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Core Conditions - CVS > Circulatory Shock/Hypotension II > Flashcards

Circulatory Shock/Hypotension II Flashcards

1
Q

What is the guideline for hypovolaemic shock?

A

Loss of > 20% intravascular fluid (reduced preload) leading to reduced cardiac output (CO).

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2
Q

What is the pathogenesis of hypovolaemic shock?

A

Fast volume loss results in poor ability to compensate, which can be haemorrhagic or non-haemorrhagic.

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3
Q

What are the haemorrhagic causes of hypovolaemic shock?

A

Trauma-associated blood loss (~20% / 1L), internal haemorrhage (e.g., pelvis/long bones, spleen, liver abdominal vessel rupture, AAA), upper GI bleed (variceal), intra- and post-operative bleeding, and post-partum haemorrhage.

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4
Q

What are the non-haemorrhagic causes of hypovolaemic shock?

A

Dehydration, GI fluid loss (diarrhoea, vomiting, surgical drainage), skin fluids (burns, heat stroke), and renal loss (adrenal insufficiency, salt-wasting nephropathies).

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5
Q

What are the clinical features of hypovolaemic shock?

A

Tachycardia, tachypnoea, weak pulse, hypotension, narrow pulse pressure, cold/clammy skin, poor capillary refill, and symptoms of fluid loss (decreased turgor).

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6
Q

What investigations are used for hypovolaemic shock?

A

RUSH or FAST scan bedside ultrasound (U/S), and full blood count (FBC) for haemoglobin/haematocrit levels.

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7
Q

What is the management for hypovolaemic shock?

A

Fluid resuscitation and possibly blood/blood product transfusion.

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8
Q

What is the guideline for cardiogenic and obstructive shock?

A

Blood pressure (BP) < 90mmHg with urine output < 20 ml/hr and normal or elevated left ventricular filling pressure.

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9
Q

What is the pathogenesis of cardiogenic shock?

A

Failure of myocardial pump resulting from intrinsic myocardial damage (non-obstructive) or extrinsic pressure (obstructive).

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10
Q

What are the non-obstructive causes of cardiogenic shock?

A

Myocardial infarction (MI), arrhythmias, and congestive heart failure.

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11
Q

What are the obstructive causes of cardiogenic shock?

A

Compression of the inferior vena cava (IVC) via tension pneumothorax, pericardial tamponade, constrictive pericarditis, restrictive cardiomyopathy, and pulmonary embolism.

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12
Q

What are the clinical features of cardiogenic shock?

A

Tachycardia, dyspnoea, weak pulse, hypotension, narrow pulse pressure, cold/clammy skin, poor capillary refill, and possibly increased jugular venous pressure (JVP).

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13
Q

What investigations are used for cardiogenic shock?

A

Identification of the cause, cardiac markers of acute coronary syndrome (ACS), electrocardiogram (ECG), and pulmonary artery catheterisation.

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14
Q

What is the management for cardiogenic shock?

A

Cardiopulmonary resuscitation (CPR) and managing the underlying cause, e.g., needle decompression for tension pneumothorax.

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15
Q

What is the guideline for septic shock?

A

Shock caused by capillary leakage (redistribution of fluid from intravascular to extravascular compartment) and systemic vasodilation (peripheral pooling of blood).

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16
Q

What is the pathogenesis of septic shock?

A

A dysregulated response to infection in the blood resulting in organ dysfunction, with a 40-50% mortality rate.

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17
Q

What are the common infection sites for septic shock?

A

Respiratory tract, genitourinary tract, gastrointestinal tract (GIT), skin, and soft tissue.

18
Q

What are the common infective microbes causing septic shock?

A

Gram-positive: Pneumococcus, Staphylococcus, Streptococcus, Enterococci, Listeria; Gram-negative: Klebsiella, Pseudomonas, Escherichia, Haemophilus, Legionella, Neisseria.

19
Q

What are the clinical features of septic shock?

A

Tachycardia, tachypnoea, bounding pulse, hypotension, wide pulse pressure, flushed/warm skin, hyper or hypothermia, acute oliguria despite fluid resuscitation.

