Clinical Shock Flashcards
Define shock
A condition characterised by impaired cellular function as a result of a reduction in the effective circulating volume
What are the three different types of shock
Hypovolemic - low volume
Cardiogenic - failure of the pump
Distributive - abnormal distribution
What is hypovolemic shock
Loss of blood through haemorrhage
Loss of plasma through burns
Loss of fluids through D&V
Severe dehydration
What is cardiogenic shock
Reduced ability of the heart to pump effectively
Myocardial infarction
Cardiac arrhythmias
Cardiac tamponade
Lung pathology (tension/PE)
What is neurogenic distributive shock
Neurogenic - sympathetic and parasympathetic mechanisms are disrupted.
Body loses venous fine
-Severe head injury
-Spinal injury
-Drug reaction
-Neurological illness
What are the three types of distributive shock
Neurogenic
Sepsis
Anaphylaxis
What is sepsis distributive shock
Sepsis - damage caused by overwhelming bacterial infection
What is anaphylactic distributive shock
An ‘over reaction’ to a benign substance
Histamine and prostaglandin released into general circulation, increases oedema, laryngeal oedema and a fluid shift
how can you tell there is internal bleeding in the lungs
Bright red and frothy substance coughed up through the trachea and airways.
HAEMOPTYSIS
What are the 4 signs of abdominal organs internal bleeding
Abdominal distension-blood, fluid
Abdominal tenderness- significant if over liver, spleen or renal angles
Generalised Guarding-suggests peritonitis (massive bleeding it perforation)
Pelvic instability- avoid repetitive examination
What is haematuria
When urine is a cloudy/smoky colour
Can sometimes see micro clots
Is a sign of Abdominal organ internal bleed
What is Grey Turners and what is it a sign of
Sign of haemorrhage of the pancreas
Rashy Bruising of the stomach
What is cullens sign and what is it a sign of
Bruising around the belly button
Periumbilical ecchymosis (bruising around umbilicus) or
Blood leaking into abdominal cavity
What is a sign of an upper GI bleed
A dark coffee colour is vomitted up. Looks like coffee grounds. Had a pt with this.
Haematesis
What is a sign of a lower GI bleed
Black tarry stalls
Offensive smell and tarry colour
MELENA
What are the 4 stages the body goes through to compensate for blood loss
Initial stage
Compensatory
Progressive
Refractory
What is the initial stage of the body compensating for blood loss
Cardiac output is decreased, and tissue perfusion is threatened
What is the compensatory stage of the body compensating for blood loss
The body’s homeostatic mechanisms attempt to maintain CO, blood pressure and tissue perfusion
What is the progressive stage of the body compensating for blood loss
The compensatory mechanism begin failing to meet tissue needs and the shock cycle is perpetuated
What is the refractory stage of the body compensating for blood loss
Shock becomes unresponsive to therapy and is considered irreversible
What are the indications of severity for blood loss
Pulse - Initially up but eventually goes down
Resps- Initially up but eventually goes down
Pupils - Dilate as hypoxia develops
Skin - Pale, grey, cyanosis
BP- Drop in BP
GCS - Confusion, lowered GCS
How many stages of shock are there
4
indications of Stage one of shock (Up to 15% blood loss)
Normal resps
Pallor of skin
Normal capillary refil
Pulse rate above 100
No change in BP
indications of Stage 2 of shock (15-30% blood loss)
Pallor, cool, clammy skin
Extended time for Cap refill
Pulse rate above 100
Increased resps (15-30)
Normal systolic but elevated diastolic
Narrowing pulse pressure
indications of stage 3 of shock (30% to 40% blood volume loss)
Anxiety, restlessness and agitation
Pulse rate in excess of 120bpm
Resp rate - 30-40
Systolic BP <100mmHg or less
indications of the 4th stage of shock (over 40% blood loss)
Moribound appearance
Central cyanosis
Altered level of consciousness
Tachycardia/weak pulse
Resp distress 40 resp rate
Systolic BP of 70mmHg or less
