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Emergency Medicine > Assessment of Shock > Flashcards

Assessment of Shock Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is shock? What does it result in?

A

Inadequate O2 delivery to cells

  • Inadequate cellular energy production
  • Cellular dysfunction
  • Organ dysfunction
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2
Q

What determines O2 delivery to cells? (The tree of life)

A

Delivery of oxygen is a consequence of cardiac output and Hb conc.

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3
Q 
Define:
Stroke volume
Preload
Afterload
Contractility
Systemic vascular resistance
A

Stroke volume: Volume of blood ejected from LV

Preload: LV vol at end fo diastole

Afterload: Load that the heart must eject blood against

Contractility: intrope

SVR: resistance to bloodflow determined by vasomotor tone

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4
Q

Where on the tree of life is affected by shock?

A

Cardiac output

Blood pressure

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5
Q

How does shock differ from dehydration?

A

Shock is a decrease of IV fluid, is life-threatening.

Dehydration is a decrease of interstitial fluid, not imminently life threatening.

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6
Q

What are the clinical signs of dehydration?

A

Tacky mm
Skin tenting
Dry tear film/sunken eyes

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7
Q

Which clinical signs of shock are assessed?

A 
HR
Pulse quality
MM colour
CRT
Extremity/body temp
Mentation
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8
Q

What are the normal HR for dogs and cats? How does shock affect HR?

A

D - 60-120bpm
C - 160-200bpm

+ Tachycardia due to compensation
+ Bradycardia in cats
+ Bradycardia due to decompensation

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9
Q

How should HR be monitored?What are DDx for tachy/bradycardia in shock?

A

ECG
T - hypoxaemia, anaemia, pain, arrhythmia

B - arrhythmia, increased intracranial pressure

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10
Q

How is pulse quality assessed? Where can the pulse be taken?

A

Auscultate at the same time as assessing pulses to check for cardiac deficits, quality and speed.

  • Femoral
  • Metatarsal
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11
Q

How might shock affect mm colour? What are the DDx?

A

Pale - anaemia, hypoxaemia

Hyperaemic - gingivitis

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12
Q

What do decreased extremity and body temps indicate in shock?

A

E - Mild/moderate shock

B - cats, severe shock in dogs

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13
Q

How might mentation by affected by shock?

A

Obtunded
Stuporous
Comatosed

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14
Q

What can be used as markers of shock later on?

A

Lactate level >2.5mmol/L

BP decrease

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15
Q

What are the 4 types of shock?

A

Hypovolaemic
Obstructive
Cardiogenic
Vasodilatory

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16
Q

What can cause hypovolaemic shock?

A 
Dehydration
V/D
Haemorrhage
3rd space loss
PU
17
Q

What can cause obstructive shock?

A

GDV
Pericardial effusion
Pneumothorax

18
Q

What can cause cardiogenic shock?

A

Arrhythmia
Systolic dysfunction
Poor contractility

19
Q

How do the 6 clinical signs vary with mild-moderate-severe vasoconstrictive shock?

A

HR
Mild - Increased +
Moderate - Increased ++
Severe - Decreased +

Pulse quality
Mild - Increased or decreased
Moderate - Decreased ++
Severe - Decreased +++

MM
Mild - Pale pink (1.5-2CRT)
Moderate - Pale (2-3CRT)
Severe - Very pale (>3CRT)

Extremity/Body temp
Mild - Decreased +
Moderate - Decreased ++ 
         Body temp - D in cats (+)
Severe - Cats and dogs decreased BT +
20
Q

How are the three types of vasoconstrictive shock diagnosed?

A

History
PE
Diagnostic tests

21
Q

What are the clinical signs of hypovolaemic shock?

A

Dehydration
Pleural effusion
Abdominal distension
Free fluid on US

22
Q

What are the clinical signs of obstructive shock?

A

Distended abdomen

Decreased H and L sounds

23
Q

How is cardiogenic shock diagnosed?

A

History
PE - juglar distension, thoracic asuc
ECG
Echo

24
Q

What can cause vasodilatory shock?

A

SIRS
Sepsis
Anaphylaxis
Anaesthesia

25
Q

What are the clinical signs that differentiates vasoconstrictive and vasodilatory shock?

A

mm colour

pale - vasoconstrictive
dark - vasodilatory

26
Q

What mechanisms cause vasodilatory shock?

A

Decreased vasomotor tone
Increased capillary permeability
Decreased oncotic pressure

27
Q

What is SIRS? How does it differ from sepsis?

A

Systemic inflammatory response syndrome > Pro-inflammatory responses overwhelm anti-inflammatory responses and causes systemic inflammation

Sepsis = SIRS + infection

28
Q

What are the imortant points to remember about shock?

A

Bradycardia > Cardiac arrest
Vasodilatory shock > Dark MMs
Can have more than one type of shocl

Emergency Medicine (4 decks)

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