Mx Of Shock

Question 1

Initial approach in Mx of shock:

Answer 1

1. Airway - stridor/gurgling/ tracheal tug
2. Breathing - listen/ look for tachypnoea
3. Circulation - BPs/ blood loss/ capillary refill/ pulse rate (rate & volume)/ pale/ diaphoretic

Question 2

Different POC tests to consider:

Answer 2

1. ECG
2. Blood gas
3. Pregnancy test
4. U/S

Question 3

How to start ADR infusion:

Answer 3

1. 8U in 200 mls N/S
2. Aim for MAP of 65
3. Increase drip rate until MAP = 65

Question 4

Can you start ADR infusion on a peripheral line?

Answer 4

1. Yes
2. But try switch to central line within 4 hours
3. Use grey/green jelco in cubital fossa

Question 5

Signs of good perfusion:

Answer 5

1. MAP = 65
2. Improving GCS
3. U-O > 0.5 ml/kg/hr

Question 6

How much fluid can you give before starting ADR infusion in septic shock patient?

Answer 6

1. Give bolus of 30mls / kg IVI bolus

2. If still hypotensive - start ADR infusion

Question 7

Mx of anaphylaxis (bee sting):

Answer 7

1. ADR IMI: 1/2 amp IMI stat in adults; 0.3 amp IMI in child
2. Then give fluids

Question 8

Principles of Mx of bleeding pt:

Answer 8

1. Look for 1 on the floor + 4 more (chest, abdomen, pelvis, long bones)
2. 30 mls/ kg bolus
3. Will need blood T/F: RCC +/- FDPs

Question 9

Mx of shocked CCF pt w/ hypotension:

Answer 9

1. Fluid bolus @ 15 mls/ kg

2. Lift up pt’s legs - giving 500 ml bolus - 10% drop in HR or increase MAP means pt is fluid responsive

Question 10

Criteria for giving cyclokapron:

Answer 10

1. Tachycardia + hypotension (high shock index)

2. Time limit from injury < 3 hrs (when giving > 3 hrs can increase bleeding)