Heamo Types of shock Flashcards
What is anaphylaxis
This is a type of Distributive shock. It is characterized by an over stimulation of vasodilatory substances being relised. Causing the hypo-perfusion (shock)
Can anaphylaxis be prolonged?
YES
Anaphylaxis can have a prolonged effect even after the administration of adrenaline.
Otherwise known as the Secondary reaction
How does anaphylaxis occur
This occurs in 2 main phases the first being the sensitization phase
The allergen crosses paths with dendritic cell. Dendritic cells then present the protein sequence of the allergen to T helper cells.
The T cells release a bunch of pro inflammatory cytokines that instruct the B cells to create and release Allergen specific IGE mediators.
These IGE mediators then go on and join to the membrane of Mast Cells
(This is Sensitization no allergic response)
The next phase is where you get a allergic response (Allergic phase)
The next time the body encounters the allergen. The specific allergen then binds to the presenting Mast cells (Cross linking)
This Cross linking instructs the mast cells to release a massive amount of pro inflammatory mediators (Histamine, prostaglandins)
What are the different types of pro inflammatory mediators
Histamine
Leukotrines
Prostaglandins
Cytokines
What are the consequences of Histamine release
Binding to H1 & H2 receptors causing nitric acid release
(Prominent vasodilation, vessel leakage, bronchoconstriction, urticaria)
What consequences to leukotrines have
Binding to smooth muscle & endothelial cells
(Promotes POTENT Bronchocontriction, increased muscular secretion, vessel leakage)
What consequences do prostaglandins have
Binding to smooth muscle, endothelium and immune cells
(More vasodilation, bronchocontriction, promotes further inflammation)
What consequences to cytokines have
Potentiate further esonophil activation and increase vascular leakage
What is the management as a paramedic for anaphylaxis
large bore IV acess
Repeat IM adrenaline ever 10 mins is nessesary
Give fluids is poor perfusion (1 litre for adults 20kg for peads)
Adrenaline infusion for adults 1:1000000 at 2 drops per sec (OUT OF SCOPE!!)
Does angiodema always mean anaphylaxsis?
No
Angioedema is the accumulation of fluid in the interstitial space in the face, mouth and neck.
Anaphylaxsis has to be multi system so just having angiodema does not mean they have anaphylaxsis
Treatment: 5mg nebulised adrenaline.
What is neurogenic shock
this is a distributive shock that attributed to the distribution of the vasomotor centre of the brain or the autonomic pathways within the spinal cord
what are some causes for neurogenic shock
TBI
SCI above (T6)
Drugs
Hypoxia
Hypoglycemia
Ectopic pregnancy
Miscarriage
In neurogenic shock is there normal or decreased sympathetic activity
It is not that there is decreased sympathetic but it is more unopposed parasympathetic activity.
What is the patho behind neurogenic shock
Signs & symptoms
Hypotention
Bradycardia
Hypothermia
Warm, dry skin (below injury) Above the injury vascontriction is still occuring and below the injury the vasodilation is increased as a result makes the skin warmer
Lowered CO
(Flaccid paralysis below injury)
What is the difference between neurogenic shock and hypovolemic
What is our management for neruogenic shock
Discover and correct or remove the underlying cause
Spinal stabilization and immobilisation
Gain a large-bore IV access
Give fluids for POOR PERFUSION
(Adults 1L saline, administer 1 further dose if needed)
(Children 40ml/kg of saline)
Observe for fluid overload
CCP
Meteraminol
Adrenaline infusion/atropine
Pacing
What is the patho of sepsis
what phases can sepsis be broken into
Warm phase (compensatory)
Massive vasodilation
Pink, warm skin
Decreased SVR
Increased HR
Increased CO
Palpable pulse
Cold phase (decomp) going towards irreversible shock
Tachycardia
Weak pulse
Tachypoena
Mottled skin
What is the management of sepsis
Give O2
Administer 1 -2 L saline if signs of poor perfusion
20ml/kg for a child
CCP backup for metaraminol and adrenaline infusion
What are the indications for antibiotics
Sepsis in a pt with 12 years or older with 1 or more clinical features indication antibiotics and time to hospital is 30 mins or more
Cefazolin
1g IV over 1-2 into a running line
Ceftriaxone
2g IV over 1-2 mins into a running line
What is Menengococcal septicaemia
What is obstructive shock
This is a reduciton of cardiac output caused by an obstruction within the central circulation
Can be caused by Impairment of diastoic filling
Excessive overload
How does a tension pneumothorax cause obstructive shock
This is because there is a one-way valve allowing air to enter with each breath. This eventually collapses the lung and puts pressure on the surrounding organs and blood vessels
