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Surgery > Shock > Flashcards

Shock Flashcards

1
Q

What is shock

A

Hypoxia at cellular level

Inadequate tissue perfusion

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2
Q

Most common type of shock

A

Hypovolemic shock

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3
Q

Isolated head bleed can lead to shock?

If shock present what will be next step

A

No it cannot

If hypovolemic shock search for other site of bleeding

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4
Q

Which arterial bleed is more severe and why

A

Transection less bleeding due to vasospasm

Laceration vasospasm leads to opening of artery more bleeding

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5
Q

Why is venous bleed presented late

A

Because it’s a gradual ooze so more time for body to compensate

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6
Q

Types of hemorrhage

A

Primary
Reactionary
Secondary

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7
Q

What is reactionary hemorrhage

A

Occurs 4-24 hrs after surgery

Due to increase BP or slippage/granny knot

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8
Q

As per stages of hypovolemic shock in which stage does SBP falls
Features of this class

A 
Class 3 shock 
Percentage blood loss in 30-40% 
Pulse rate increases
Diastolic falls
Respiratory rate increase
Urine output decrease
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9
Q

Class 1 Hypovolemic shock

A

0-15% blood loss (400-500cc)

Vitals are normal
Treatment oral liquid

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10
Q

Characteristic of compensated hypovolemic shock

A

Sympathetic activation due to blood loss( 15-30%)

Leads to tachycardia, peripheral vasoconstriction blood supply to vital organ increase

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11
Q

Earliest indicator of hypovolemia

A

Tachycardia

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12
Q

Best indicator to determine amount of fluid required in shock

A

Pulmonary capillary wedge pressure > CVP

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13
Q

Best clinical indicator of fluid resuscitation in shock

A

Urine output

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14
Q

Best end point of resuscitation

A

Mixed venous oxygen saturation

MVOS

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15
Q

Muscle or brain perfusion can be assessed by

A

NIRS NEAR INFRA RED SPECTROSCOPY

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16
Q

Normal value of MVOS
Less than 50% MVOS can be seen un
High MVOS

A

50-70%
Cardiogenic shock, hypovolemic shock
Septic shock

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17
Q

Shock index

What does it indicate

A

HR/SBP

>0.9 Higher mortality

18
Q

Most sensitive indicator

A

Modified shock index = HR/MAP

18
Q

Most sensitive indicator

A

Modified shock index = HR/MAP

19
Q

Parameters to define massive blood transfusion

A

Replace entire circulating volume in 24 hrs
More than 10 unit blood in 24 hrs
More than 4 unit blood in one hr

20
Q

Most common blood transfusion reaction

A

Febrile

21
Q

What is TACO
C/F
Treatment

A

Transfusion ass cardiac overload
Puffiness of face edema
Diuretic

22
Q

Anticoagulant used in blood transfusion is citrate

Effect of citrate on blood ion level

A

Chelates calcium and magnesium

Hypo calcemia and magnesemia

23
Q

Effect on GIT due to hypovolemic shock

A

Most sensitive mucosa of git is gastric and leads to steess ulcer

24
Q

Gut perfusion is measured by

A

Sublingual capnometry
Mucosal ph
Laser doppler flowmetry

25
Q

ROPE index full form

And its use

A

Rate over pressure difference =PR/PP
Less than 3 stable pt
More than 3 decompensated hemorrhagic shock

26
Q

What is TRALI

A

Transfusion related acute lung injury
Develops within 6hrs of transfusion
Due to anti hla antibody

27
Q

Most common cause of death in massive blood transfusion

What is terrible triad of trauma

A

Coagulopathy
Hypothermia
Acidosis
Dilutional coagulopathy

28
Q

How to prevent coagulopathy after massive blood transfusion

A

PRBC:FFP:PLATELETS
1:1:1

29
Q

Name the score to decide massive blood transfusion

A

ABC score

TASH Trauma ass severe hemorrhage score

30
Q

What is occult hypoperfusion

A

Normal cvs parameters and urine output

Low mvos and acidosis

31
Q

Dynamic fluid response in shock

What happens in non responder and transient responder

A

Bolus of fluid 250-500 cc, CVP rises by 2-5 cm and normalizes in 20 min
Non responder no change
Transient responder will show rise but return to pre treatment value in 10-15 min

32
Q

Peri operative RBC transfusion criteria

Hb(g/dl)

A

Less than 6 pt will benefit from transfusion
6-8 only give blood if losses are present
More than 8 no indication

33
Q

Bradycardia and hypotension is seen in which type of shock why

A

Neurogenic shock due to loss of sympathetic tone

34
Q

In anaphylactic shock tachycardia and hypotension is seen

What is underlying pathology

A

Histamine release which is vasodilator warm extremities pooling of blood
And sympathetic tone is normal so tachycardia

35
Q

Systemic inflammatory response syndrome define

A

Body response to inflammation release of il 16 tnf alpha

36
Q

Parameter for sirs

A

Temp <36 or >38
Wbc less than 4k more than 12k or 10% band forms in smear
Respiratory rate more than 20
Pulse rate more than 90

Any 2 present SIRS

37
Q

Sepsis vs septic shock vs mods

A

Sepsis - SIRS + Known foci of infection
Septic shock sepsis hypotension which fails to respond to fluid
Mods failure of 2 or more organs

38
Q

What ia SOFA score and what is its modification

A

Sequential Organ Failure Assessment Score
Sepsis= SOFA score more than 2 and known foci of infections

qSOFA is quick sequential organ failure assessment score

39
Q

Parameters of qSOFA

A

SBP FALLS LESS THAN 100
ALTERED MENTAL STATUS
RR MORE THAN 22/MIN

40
Q

New definition of sepsis and septic shock

A

Sepsis life threatening organ dysfunction caused by dysregulated host response to infection

Septic shock need for vasopressor and serum lactate more than 2mmol/L

41
Q

Septic shock mgt

Goal of initial resuscitation of sepsis

A

First fluids
If no response start inotropes and vasopressor

In first 6 hrs goal is  
CVP 8-12 mm Hg 
MAP > 65 mm Hg
MVOS >65%
Normalize lactate

Surgery (5 decks)

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