PBL 9 Flashcards
How much blood do you need to lose before you go into hypovolaemic shock?
Losing about 1/5 or more of the normal amount of blood in your body causes hypovolemic shock.
What can cause hypovolaemic shock? (7)
- Bleeding from cuts
- Bleeding from other injuries
- Internal bleeding, such as in the gastrointestinal tract
- Burns
- Diarrhea
- Excessive perspiration
- Vomiting
What are the symptoms of shock? (9) (symptoms: observed or experienced by the patient)
- Anxiety or agitation
- Cool, clammy skin
- Confusion
- Decreased or no urine output
- General weakness
- Pale skin color (pallor)
- Rapid breathing
- Sweating, moist skin
- Unconsciousness
- The greater and more rapid the blood loss, the more severe the symptoms of shock.
What are the signs of shock, which are apparent through tests? (3)
- Low blood pressure
- Low body temperature
- Rapid pulse, often weak and thready
What is the first aid treatment for shock? (5)
- Keep the person comfortable and warm (to avoid hypothermia).
- Have the person lie flat with the feet lifted about 12 inches to increase circulation. However, if the person has a head, neck, back, or leg injury, do not change the person’s position unless he or she is in immediate danger.
- Do not give fluids by mouth.
- If person is having an allergic reaction, treat the allergic reaction.
- If the person must be carried, try to keep him or her flat, with the head down and feet lifted. Stabilize the head and neck before moving a person with a suspected spinal injury.
What are the general goals of the treatment of shock (after first aid) (2)
- The goal of treatment is to replace blood and fluids. An intravenous (IV) line will be put into the person’s arm to allow blood or blood products to be given.
- Medicines such as dopamine, dobutamine, epinephrine, and norepinephrine may be needed to increase blood pressure and the amount of blood pumped out of the heart (cardiac output).
What would you use to monitor a patient with shock? (2)
- Heart monitoring, including Swan-Ganz catheterization
- Urinary catheter to collect and monitor how much urine is produced
What is the prognosis (outlook) in hypovolaemic shock?
Hypovolemic shock is always a medical emergency. In general, patients with milder degrees of shock tend to do better than those with more severe shock. In cases of severe hypovolemic shock, death is possible even with immediate medical attention. The elderly are more likely to have poor outcomes from shock.
What are the possible complications of shock? (5)
- Kidney damage
- Brain damage
- Gangrene of arms or legs, sometimes leading to amputation
- Heart attack
- Severe shock can lead to death
What are the four different types of shock? What causes them?
Hypovolemic — Hypovolemic shock is a consequence of decreased preload due to intravascular volume loss. Cardiogenic — Cardiogenic shock is a consequence of cardiac pump failure. Distributive — Distributive (vasodilatory) shock is a consequence of severely decreased Systemic Vascular Resistance (due to systemic inflammatory response, or anaphylaxis for example) Combined — The different types of shock can coexist.
Describe the haemodynamic parameters you would expect to see in hypovolaemic shock.
Hypovolemic — Hypovolemic shock is a consequence of decreased preload due to intravascular volume loss. During hypovolemic shock, the diminished preload decreases the Cardiac Output and the SVR increases in an effort to compensate for the diminished CO and maintain perfusion to the vital organs. The PCWP is decreased
Describe haemodynamic parameters you would expect to see in cardiogrnic shock
Cardiogenic shock is a consequence of cardiac pump failure. During cardiogenic shock, the cardiac pump failure decreases the Cardiac Output and the Systemic Vascular Resistance increases in an effort to compensate for the diminished CO and maintain perfusion to the vital organs. The PCWP is increased.
Describe the haemodynamic parameters you would expect to see in Distributive shock
Distributive (vasodilatory) shock is a consequence of severely decreased Systemic Vascular Resistance. The CO is typically increased in an effort to compensate for the diminished SVR. The PCWP may be low or normal (table 1). There are many causes of distributive shock eg Septic shock, Systemic inflammatory response syndrome, Toxic shock syndrome, Anaphylaxis and anaphylactoid reactions.
Describe the ways in which septic shock can also be combined shock
patients with septic shock often have a hypovolemic component (due to decreased oral intake, insensible losses, vomiting, diarrhea), a cardiogenic component (due to sepsis-related myocardial dysfunction), and a distributive component (due to the effects of inflammatory and antiinflammatory cascades on vascular permeability and vasodilation).
What is the immediate treatment for Hypovolaemic shock? What can happen if this treatment is not given?
Rapid volume repletion is indicated in patients with severe hypovolemia or hypovolemic shock. Delayed therapy can cause ischemic injury and multiorgan system failure.
