Shock Flashcards
What is shock
Hypoxia at cellular level
Inadequate tissue perfusion
Most common type of shock
Hypovolemic shock
Isolated head bleed can lead to shock?
If shock present what will be next step
No it cannot
If hypovolemic shock search for other site of bleeding
Which arterial bleed is more severe and why
Transection less bleeding due to vasospasm
Laceration vasospasm leads to opening of artery more bleeding
Why is venous bleed presented late
Because it’s a gradual ooze so more time for body to compensate
Types of hemorrhage
Primary
Reactionary
Secondary
What is reactionary hemorrhage
Occurs 4-24 hrs after surgery
Due to increase BP or slippage/granny knot
As per stages of hypovolemic shock in which stage does SBP falls
Features of this class
Class 3 shock Percentage blood loss in 30-40% Pulse rate increases Diastolic falls Respiratory rate increase Urine output decrease
Class 1 Hypovolemic shock
0-15% blood loss (400-500cc)
Vitals are normal
Treatment oral liquid
Characteristic of compensated hypovolemic shock
Sympathetic activation due to blood loss( 15-30%)
Leads to tachycardia, peripheral vasoconstriction blood supply to vital organ increase
Earliest indicator of hypovolemia
Tachycardia
Best indicator to determine amount of fluid required in shock
Pulmonary capillary wedge pressure > CVP
Best clinical indicator of fluid resuscitation in shock
Urine output
Best end point of resuscitation
Mixed venous oxygen saturation
MVOS
Muscle or brain perfusion can be assessed by
NIRS NEAR INFRA RED SPECTROSCOPY
Normal value of MVOS
Less than 50% MVOS can be seen un
High MVOS
50-70%
Cardiogenic shock, hypovolemic shock
Septic shock
Shock index
What does it indicate
HR/SBP
>0.9 Higher mortality
Most sensitive indicator
Modified shock index = HR/MAP
Most sensitive indicator
Modified shock index = HR/MAP
Parameters to define massive blood transfusion
Replace entire circulating volume in 24 hrs
More than 10 unit blood in 24 hrs
More than 4 unit blood in one hr
Most common blood transfusion reaction
Febrile
What is TACO
C/F
Treatment
Transfusion ass cardiac overload
Puffiness of face edema
Diuretic
Anticoagulant used in blood transfusion is citrate
Effect of citrate on blood ion level
Chelates calcium and magnesium
Hypo calcemia and magnesemia
Effect on GIT due to hypovolemic shock
Most sensitive mucosa of git is gastric and leads to steess ulcer
Gut perfusion is measured by
Sublingual capnometry
Mucosal ph
Laser doppler flowmetry
ROPE index full form
And its use
Rate over pressure difference =PR/PP
Less than 3 stable pt
More than 3 decompensated hemorrhagic shock
What is TRALI
Transfusion related acute lung injury
Develops within 6hrs of transfusion
Due to anti hla antibody
Most common cause of death in massive blood transfusion
What is terrible triad of trauma
Coagulopathy
Hypothermia
Acidosis
Dilutional coagulopathy
How to prevent coagulopathy after massive blood transfusion
PRBC:FFP:PLATELETS
1:1:1
Name the score to decide massive blood transfusion
ABC score
TASH Trauma ass severe hemorrhage score
What is occult hypoperfusion
Normal cvs parameters and urine output
Low mvos and acidosis
Dynamic fluid response in shock
What happens in non responder and transient responder
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
Peri operative RBC transfusion criteria
Hb(g/dl)
Less than 6 pt will benefit from transfusion
6-8 only give blood if losses are present
More than 8 no indication
Bradycardia and hypotension is seen in which type of shock why
Neurogenic shock due to loss of sympathetic tone
In anaphylactic shock tachycardia and hypotension is seen
What is underlying pathology
Histamine release which is vasodilator warm extremities pooling of blood
And sympathetic tone is normal so tachycardia
Systemic inflammatory response syndrome define
Body response to inflammation release of il 16 tnf alpha
Parameter for sirs
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
Sepsis vs septic shock vs mods
Sepsis - SIRS + Known foci of infection
Septic shock sepsis hypotension which fails to respond to fluid
Mods failure of 2 or more organs
What ia SOFA score and what is its modification
Sequential Organ Failure Assessment Score
Sepsis= SOFA score more than 2 and known foci of infections
qSOFA is quick sequential organ failure assessment score
Parameters of qSOFA
SBP FALLS LESS THAN 100
ALTERED MENTAL STATUS
RR MORE THAN 22/MIN
New definition of sepsis and septic shock
Sepsis life threatening organ dysfunction caused by dysregulated host response to infection
Septic shock need for vasopressor and serum lactate more than 2mmol/L
Septic shock mgt
Goal of initial resuscitation of sepsis
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
