haemorrhage and shock

Question 1

define massive haemorrhage

Answer 1

50% blood vol loss in 3 hours
blood loss of 150ml/min

Question 2

how does massive haemorrhage present clinically?

Answer 2

HR >110bpm systolic BP <90

Question 3

what is hypovolaemic shock?

Answer 3

acute haemorrhage fluid state decreases

Question 4

what causes hypovolaemic shock?

Answer 4

bleeds
burns
dehydration

Question 5

what is cardiogenic shock?

Answer 5

reduced contractility or reduced HR

Question 6

what causes cardiogenic shock?

Answer 6

MI
valve problems
cardiomyopathies
dysrhythmias

Question 7

what is obstructive shock?

Answer 7

direct obstruction causing restriction of cardiac filling

Question 8

what causes obstructive shock?

Answer 8

PE
air/fat embolus
tamponade
tension pneumothorax

Question 9

what is distributive/septic shock?

Answer 9

profound vasodilation leading to poor perfusion

Question 10

what causes distributive/septic shock?

Answer 10

sepsis
anaphylaxis
acute liver failure
spinal cord injury

Question 11

what is the initial response to shock?

Answer 11

sympatho-adrenal response
neuro endocrine response = release of pituitary hormones, cortisol and glucagon

Question 12

what is the secondary response to shock?

Answer 12

lots of inflammation
loss of vascular reactivity (failure of smooth muscle contraction)
haemodynamic changes
myocardial dysfunction, pulmonary oedema

Question 13

what investigations are used in shcok?

Answer 13

BP
monitor
urine - renal perfusion
consciousness - neuro
cardiac output, central venous pressure
acidosis, lactate levels

Question 14

what is the management of shock?

Answer 14

ABCDE
fluids
- increase MAP, decrease HR, increase urine output

Question 15

what is the target MAP when managing a patient with shock?

Answer 15

65-70mmHg

Question 16

what can happen if patient is given too much fluid?

Answer 16

oedema
ARDS
bowel oedema

Question 17

what meds can you give in severe cases of shock?

Answer 17

adrenaline/noradrenaline -> alpha/beta adrenergic agonist (vasoconstriction)
vasopressin (ADH) - dopamine is a precursor
dobutamine in cardiac failure

Question 18

what are the common transfusion reactions?

Answer 18

acute haemolytic transfusion reaction
non-haemolytic febrile transfusion reaction
transfusion associated circulatory overload
minor allergic reactions
anaphylaxis

Question 19

how does a patient present with AHTR?

Answer 19

fever
pruritus
flank pain
dyspnoea

Question 20

what is management for AHTR?

Answer 20

stop transfusion immediately
ABCDE
coomb’s test

Question 21

how would a patient with NHFTR present?

Answer 21

fever
chills
malaise

Question 22

what is the management for NHFTR?

Answer 22

stop transfusion immediately
acetaminophen

Question 23

how would a patient with TACO present?

Answer 23

respiratory distress within 6hr
raised BP
raises JVP (elderly)

Question 24

what is management for TACO?

Answer 24

oxygen
support
diuretics

Question 25

how would a patient with MAR present?

Answer 25

hives (urticaria)

Question 26

how would a person with anaphylactic shock present?

Answer 26

shock
hypotension

Question 27

what is management for anaphylactic shock?

Answer 27

noradrenaline (epinephrine)

Question 28

what is management for MAR?

Answer 28

anti-histamine