Critical care

Question 1

Main definition of shock

Answer 1

Inadequate organ perfusion

may or may not be accompanied by hypotension

Question 2

List the 4 types of shock

Answer 2

1. Hypovolemic
2. Cardiogenic
3. Distributive
4. Obstructive

Question 3

Reason for low blood pressure during hypovolemic shock

Answer 3

Low SV due to lack of cardiac filling from fluid loss

Question 4

Example of hypovolemic shock

Answer 4

• Bleeding (trauma)

- Fluid loss in diarrhoea

Question 5

Reason for low blood pressure during cardiogenic shock

Answer 5

Low HR or low SV

Question 6

Example of cardiogenic shock

Answer 6

• MI (low SV)

- Bradycardia, dysrhythmia (low HR)

Question 7

Reason for low blood pressure during distributive shock

Answer 7

Vasodilation, leading to low systolic vascular resistance

Question 8

Example of distributive shock

Answer 8

• Sepsis

- Anaphylaxis

Question 9

Reason for low blood pressure during obstructive shock

Answer 9

Low SV

Question 10

Example of obstructive shock

Answer 10

• PE
• other emboli
• anything else causing mechanical resistance to ventricular outflow

Question 11

Treatment for compensated hypovolemic shock (stage 1 &2)

Answer 11

1. Lie down
2. Stop bleeding
3. IV fluids

Question 12

Treatment for uncompensated hypovolemic shock (stage 3 &4)

Answer 12

1. Lie down, elevate legs
2. Stop bleeding
3. IV fluids, blood transfusion
4. Oxygen mask
5. Prevent hypothermia

Question 13

How to assess acutely unwell patient

Answer 13

C-ABCD

Catastrophic Haemorrhage
Airway
Breathing
Circulation
Disability

Question 14

What to assess during disability

Answer 14

• AVPU (and GCS if necessary)
• Pupil response
• Blood glucose

Question 15

What are the 6 parameters in NEWS

Answer 15

• Respi rate
• O2 sats
• Blood pressure
• Heart rate
• Temperature
• Consciousness level

Question 16

Which is the most sensitive indicator in NEWS

Answer 16

Respi rate

Question 17

What might be signs of hypotension in a patient

Answer 17

• Passing less urine

- Irritable patient

Question 18

Why is a heart rate above 130 very worrying

Answer 18

SHORTER DIASTOLE

• Reduced stroke volume as ventricle not filling enough, leads to ischaemia
• Lower heart perfusion as perfusion tends to happen during diastole

Question 19

What level of oxygen should be given to an acutely unwell patient

Answer 19

15L non-rebreather mask

reassess and lower down later if necessary, but do not start them on anything lower acutely

Question 20

What investigations should be done if sepsis is suspected

Answer 20

• FBC
• CRP
• Blood cultures
• MSU
• Urine microscopy, culture and sensitivities
• CXR

Question 21

3 ins and 3 outs of sepsis

Answer 21

• lactate and oxygen
• urine output and IV fluids
• blood culture and IV antibiotics