haemorrhage and shock Flashcards
define massive haemorrhage
50% blood vol loss in 3 hours
blood loss of 150ml/min
how does massive haemorrhage present clinically?
HR >110bpm systolic BP <90
what is hypovolaemic shock?
acute haemorrhage fluid state decreases
what causes hypovolaemic shock?
bleeds
burns
dehydration
what is cardiogenic shock?
reduced contractility or reduced HR
what causes cardiogenic shock?
MI
valve problems
cardiomyopathies
dysrhythmias
what is obstructive shock?
direct obstruction causing restriction of cardiac filling
what causes obstructive shock?
PE
air/fat embolus
tamponade
tension pneumothorax
what is distributive/septic shock?
profound vasodilation leading to poor perfusion
what causes distributive/septic shock?
sepsis
anaphylaxis
acute liver failure
spinal cord injury
what is the initial response to shock?
sympatho-adrenal response
neuro endocrine response = release of pituitary hormones, cortisol and glucagon
what is the secondary response to shock?
lots of inflammation
loss of vascular reactivity (failure of smooth muscle contraction)
haemodynamic changes
myocardial dysfunction, pulmonary oedema
what investigations are used in shcok?
BP
monitor
urine - renal perfusion
consciousness - neuro
cardiac output, central venous pressure
acidosis, lactate levels
what is the management of shock?
ABCDE
fluids
- increase MAP, decrease HR, increase urine output
what is the target MAP when managing a patient with shock?
65-70mmHg
what can happen if patient is given too much fluid?
oedema
ARDS
bowel oedema
what meds can you give in severe cases of shock?
adrenaline/noradrenaline -> alpha/beta adrenergic agonist (vasoconstriction)
vasopressin (ADH) - dopamine is a precursor
dobutamine in cardiac failure
what are the common transfusion reactions?
acute haemolytic transfusion reaction
non-haemolytic febrile transfusion reaction
transfusion associated circulatory overload
minor allergic reactions
anaphylaxis
how does a patient present with AHTR?
fever
pruritus
flank pain
dyspnoea
what is management for AHTR?
stop transfusion immediately
ABCDE
coomb’s test
how would a patient with NHFTR present?
fever
chills
malaise
what is the management for NHFTR?
stop transfusion immediately
acetaminophen
how would a patient with TACO present?
respiratory distress within 6hr
raised BP
raises JVP (elderly)
what is management for TACO?
oxygen
support
diuretics
how would a patient with MAR present?
hives (urticaria)
how would a person with anaphylactic shock present?
shock
hypotension
what is management for anaphylactic shock?
noradrenaline (epinephrine)
what is management for MAR?
anti-histamine
