Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

AIP: Trauma > Hypotensive shock > Flashcards

Hypotensive shock Flashcards

1
Q

What is the definition of shock?

A

inadequate tissue perfusion and oxygenation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 4 key types of shock in the trauma patient?

A
  1. Hypovolaemic
  2. Cardiogenic
  3. Obstructive
  4. Neurogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is hypovolaemic shock?

A

loss of circulating volume e.g. haemorrhage or burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is cardiogenic shock?

A

faliure of the pump mechanism e.g. cardiac contusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is obstructive shock?

A

cardiac output is compromised by external compressive forces e.g. tension pneumothorax or cardiac tamponade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is neurogenic shock?

A

vasodilatation from loss of sympathetic outflow e.g. spinal injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the definition of haemorrhage?

A

acute loss of circulating blood volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most common cause of shock in the trauma patient?

A

haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are 5 examples of potential sources of haemorrhage?

A
  1. External bleeding
  2. Chest
  3. Abdomen and retroperitoneum
  4. Pelvis
  5. Femurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are 7 clinical features of shock due to haemorrhage?

A
  1. Tachypnoea
  2. Tachycardia (bradycardia is a late terminal sign)
  3. Hypotension (systolic BP < 90mmHg)
  4. Pallor and cold peripheries
  5. Reduced conscious level
  6. Reduced urinary output
  7. ABG metabolic acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What pattern might an ABG show in shock due to haemorrhage?

A

metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the blood volume in a healthy adult?

A

7% of ideal body weight i.e. 70kg patient has circulating blood volume of approimately 5L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How can hypovolaemic shock be graded?

A

Grades I-IV based on volume of blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the volume of blood loss is seen in each grade of hypovolaemic shock?

A

I: up to 750ml, <15%

II: 750-1500ml, 15-30%

III: 1500-200ml, 30-40%

IV: >2000ml, >40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What clinical features may be seen in Grade I blood loss?

A

tachypnoea, may have mild tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are 3 clinical features of grade II blood loss?

A
  1. tachycardia >100
  2. narrowed pulse pressure
  3. pallor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are 2 clinical features of grade III blood loss?

A
  1. hypotension
  2. reduced GCS, confused or anxious
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are 3 clinical features of grade IV blood loss?

A
  1. may become bradycardic
  2. marked hypotension
  3. becoming unconscious
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 7 situations when there may be an underestimation of blood loss in haemorrhage?

A
  1. elderly
  2. medications e.g. beta blockers
  3. pacemarkers
  4. hypothermia
  5. children
  6. pregnancy
  7. athletes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why might there be an underestimation of blood loss in the elderly?

A

less able to compensate for acute hypovolaemia as their sympathetic drive is reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why might there be an underestimation of blood loss in people taking beta blockers?

A

beta blockers will prevent a tachycardia in response to blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why might there be an underestimation of blood loss in the patients with pacemakers?

A

pulse will not be altered by blood loss i.e. won’t see tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why might there be an underestimation of blood loss in hypothermia?

A

respiratory rate, pulse and blood pressure will be low regardless of blood loss

24
Q

Why might there be an underestimation of blood loss in children?

