veins
Muffled heart sounds
What signs indicate cardiogenic shock? (3)
Patient will usually have presentation with adverse cardiac features (such as chest pain, syncope or signs of heart failure) and cold peripheries, as well as abnormal ECG.
What signs indicate neurogenic shock?
Syndrome is specific to trauma and different to spinal shock; indicated by bradycardia and hypotension with peripheral dilation/warmth (due to loss of normal sympathetic response to blood loss).
What is considered to be the most common type of shock?
Sepsis
When is blood transfusion recommended in a haemodynamically stable patient?
Only when the haemoglobin is <70g/L, with a target of 70-100g/L.
When should a major haemorrhage protocol be activated?
When a bleeding patient becomes haemodynamically unstable.
What are the four potential rhythms of cardiac arrest?
Ventricular tachycardia
Ventricular fibrillation
Asystole
Pulseless electrical activity (PEA)
Which of the four potential rhythms of cardiac arrest are shockable? (2)
Ventricular tachycardia
Ventricular fibrillation
What are the eight causes of cardiac arrest?
Hypothermia
Hypovolaemia
Hyper/hypokalaemia
Hypoxia
Tamponade
Tension Pneumothorax
Thrombus
Toxins
