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ATLS > Chapter 3 Shock > Flashcards

Chapter 3 Shock Flashcards

1
Q

Define Shock

A

abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation

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2
Q

What is the most common type of shock in an injured trauma pt?

A

hemorrhagic

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3
Q

Define Cardiac output

A

Vol of blood pumped by the heart per minute

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4
Q

Define stroke vol

A

Amount of blood that leaves the heart w/ each cardiac contraction

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5
Q

What is stroke vol determined by?

A

Preload
Myocardial contractility
Afterload

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6
Q

Define preload

A

Volume of venous blood returned to the L and R side of the heart.

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7
Q

Define afterload

A

Also known as PVR

Amount of resistance to forward flow of blood leaving the heart

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8
Q

CO = ____ X _____

A

CO = Heart rate (BPM) X Stroke Vol (mL/beat)

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9
Q

Early physiologic response to blood loss is _____

A

Compensatory

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10
Q

What are the three main compensatory reactions to blood loss?

A

Vasoconstriction-Preserves blood flow to heart, kidney and brain
Catecholamine release- Increases PVR
Heart Rate Increase - to preserve C.O

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11
Q

What are the first signs of shock due to volume loss

A

Tachycardia

Cutaneous vasoconstriction

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12
Q

When does a decrease in systolic pressure occur?

A

Not until 30% vol loss occurs (SO THIS IS NOT A GOOD INDICATOR)

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13
Q

Define Tachycardia in an adult

A

HR > 100 BPM

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14
Q

Define Tachycardia in a pre-school age child

A

HR >140BPM

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15
Q

Define tachycardia in an infant

A

HR > 160 BPM

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16
Q

Define Tachycardia in a school age child-Puberty

A

HR >120 BPM

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17
Q

When looking for source of Hemorrhagic shock the term “The floor plus 4 more” refers to what?

A 
Blood loss from
Chest
Abdomen
Pelvis
Retroperitoneum
External bleeding
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18
Q

What sources of Non-hemorrhagic shock should be considered as well?

A 
Cardiogenic shock
Cardiac Tamponade
Tension PTX
Neurogenic shock
Septic Shock
19
Q

When should cardiogenic shock be considered possible?

A

Blunt cardiac injury when mech of injury is rapid deceleration
Also can be secondary to MI

20
Q

What labs/tests should be done to detect and monitor possible cardiogenic shock?

A

ECG continuous monitor

Cardiac enzymes

21
Q

When should Cardiac Tamponade as a cause of shock be considered?

A 
Blunt/penetrating chest trauma 
Tachycardia
Muffled heart sounds
dilated engorged Neck veins
Hypotension without response to fluid resusc.
22
Q

What labs/tests should be done to detect and monitor possible cardiac tamponade in the case of shock?

A

ECG is not quick or that helpful although can detect

FAST US will identify pericardial fluid

23
Q

What symptoms of Tension PTX differ from Cardiac tamponade

A

All of the symptoms of cardiac tamponade are present in T PTX except for muffled heart sounds, Breath sounds (which are absent in tPTX), and Hyperresonance (echoes in tPTX)

24
Q

If patient has an isolated intracranial injury but appears to be in neurogenic shock what must be done?

A

Look for other cause!

Isolated intracranial injury does not cause neurogenic shock unless the brainstem is involved.

25
Q

Classic presentation of neurogenic shock

A

Hypotension without tachycardia or cutaneous vasoconstriction

26
Q

When should septic shock be considered in trauma pt?

A

Delayed presentation to ED.

27
Q

Class I hemorrhage definition

and exam parameters

A

< 15% blood loss

All measurable parameters remain stable

28
Q

Class II hemorrhage definition

and exam parameters

A 
15-30% blood loss
HR can remain same or increase
Tachypnea
Pulse pressure drops
All other parameters remain stable
29
Q

Class III hemorrhage definition

and exam parameters

A

31-40% blood loss
Marked tachycardia and tachypnea
Significant mental status change
Measurable systolic pressure drop

30
Q

Class IV hemorrhage definition and exam parameters

A

> 40% blood loss
Tachycardia
marked systolic drop
Narrow pulse pressure or no traceable diastolic bp

31
Q

Treat all shock as if it is _____ until proven otherwise

A

hemorrhagic

32
Q

Steps to physical exam of shock pt

A

A and B- Establish airway and proper ventilation- provide supp O2, maintain O2 sat 95%
C- STOP THE BLEEDING, obtain IV access
D-Determine lvl of consciousness and assess cerebral perfusion
E-Expose to determine addl bleeding and keep warm!

33
Q

Why is Gastric Decompression necessary in shock

A

To prevent aspiration

34
Q

Why is urinary Cath helpful in shock?

A

To assess hematuria and measure urinary output

35
Q

When is urinary cath contraindicated?

A

urethral injury

36
Q

What is the proper protocol for initial fluid tx?

A

Initial warmed fluid bolus of isotonic fluid
Usual bolus is 1L in adults and 20mL/kg in children < 40kg.
bolus amount includes pre-hospital amount

37
Q

Three different patient response schemes

A

Rapid response
Transient response
Minimal or No response

38
Q

Rapid response to hemorrhage indicates which class of hemorrhage?

A

Class 1 <15% loss

39
Q

What intervention should be given to pt with rapid response?

A

no further fluid management required after initial resusc.

40
Q

Define transient response

A

Pt responds to initial bolus but return to unstable status once maintenance fluid is started

41
Q

Transient response indicates what class of loss in shock?

A

Class II - III between 15-40%

indicates pt is still bleeding somewhere

42
Q

What intervention should occur to pt that is a transient responder?

A

Blood product and blood should be started,
Re-eval for operative or angiographic control
consider activating MTP

43
Q

What intervention should occur in pt w/ no response to fluid/blood resusc.

A

Immediate operative or angioembolization
Consider other types of shock (tamponade or PTX)
Initiate MTP

44
Q

Define MTP

A

> 10u pRBCs w/ the first 24h of admission or

>4u in 1 hour

ATLS (5 decks)

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