Haemorrhage & Shock Flashcards
Who is at risk of hypovolaemic shock?
Patients suffering from profuse bleeding or haemorrhage
List the early symptoms of hypovolaemic shock?
- Tachycardia
- Skin pallor
- Hypotension
- Confusion, aggression, drowsiness, coma
- General weakness
- Thirst
- Reduced urine output
What clinical situations would result in the degree of blood loss maybe being miss-interpreted?
- Elderly population
- Patients on certain medications (beta-blockers, antihypertensives, antianginals)
- Patients with pacemakers
- Athletes
- Pregnancy
- Hypothermia
Describe how Cardiogenic shock presents?
- Distended jugular veins due to increased jugular venous pressure
- Weak/absent pulse
- Arrhythmia
- Often with tachycardia
- Lips/nail beds are cyanosed
- Can produce a thrombi/emboli
What 3 types does distributive shock include?
- Septic (infectious)
- Anaphylactic
- Neurogenic
What features typically occur in septic shock?
SIRS (system inflammatory response syndrome) and can lead to fever and induced warm and sweaty skin due to vasodilation
How does anaphylactic shock present?
- Hives on the skin
- Localised oedema
- Narrowing of the airway
- Throat swelling
- Burning skin
- Itching
- Coughing
- Wheezing etc.
What can cause obstructive shock?
- Cardiac tamponade
- Aortic aneurysm
- Pneumothorax
- Pulmonary embolism
How are the main manifestations of obstructive shock produced?
Massive release of histamine which causes intense vasodilation
What can lead to cardiogenic shock?
- Myocardial damage (MI)
- Dysrhythmias
- Mechanical defect (valve damage)
What is the main consequence of obstructive shock?
Elevated right heart pressure and impaired venous return leading to signs of right heart failure
What are the 2 signs of right heart failure?
- Raised central venous pressure
2. Jugular venous distension
What essentially is distributive shock?
When the blood volume is normal, but the volume of the vascular compartment is increased
Describe anaphylactic shock?
Severe systemic allergic reaction and is characterised by massive vasodilation, pooling of blood in the peripheral vessels and increased capillary permeability
What is the possible treatments for anaphylactic shock?
- Discontinuance of agent
- Application of measures to reduce absorption
- Monitoring of CVS and RS
- Maintenance of gas exchange and perfusion
- Adrenaline constricts blood vessels and relaxes the airways
- Antihistamines, corticosteroids & oxygen
What can cause septic shock?
- Peritonitis
- Abortion
- Rupture of gut
- Skin infections
- Inflammatory and immune responses accompanied by histamine release
- Indwelling urinary or intravenous catheter
Who are particular susceptible to septic shock?
- Elderly
- Those with extensive trauma, burns, neoplastic disease
- Diabetes
How does the patient present as sepsis continues?
- Greyish tinge due to stasis of blood in capillary vessels
- Cyanosis due to reduced oxygenation of haemoglobin
What can cause neurogenic shock?
- Brain injury
- Depressant action of drugs
- Anaesthesia
- Hypoxia
- Hypoglycaemia
What urine output is indicative of severe shock and inadequate renal perfusion?
20ml/hr
What are the 5 complications of shock?
- Shock lung (adult respiratory distress syndrome)
- Gastrointestinal ulceration
- Disseminated intravascular coagulation (DIC)
- Renal damage
- Multiple organ failure
What is the 1st line treatment for hypovolaemic shock?
Saline (0.9%)
What does BUFALO stand for in regards to sepsis treatment?
- Blood cultures
- Urine output
- Fluids
- Antibiotics (broad spectrum)
- Lactate and FBC
- Oxygen
How do you work out the SIRS score?
2 or more of the following:
- Temp >38oC or <36oC
- Heart rate >90
- Respiratory rate >20 or PaCO2 <32mmHg
- WBC >12,000/min or <4,000mm
What is lactate a measure of?
Organ underperfusion
What drug can you prescribe for pyrexia?
Paracetamol
What are IV drug users at high risk of and why?
Infecting right heart valves through injecting into veins which then drain into the right atrium of the heart, allowing infection to spread onto the tricuspid and pulmonary valves
