Clinical Shock Flashcards
What are the 3 intact mechanisms that the body needs to function properly
Effective heart (pump) Intact and functioning blood vessels (pipes) Adequate volume of blood (fluid)
What are the 5 types of shock?
C - cardiogenic H - hypovolaemic A - anaphylactic shock N - neurogenic T - toxic/septic
What are the common causes for cardiogenic shock?
Heart failure Myocardial Infarction Myocarditis Tension Pneumothorax Cardiac Tamponade (bleeding into the pericardial sac)
What are the common causes of hypovolaemic shock?
Whole blood loss - external/internal bleeding
Plasma loss from burns
Electrolyte/water loss - dehydration (D and V)
What are the common causes of neurogenic shock?
High spinal cord injury
Poisons
Fainting
What are the common causes of septic shock?
Meningococcal meningitis
Peritonitis
Cardiac conditions (myocarditis)
How many stages are there in shock recognition?
4
Explain stage 1 of shock
Up to 15% blood volume loss
Normal respirations 15-20 Pallor of skin Normal capillary refill Pulse rate in excess of 100 bpm No change in systolic or in diastolic blood pressure
Explain stage 2 of shock
15% to 30% blood volume loss
Pallor, cool, clammy skin Extended time for capillary refill Pulse rate in excess of 100 bpm Increased respiratory rate (15-30) Normal systolic, but elevated daisy stolid blood pressure Narrowing pulse pressure
Explain stage 3 of shock
30% to 40% blood volume loss
Anxiety, restlessness and agitation
Pulse rate in excess of 120 bpm
Resp rate 30-40
Falling systolic blood pressure to 100mmHg or less
Explain stage 4 of shock
Over 40% blood volume loss
Moribund appearance - waxy mannequin appearance Central cyanosis Altered level of consciousness Marked tachycardia/weak pulse Signs of respiratory distress (40+) Systolic blood pressure 70mmHg or less
Shock in pregnancy
Cardiac output increases by 20-30% in the first 10 weeks of pregnancy
Average heart rate increases by 10-15 beats per minute
Both systolic and daisy stolid BP falls on average by 10-15mmHg
After week 10 both blood volume (45% increase) and numbers of red cells increase but not in proportion, so the patient becomes relatively anaemic
How many rules are there for shock in pregnancy?
3
What is rule 1 for shock in pregnancy?
The maternal well-being is essential to the survival of the foetus and thus resuscitation of the mother must always be the priority
What is rule 2 for shock in pregnancy?
Compression of the inferior vena cava by the foetus is a serious potential complication during pregnancy and suitable positioning or manual displacement must be employed
What is rule 3 for shock in pregnancy?
Signs of shock appear late during pregnancy and hypotension is an extremely late sign. Usually indicating 35% blood loss (stage 3 shock).
What is anaphylactic shock?
Anaphylaxis is best described as a severe allergic reaction (hypersensitivity) often affecting the whole body.
Anaphylaxis occurs when patients are exposed to an allergen to which they may become over sensitive
What is an Antigen?
It is any substance that the body regards as foreign or potentially dangerous and against which it produces an antibody (immune response)
What is an allergen?
It is an antigen to which an individual is hypersensitive
Eg All nuts (main category) are antigens, peanuts (sub category) are an allergen
What is an antibody?
It is a protein produced in response to a specific foreign substance (antigen) that destroys or inactivated the foreign substance
What is an allergy?
It is an adverse reaction on re-exposure to a substance that does not ordinarily cause adverse symptoms in the average person
What is Anaphylactic shock?
It is an extreme and generalised allergic reaction in which widespread histamine release causes oedema, bronchoconstriction, heart failure, circulatory collapse and sometimes death
What are the different ways by which you can have anaphylactic shock
Injection - vaccines
Ingestion - food
Absorption - toxins
Inhalation - dust and molds
What are the systems Anaphylactic shock can affect?
Respiratory Cardiovascular Gastrointestinal Nervous And the skin
What are the early stages of an allergy?
Itchy rash Swelling around eyes Prickly lips Dry, non productive cough Restlessness
Signs and symptoms for anaphylaxis
Flushed skin Tachycardia Chest tightness Tongue and throat swelling Wheeze Hoarseness Dyspnoea
Signs and symptoms for Anaphylactic shock
Stridor Hypotension Bronchospasm Cyanosis Circulatory collapse Respiratory collapse May also include - Nausea/vomiting Abdo cramps Profuse watery diarrhoea Abdo distension Headache Dizziness Confusion Collapse
What drugs would you give for anaphylactic shock?
Oxygen - high flow, 15ltr per min
Nebulised salbutamol - only if wheeze on expiration
Adrenaline 1:1000
What is the definition of shock?
Inadequate Tissue Perfusion ( not enough oxygen getting to tissue)
