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Year 1 Semester 2 > Case 16 > Flashcards

Case 16 Flashcards

1
Q

What is shock?

A

A life threatening condition where there is circulatory failure (decreased blood flow). There is inadequate tissue and organ perfusion.

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2
Q

What is hypovolemic shock?

A

Shock caused by significant loss of fluids from body
Causing decreased blood flow
Eg caused by diarrhea, vomiting or bleeding

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3
Q

What is cardiogenic shock?

A

Heart failure (pump failure)
Causing decreased blood flow

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4
Q

What is obstructive shock?

A

Obstruction of blood flow within circulatory system
Causing decreased blood flow
Eg due to cardiac tamponade, pulmonary embolism, tension pneumothorax

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5
Q

What is distributive shock?

A

Includes septic shock, anaphylactic shock, neurogenic shock

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6
Q

What is septic shock?

A

A form of sepsis
Widespread inflammatory response leading to impaired blood flow to vital organs

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7
Q

What is anaphylactic shock?

A

Life threatening allergic reaction
Immune system overreacts triggering widespread release of histamine
This causes sudden drop in blood pressure and airway constriction
Sharp decrease in blood flow to vital organs

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8
Q

What is neurogenic shock?

A

Caused by disruption of autonomic nervous system
Leads to vasodilation and decreased vascular tone
This leads to sudden drop in blood pressure and impaired blood flow to vital organs
Often associated with spinal cord or brain injury

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9
Q

What is cardiac tamponade?

A

Fluid accumulation in pericardial sac (around heart) causing compression of heart chambers

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10
Q

Explain the 4 stages of shock?

A

1)INITIAL - Initial response to low O2
-Body responds by increasing hr and peripheral vasoconstriction

2)COMPENSATORY - Body can maintain blood pressure to some extent but is working very hard to compensate

3)PROGRESSIVE - Compensatory mechanisms begin to fail
- Organs begin to fail due to inadequate perfusion

4)REFRACTORY - Body can no longer respond to medical treatment and the shock is irreversible
-Severe organ failure and high risk of death

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11
Q

Symptoms of shock?

A

Tachycardia
Tachypnoea
Pale, cool, clammy skin
Weakness and fatigue
Dizziness
Confusion and disorientation
Low blood pressure
Prolonged capillary refill time (due to peripheral vasoconstriction)
Enlarged pupils
Nausea or vomiting
Decreased level of consciousness
Changes in mental state or behaviour (eg anxious or agitated)

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12
Q

State physiological effects of shock and trauma on the cardiovascular system?

A

-Hypotension (low blood pressure)
-Tachycardia (in response to the LBP)
-Decreased cardiac output
-Cardiac arrhythmias
-Myocardial ischaemia - inadequate blood supply to heart muscle
… this can manifest as angina or myocardial infarction (HA)
-Peripheral vasoconstriction
-Activation of coagulation system - causing widespread clotting in small blood vessels leading to organ dysfunction and bleeding complications

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13
Q

What is hypovolemia?

A

Fluid loss from body

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14
Q

What is third spacing?

A

When fluid accumulates in interstitial spaces rather than remaining in blood vessels or compartments in cells

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15
Q

Causes of hypovolemia?

A

-Insufficient fluid intake
-Excessive sweating
-Increased urinary output
-Haemorrhage (blood loss)
-Vomiting
-Diarrhea
-Burns (causing fluid loss through damaged skin)
-Third spacing (when fluid accumulates in interstitial spaces rather than remaining in blood vessels)

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16
Q

What is fluid replacement therapy?

A

Fluid injected into veins
Increases volume of intravascular fluid
Leads to an expansion of circulating blood volume
This fluid moves via osmosis throughout the body replacing lost fluids

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17
Q

What are the 3 different fluid compartments in the body?

A

Intravascular compartments - blood
Interstitial compartments - surrounds cells of tissues and organs
Intracellular compartments - inside cells

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18
Q

2 types of fluid used for fluid replacement therapy?

A

Crystalloids
Colloids - eg albumin

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19
Q

What are crystalloids?

A

Solutions of water and electrolytes used for fluid replacement therapy

20
Q

What are colloids?

A

Solutions of liquid containing large molecules (eg protein and starches) used for fluid replacement therapy
The large molecules exert oncotic fluid pressure in intravascular space which helps retain fluid
- Eg albumin

21
Q

What is albumin?

A

Natural colloid derived from plasma
Made of protein components of plasma suspended in saline

22
Q

What are Packed Red Blood Cells transfusions used for?

A

Restore oxygen carrying capacity and improve tissue oxygen levels in patients with acute blood loss or anaemia

23
Q

What are Fresh Frozen Plasma transfusions used for?

A

Used to correct coagulation abnormalities by replenishing clotting factors

24
Q

What is contained in Fresh Frozen Plasma?

