Critical Illness Flashcards

1
Q

What is the definition of shock?

A

Acute circulatory failure with inadequate or inappropriately distributed tissue perfusion (systolic<90mmhg)

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2
Q

What is hypovolaemic shock, and what can cause it?

A

Loss of intravascular volume, caused by: - Haemorrhagic shock (trauma, GI bleeding, AAA) - DKA - GI fluid loss - Extensive burns - Fluid loss from fistulae or drains

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3
Q

How is hemorrhagic shock classified?

A

1 - <750ml lost, no physiological changes 2 - 750-1500ml lost, pale/cold/clammy, parameters raised 3 - 1500-2000ml lost, altered mental state 4 - >2000ml lost, close to cardiac arrest As stages increase, pulse pressure becomes narrower, resp rate and heart rate increase, and urine output decreases

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4
Q

What is distributive shock, and what causes it?

A

Vasodilation with increased capillary permeability and reduced vascular resistance, caused by: - Sepsis - Anaphylaxis - Neurogenic shock (spinal cold injury) - Endocrine failure (Addison’s)

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5
Q

What is obstructive shock, and what causes it?

A

Physical obstruction to blood flow in the great vessels or the heart itself, caused by: - Tension pneumothorax - Massive PE - Cardiac tamponade

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6
Q

What is cardiogenic shock, and what causes it?

A

Pump failure, caused by: - MI - Arrythmia - Myocarditis - Cardiac tamponade

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7
Q

What is dissociative shock, and what causes it?

A

Oxygen unable to enter the cells, due to: - Cyanide poisoning

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8
Q

What are some compensatory mechanisms in shock?

A

Increased RR - blow off C02 from acidosis Vasoconstriction - adrenaline released in response to hypotension Decrease in urine output - low BP causes ADH production

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9
Q

What are the four stages of shock?

A
  1. Initial 2. Compensatory 3. Progressive - failure of compensatory mechanisms 4. Refractory - vital organs have failed, death imminent
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10
Q

How should anaphylactic shock be managed?

A

IM adrenaline (500mcg) IV fluid bolus Steroids (hydrocortisone) Antihistamines (chlorphenamine)

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11
Q

How should cardiogenic shock be managed?

A

MONA (morphine, oxygen, nitrates, aspirin) DONT give fluids

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12
Q

How should tension pneumothorax be managed?

A

Needle thoracocentesis - to drain air 02

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13
Q

How should hemorrhagic shock be managed?

A

FIND THE CAUSE AND TREAT IT RESTORE CIRCULATING VOLUME - O negative blood (large bore IV), IV fluids STOP BLEEDING Tranexamic acid (stop bleeding)

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14
Q

How should septic shock be managed?

A

Sepsis 6 3 in - o2, antibiotics (tazocin + gentamicin), fluids (20ml/kg crystalloid) 3 out - lactate, UO, blood cultures

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15
Q

How should hypovolaemic shock be managed?

A

Treat underlying cause Give fluid bolus Raise LEGS

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16
Q

What parameters does EWS look at?

A

Respiratory rate (shouldn’t be over 25 or below 8) Heart rate (shouldn’t be over 130) Systolic BP (shouldn’t be over 220 or below 90) Oxygen sats Temperature Level of consciousness (AVPU)

17
Q

What does a NEWS score of 1-4 mean?

A

Low clinical risk - monitor every 4 hours (as oppose to 12 hours if 0)

18
Q

What does a NEWS score of 5-6 mean?

A

Medium clinical risk - monitor every hour, escalate care

19
Q

What does a NEWS score of 7+ mean?

A

High clinical risk - continuous monitoring and escalated care, consider ICU

20
Q

What does level 2 care mean?

A

Single organ failure, usually requires HDU admission

21
Q

What does level 3 care mean?

A

Multiorgan failure, usually requires ICU admission

22
Q

What investigations should be done for someone with suspected haemorrhagic shock?

A

ABG, blood group and save, FBC, U&E

23
Q

What is the mechanism behind haemorrhage shock?

A

3 changes: - Baroreceptors detect change and increased HR, sympathetic nervous system and vasoconstriction - Adrenaline and steroids released - Reduced renal perfusion due to RAAS activation and water retention

24
Q

What is the definition of major haemorrhagic shock?

A

Loss of 70ml/kg in 34 hr (or 50% of blood volume in 3 hours)

25
Q

In severe blood loss, what are the things that can kill you?

A

Acidosis Hypothermia Coagulopathy Each one may lead to another, causing a downward spiral

26
Q

What are the 4 signs of brain herniation?

A
  1. CN3 palsy (pupil dilation) 2. Motor posturing (decorticate - flexed) 3. Lower rigidity 4. Hyperventilation
27
Q

What are the 4 signs of raised ICP?

A
  1. Decreased consciousness 2. Cushings response 3. Vomiting 4. CN 6 palsy
28
Q

What is Cushing’s response?

A

Triad of: 1. Increased BP 2. Decreased pulse 3. Slow, irregular respiration This indicates death within minutes to hours

29
Q

What should normal cerebral blood flow be?

A

750 millliletres per minute

30
Q

What should normal ICP be?

A

7-15 mmHg

31
Q

What investigations should be done for someone with suspected brain trauma?

A

Bedside - obs, ECG Bloods - oxygen, haemoglobin Imaging - CT, MRI Special - cerebral perfusion pressure

32
Q

What is a decompression craniectomy?

A

A surgical procedure to allow brain expansion if there is raised ICP