20
Q

What investigations are used for septic shock?

A

Full blood count (FBC) with leucocytosis, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hyperglycaemia without diabetes history, and positive blood cultures.

21
Q

What is the management for septic shock?

A

Fluid resuscitation, vasopressors (adrenaline), and intravenous broad-spectrum antibiotics (e.g., Tazocin and Vancomycin).

22
Q

What is the guideline for neurogenic shock?

A

Loss of sympathetic vascular tone and interruption of autonomic pathways leading to decreased vascular resistance.

23
Q

What is the pathogenesis of neurogenic shock?

A

Loss of sympathetic vascular tone and interruption of autonomic pathways, leading to decreased vascular resistance.

24
Q

What are the causes of neurogenic shock?

A

Spinal cord injury, spinal anaesthetic, traumatic brain injury, cerebral haemorrhage, and poisoning.

25
Q

What are the clinical features of neurogenic shock?

A

Bradycardia, tachypnoea, hypotension, normal pulse pressure, flushed/warm skin, and severe back or neck pain.

26
Q

What investigations are used for neurogenic shock?

A

None specific mentioned.

27
Q

What is the management for neurogenic shock?

A

Fluid resuscitation and atropine for bradycardia.

28
Q

What is the guideline for anaphylactic shock?

A

Type 1 (Ig-E mediated) hypersensitivity reaction leading to degranulation of mast cells and histamine release, lowering blood pressure.

29
Q

What is the pathogenesis of anaphylactic shock?

A

Type 1 (Ig-E mediated) hypersensitivity reaction causing mast cell degranulation and histamine release, which lowers blood pressure.

30
Q

What are the causes of anaphylactic shock?

A

Drug reactions, insect allergies, food allergies, and contrast medium allergies.

31
Q

What are the clinical features of anaphylactic shock?

A

Tachycardia, tachypnoea, hypotension, narrow pulse pressure, flushed/itchy skin, bronchospasm (wheeze, stridor, cyanosis), angioedema, vomiting, and diarrhoea.

32
Q

What investigations are used for anaphylactic shock?

A

Full blood count (FBC) with eosinophilia.

33
Q

What is the management for anaphylactic shock?

A

Adrenaline and airway support (e.g., intubation, nebulizers).

34
Q

What does RUSH stand for in the context of shock?

A

RUSH stands for Rapid Ultrasound for Shock and Hypotension.

35
Q

What is the primary purpose of the RUSH scan?

A

The primary purpose of the RUSH scan is to quickly identify the cause of shock and guide initial management.

36
Q

What are the key components assessed in the RUSH scan?

A

The key components are:
1. Heart: Assess for pericardial effusion, left ventricular function, right ventricular function.
2. IVC (Inferior Vena Cava): Evaluate for size and respiratory variation to estimate volume status.
3. Morrison’s pouch (right upper quadrant): Check for free fluid.
4. Aorta: Check for aneurysm or dissection.
5. Pulmonary: Assess for pneumothorax, pleural effusion, or interstitial syndrome (e.g., pulmonary oedema).

37
Q

What does FAST stand for in the context of trauma?

A

FAST stands for Focused Assessment with Sonography for Trauma.

38
Q

What is the primary purpose of the FAST scan?

A

The primary purpose of the FAST scan is to quickly identify free fluid (e.g., blood) in the peritoneal, pericardial, or pleural spaces, primarily in trauma settings.

39
Q

What are the key components assessed in the FAST scan?

A

The key components are:
1. Perihepatic and hepatorenal space (Morrison’s pouch): Check for free fluid.
2. Perisplenic space: Check for free fluid.
3. Pelvis (pouch of Douglas in females, rectovesical pouch in males): Check for free fluid.
4. Pericardium: Check for pericardial effusion.

40
Q

How does the RUSH scan differ from the FAST scan?

A
  1. The RUSH scan is more comprehensive and used in both trauma and medical patients to determine the cause of shock
  2. The FAST scan is focused on trauma patients to quickly identify free fluid indicative of internal bleeding.

Core Conditions - CVS (26 decks)

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