A

Liquid portion of blood separated from red blood cells and platelets
Contains clotting factors, fibrinogen, albumin and other proteins used for coagulation and haemostasis

25
Q

What are Platelet transfusions used for?

A

Used to prevent and treat bleeding in patients with low platelet count (thrombocytopenia)

26
Q

What is venous compliance?

A

Ability of veins to stretch and accommodate changes in blood volume

27
Q

What is vascular tone?

A

Degree of constriction or relaxation in blood vessels

28
Q

Potential impacts of bone fracture on circulation?

A

Can cause bleeding
Compartment syndrome (increased pressure in muscle compartment - leading to impaired load flow and tissue damage)
Oedema (swelling) can compress blood vessels
Risk of fat embolism (fracture causes fat to enter blood stream)
Immobilisation due to fracture causes venous stasis -increased risk of deep vein thrombosis
Impaired perfusion

29
Q

What is artificial ventilation?

A

Use of mechanical ventilators to deliver mixture of air and oxygen into lungs

30
Q

When may artificial ventilation be used?

A

Respiratory failure
When patient is under general anaesthetic
To protect airways of patients at risk (eg risk of aspiration - inhalation of unwanted substance)
When patients have respiratory muscle fatigue

31
Q

What is acidosis?

A

Accumulation of acid OR decrease in bicarbonate levels in blood

32
Q

What is metabolic acidosis and what is it caused by?

A

Various conditions which lead to accumulation of acid or loss of bicarbonate
Common causes:
-excessive production of metabolic acids
(Eg lactic acidosis in hypoxia, ketoacidosis in uncontrolled diabetes, accumulation of organic acids from renal failure)
-Impaired renal excretion of acids
-Loss of bicarbonate (eg by diarrhoea)

33
Q

What is respiratory acidosis and what is it caused by?

A

Inadequate CO2 removal due to hypoventilation or impaired gas exchange
Due to:
-Respiratory depression (eg due to drug overdose, head injury, CNS depression)
-Lung disease (eg COPD, pneumonia, Neuromuscular disease affecting respiratory muscles

34
Q

Signs and symptoms of acidosis?

A

Tachypnea or kussmaul respirations in order to try to remove CO2
Headache, confusion, drowsiness, lethargy, restless, agitated
Coma in severe cases
Nausea, vomiting, diarrhoea
Abdominal pain and discomfort
Electrolyte imbalances
Dehydration

35
Q

What are Kussmaul respirations?

A

Deep, rapid, laboured breaths
Typically found during metabolic acidosis (to attempt to remove excess CO2)

36
Q

Explain Glasgow Coma Scale (GCS)?

A

Assesses patients consciousness level based on: eye opening, verbal response, motor response.
Score of 3-15, lower means lower level of consciousness
(3- deply unconscious and 15-fully awake and alert)
EYE OPENING: 1 - no eye opening 4- spontaneous eye opening
VERBAL RESPONSE: 1 - no verbal response 5- orientated and converses normally
MOTOR RESPONSE: 1-no motor response 5-obeys commands

37
Q

Explain AVPU and what it is used for?

A

AVPU is a simple and rapid method to assess consciousness level usually used in emergency situations
A- alert
V- verbal (responds to verbal stimuli)
P - pain (responds to pain stimuli)
U - unresponsive

38
Q

What is delirium?

A

Serious and often sudden change in mental status
Confusion, disorientation, altered consciousness (more/less consciousness than normal)

39
Q

Why do many ICU patients experience delirium?

A

Social isolation
Immobility
Disrupted sleep schedule
Sleep deprivation
Underlying conditions predispose them
Medications used (sedatives, opioids and anticholinergic medications)
Mechanical ventilation can cause confusion
ICU environment is disorientating, stimulating and unfamiliar
Metabolic and electrolyte imbalances

40
Q

Location and function of internal jugular vein?

A

Descends alongside internal carotid in neck
Drains blood from brain, face and neck

41
Q

Location and function of external jugular vein?

A

Descends down lateral aspect of neck
Drains blood from scalp and parts of face and neck

42
Q

Location and function of subclavian vein?

A

Starts at border of 1st rib and extends into thorax
Joins with jugular vein to form brachial plexus
Drains blood from upper limb, shoulder and chest wall

43
Q

Location and function of subclavian artery?

A

Arises from aortic arch, passes under clavicle and continues into axilla as axillary artery
Supplies upper limb, shoulder and chest walls

44
Q

Location and function of internal carotid artery?

A

In neck
Supplies brain

45
Q

Location and function of external carotid artery?

A

In neck
Supplies face, scalp and neck

46
Q

Location and function of Vagus nerve?

A

Descends down neck with carotid artery
Supplies parasympathetic innervation to neck and thorax (including heart, lungs and digestive organs)

47
Q

Location and function of Phrenic nerve?

A

Arrises from cervical plexus (at C3-C5)
Descends through the neck
Innervates diaphragm (it is crucial for breathing)

Year 1 Semester 2 (9 decks)

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