A

they will compensate well initially then deteriorate catastrophically

25
Why might there be an underestimation of blood loss in pregnancy?
blood volume increases by up to 50% of normal so may only display minimal signs fo shock with severe blood loss
26
Why might there be an underestimation of blood loss in athletes?
physiological responses to training means a larger blood volume and lower resting heart rate. therefore even with pulse of 90 may be significant tachycardia in these patients
27
What type of manoeuvre is it very important to avoid in patients with hypovolaemia due to haemorrhage?
log roll - if non-compressible haemorrhage, movements can cause dislodgement of formed clots and allow further ongoing haemorrhage
28
What should be used to transfer patients with hypovolaemia due to haemorrhage?
scoop stretcher or PAT slide to transfer patient off spinal board or trolley - NOT log roll
29
How can the back be examined in patients with hypovolaemia due to haemorrhage?
running gloved hands down back to check for haemorrhage, or 10-15 degree mini log roll to examine first one half of back then other
30
What are 6 aspects of the management of hypovolaemia due to haemorrhage?
1. Haemorrhage control 2. Fluid resuscitation 3. Massive transfusion 4. Damage control surgery 5. Prevention of hypothermia 6. Monitor response
31
How can the majority of external bleeding be controlled?
direct pressure and elevation
32
On the rare occasion that direct pressure and elevation does not help to stop external bleeding, what is the next step?
commercial tourniquet may be necessary to control limb haemorrhage
33
What are the ways to manage internal bleeding in each of the following structures: 1. chest 2. abdomen 3. pelvis 4. femurs?
1. Chest = theatre 2. Abdomen = theatre 3. Pelvis = external splintage ± theatre or embolisation 4. external splintage ± theatre
34
Which fluids should be used for initial fluid resuscitation in hypotensive shock?
warmed crystalloid
35
What blood test should be performed immediately in hypotensive shock?
blood should be taken for cross match as soon as possible, also phone blood bank to let them know if sample is urgent
36
What should be done for patients who are non-responders i.e. show no haemodynamic improvement wiht initial fluid administration?
receive urgent surgical input and O-negative blood
37
What is the management of transient responders to initial fluids?
should receive urgent surgical inpt and group-specific **or** O-negative blood
38
What is meant by a transient responder?
patients who, after receiving initial fluid resuscitation with crystalloid, have improved vital signs but subsequently deteriorate due to ongoing haemorrhage
39
What is meant by rapid responders?
patients whose vital signs stabilise permanently after fluids
40
What is the management of rapid responders to initial fluid resuscitation?
normally require only crystalloid and can wait for fully cross-matched blood if required
41
What are 2 reasons why large volumes of fluid given to patients with ongoing non-compressible haemorrhage are thought to cause poor outcomes?
1. Raising blood pressure may dislodge clots resulting in further haemorrhage 2. Fluids dilute clotting factors and the oxygen carrying capacity of the blood
42
What is the aim determining the volume of fluids given to resuscitate patients with hypovolaemic shock?
administer sufficient fluids to maintain perfusion fo the vital organs until the patient gets to theatre
43
What is the typical aim for initial fluid resuscitation in hypovolaemic shock?
boluses of 250ml to maintain a systolic blood pressure of 80-90 mmHg, a radial pulse or a verbal response
44
What is the exception to the rule of patients requiring fluid resuscitation to achieve systolic blood pressure of 80-90?
patients with evidence of head injury who require higher BP to maintain cerebral perfusion pressure: target BP is 100 mmHg
45
What are 4 options for vascular access in hypovolaemic patients?
1. peripheral venous cannulation 2. intra-osseous access 3. central venous cannulation e.g. femoral, internal jugular, subclavian 4. venous cut down e.g. saphenous
46
What is the definition of 'massive transfusion'?
replacement of the patient's **total** blood volume in \<24h **_or_** acute administration of \>**50**% estimated blood volume per hour
47
What are 5 complications of massive blood transfusion?
1. Hypothermia 2. Dilutional thrombocytopenia 3. Depletion of clotting factors 4. Oxygen affinity changes 5. Hypocalcaemia
48
What are 4 blood tests that should be used within the hour of administering massive transfusion if the patient is still under your care?
1. INR 2. APTT 3. Platelets 4. Fibrinogen
49
Who should you seek advice from when administering a massive tranfusion and regarding what?
from haematology: regarding administration of platelets, fresh frozen plasma, or cryoprecipitate
50
What is the triad that often causes death in multiple injured trauma patients?
* coagulopathy * hypothermia * acidosis →acidosis
51
What should damage control surgery involve for multiple injured trauma patients?
to control haemorrhage, prevent contamination and protect against further injury e.g. packing abdominal cavity to stop bleeding, use of shunts, only temporarily closing the abdomen or leaving it open
52
What happens following damage control surgery for trauma patients?
patient transferred to **critical care unit** for aggressive correction of coagulopathy and rewarming, before a d**efinitive surgical procedure** at a later date (usually 24-48h)
53
Why is it so important to prevent hypothermia in patients with hypovolaemia?
it can worsen **acidosis** and **coagulopathy**
54
What method of temperature monitoring should be considered?
oesophageal temperature probe
55
What can cause temperature measurements to be omitted in a trauma patient?
if patient immobilised in head blocks for suspected cervical spine injury
56
What are 3 ways to help warm a patient with hypovolaemic shock?
1. Keep patient warm externally with **blankets** and a **Bair** **hugger** 2. Fluids should be kept in **warming** **cupboard** in resuscitation room prior to administration 3. Use of a **warming system around the giving set** is another option but will slow rate of administration
57
What are 5 things that should be measured ot monitor response to fluid resuscitation in hypovolaemic shock?
1. Respiratory rate, O2 sats 2. ECG for pulse, BP 3. Catheterise for hourly urine output 4. GCS 5. ABG for acidosis, lactate or Hb

AIP: Trauma (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions