Haemmorrhage & Shock

Question 0

Name signs/symptoms of external haemorrhage

Answer 0

Arterial: oxygenated/spurting
Venous: oozing, less pressure
Capillary: slow flow/ surface injury

Question 1

Name 3 factors of haemorrhage which lead to shock

Answer 1

Haemorrhage source: arterial, venous or capillary.
Degree of vascular disruption
The amount of blood lost

Question 2

Name signs/symptoms of internal haemorrhage

Answer 2

Red blood from mouth ( haematemesis or haemoptysis), rectum (hematochezia) or other orifice
Coffee ground vomitus (GI bleed)
Malaena (black tarry stools)
Dizziness

Question 3

Define shock

Answer 3

Inadequate tissue perfusion

Question 4

What is hypoxia.

Answer 4

Low/decreased levels of oxygen in tissue

Question 5

List the bodies response to haemorrhage

Answer 5

Vascular response- Inflammatory response
Shock progression: microcirculation in shock- vasoconstriction- capillary and venue opening- cell swelling- multiple organ failure.

Question 6

Name 5 types of shock

Answer 6

Hypovolaemic- loss of volume
Cardiogenic- pump failure
Neurogenic- loss of vasometer
Anaphylactic- histamine response
Septic- systemic infection

Question 7

Outline 4 factors necessary to achieve adequate tissue oxygenation

Answer 7

Lungs- inspired O2
Heart- effective pump (CO= HRxSV)
Vasculature- changes pressure and resistance
Microcirculation- exchange of gases, nutrients and wastes

Question 8

Signs/symptoms of hypovolaemic shock

Answer 8

Anxiety, restlessness, ACS
Systematic hypotension, tachycardia, weak pulse
Cool, clammy, mottled skin, hypothermic
Tachypnoea

Question 9

Treatment for hypovolaemia

Answer 9

Haemorrhage control
Oxygen and ECG
Elevate lower extremities if injuries permit
IV/fluid therapy- 500ml boluses to maximum of 2000 ml

Question 10

Name classes of haemorrhagic shock

Answer 10

Initial-Class 1: 120, RR 30-40.

Refractory- Class 4: >40%, HR > 140, marked decrease in systolic BP.

Question 11

Signs of Cardiogenic Shock

Answer 11

Similar to hypovolaemic shock
JVD, peripheral oedema
Weak or absent pulse, dysrhythmias
Pulmonary oedema

Question 12

Treatment Cardiogenic shock

Answer 12

Oxygen, ECG, vitals
Sitting or semi recumbent
IV access and fluid therapy

Question 13

Signs of neurogenic shock (spinal/vasomotor)

Answer 13

Similar to hypovolaemic shock including:
Bradycardia, symptomatic hypotension
Warm, dry skin on limbs
Priaprism in males

Question 14

Treatment neurogenic shock

Answer 14

O2, ECG, and vitals
Spinal precautions where appropriate
IV access and fluid therapy

Question 15

Signs of anaphylactic shock

Answer 15

ACS, nausea
Airway impairment or swelling- swollen tongue, laryngeal oedema
Dyspnoea- lower airway obstruction (wheeze)
Tight chest, itching, urticaria (hives)

Question 16

Treatment Anaphylactic shock

Answer 16

Remove cause if present and IM adrenalin if indicated (0.5mg)
Oxygen, ECG, vital signs
Salbutamol if indicated, IV access & fluid therapy
Patient supine with elevated legs unless resp. distress predominates

Question 17

Signs of Septic shock

Answer 17

Similar to hypovolaemic shock except first stages;
Pyrexia (fever)
Skin warm and dry
Evidence of infection

Question 18

Treatment of Septic shock

Answer 18

Oxygen, ECG, and vital signs
Sitting or semi recumbent (BP permitting)
IV access and fluid therapy

Question 19

3 types of hypovolaemic shock?

Answer 19

THIRD SPACE SHIFT!!
Burns
Haemorrhage
Dehydration
Vomiting

Question 20

3 causes of Cardiogenic shock?

Answer 20

AMI
cardiac tamponade
Tension pneumothorax

Question 21

Name causes of neurogenic shock

Answer 21

• Injury to thoracic or cervical spinal cord

- vasovagal stimulation