Emergency Presentations Flashcards
what is shock?
inadequate blood flow to organs to meet demand
defined as MAP <65 or SBP <90 + signs (e.g. mottled skin, prolonged cap refill, low UO, agitationo and confusion, raised lactate)
What is the formula you should use for causes of shock?
MAP = CO x SVR = HR x SV X SVR
What are causes of shock then?
CARDIOGENIC
OBSTRUCTIVE
HYPOVOLAEMIC
DISTRIBUTIVE (SEPTIC, ANAPHYLACTIC)
Low HR: pump failure (cardiogenic shock, PE, tension pneumothorax, tamponade)
Low SV:
- bleeding, fluid losses
Low SVR:
- sepsis
- anaphylaxis
- neurogenic (spinal cord injury, epidural / spinal anaesthesia)
- endocrine (Addison’s, hypotyroid)
- drugs
How do you classify hypovolaemic shock?
ATLS Classes 1-4
1: compensated
2: tachycardia
3: hypotension
4: LOC
What are the types of shock?
Cardiogenic
Obstructive
Hypovolaemic
Distributive (anaphylactic, septic)
What will HR and BP be in all types of shock?
high HR, low BP
How do you treat cardiogenic shock?
Inotropes, to increase contractility (dobutamine, dopamine)
How do you manage septic shock?
Noradrenaline (to vasoconstrict, as there is excessive vasodilation) + sepsis 6
How do you manage hypovolaemic shock=
IV fluids / blood
+ treat cause
What is sepsis
Life threatening organ dysfucntion caused by dysregulated host response to infection
What is the MAP indicative of shock?
MAP <= 65mmHg
What is septic shock?
sepsis + lactate >2 (despite fluid resus) or pt needs vasopressor to maintain MAP
How do you manage sepsis
sepsis 6
find source of infection
clinician review in <1h, senior review <3h if cause is not identified
How do you manage anaphylaxis first steps
- Secure airway
- Remove cause + raise legs
- Meds
What are first line meds for anaphylaxis
- Adrenaline IM 0.5mg 1:1000 (can repeat every 5 mins PRN)
then insert IV line
- Chloramphenamine 10mg IV
- Hydrocortisone 200mg IIV
Add IV fluid bolus if in shock
What else must you do after initial management of anaphylaxis - during admission and as long term tx
Admit and monitor
ECG
Serum tryptase 1-6 hours later
As long term tx:
- Allergy clinic referral
- MedicAlert bracelet
- Discharge with 2 autoinjectors
- Teach to self inject
When can you discharge anaphylaxis patient
After observed for 6-12 hours from onset
How many patients have a biphasic response to anaphylaxis
Up to 20%
What do you do for trauma patient initially?
Primary survey (A>E approach)
but first tamponade if they have a massive haemorrhage
What do you do for A in a trauma pt
no head tilt - just JAW THRUST
Assume cervical spine blunt injury unless proven otherwise
What rules do you use for C spine in trauma pts
Canadian C spine rules - do they NEED C spine immobilisation
NEXUS criteria - to clear a C spine (if have features that cannot clinically rule out C-spine -> imaging)
When do you intubate a trauma pt
if GCS <=8
What scan must you get if trauma patient is suspected of beeding
FAST scan (Focussed Assessment with Sonography for Trauma)
What are important trauma investigations done between primary and secondary survey?
Basic tests (FBC, LFT, U&E, clotting, bone profile, pregnancy test, urine dip)
Portable XR (may be skipped if CT can be done)
FAST scan
CT scan
Diagnostic Peritoneal Lavage
What is the purpose of a secondary survey?
To minimise the risk of missed injuries
What is the definition of coma?
unrousable unresponsiveness, classified with GCS
What are causes of coma?
metabolic or neurological
list metabolic causes of coma
- Drugs, pooisoning (CO, alcohol, tricyclics)
- hypoxia, COPD
- hypothermia
- hepatic / uraemic encepalopathy
- hypoglycaemia, hyperglycaemia
- sepsis
list neuro causes of coma
trauma
infection
tumour m
vascular (stroke, haemorrhage, hypertensive encepalopathy)
epilepsy (post-ictal, non convulsive ststus epiletticus)
what type of shock is JVP raised in
cardiogenic
