Shock

Question 1

What is shock?

Answer 1

Acute circulatory failure leading to a decrease in organ perfusion
Can lead to organ death and irreversible damage if untreated due to hypoxia

Question 2

What are the different types of shock?

Answer 2

Obstructive
Distributive
Cardiogenic
Hypovolaemic

Question 3

What is hypovolaemic shock and what causes it?

Answer 3

Due to loss in circulating volume
Leads to a decrease in pre load causing a decrease in stroke volume and cardiac output
Caused by haemorrhage or dehydration (vomiting/DKA/Diarrhoea/burns)

Question 4

What is distributive shock and what are the causes?

Answer 4

Abnormal vasodilatation

Leads to decrease in vascular resistance and decrease in BP causing increase in HR

Causes (also types of shock)

• Anaphylactic- histamine causes vasodilation and increased vascular permeability causing fluid to leak out
• Septic- bacterial toxins have same effect as histamine
• Neurogenic- injury to T6 or above leads to loss of sympathetic tone

Question 5

What is cardiogenic shock and what are the causes?

Answer 5

When the heart stops pumping effectively

Leads to a decrease in stroke volume, CO and BP

Causes

• MI
• Arrhythmias
• Valve dysfunction
• Metabolic disturbances

Question 6

What is obstructive shock and what are the causes?

Answer 6

Compression on the heart or great vessels

Leads to reduced stroke volume and therefore CO and BP

Causes

• cardiac tamponade
• PE
• tension pneumothorax
• aortic dissection

Question 7

What are the 3 main symptoms of shock?

Answer 7

Hypotension
Raised lactate
Signs of reduced perfusion- increased cap refill, decreased urine output, altered consciousness

Question 8

What are symptoms of hypovolaemic shock?

Answer 8

Signs of dehydration
Tachycardia
Cool, pale, moist skin
Weak thready pulse

Question 9

What are symptoms of cardiogenic shock?

Answer 9

Weak thready pulse
Tachycardia
Cool, pale, moist skin
Tachypnoea
Crackles

Question 10

What are symptoms of obstructive shock?

Answer 10

Tachycardia
Cool peripheries
Pale
Normal fluid status

Question 11

What are symptoms of distributive shock?

Answer 11

Septic

• systemically unwell- fever
• tachycardia
• warm and flushed skin
• wide pulse pressure

Anaphylactic

• dyspnoea
• cough
• urticaria
• restlessness
• tachycardia
• pruritis

Neurogenic

• bradycardia
• warm peripheries

Question 12

What are the effects of shock on the body?

Answer 12

Resp= type 1 resp failure
Cardio- myocardial ischaemia 
Cerebral= hypoxic brain injury
Renal= pre renal AKI
GI= infection, mucosal ischaemia and decreased gut motility

Question 13

What is the general management of shock?

Answer 13

Fluid resus
IV access
High flow oxygen

Question 14

What is the management of anaphylactic shock?

Answer 14

Remove causative agent
Step wise
-0.5mg adrenaline IM and repeat every 5 mins as appropriate

• 10mg IV chlorphenamine- given if skin symptoms persisting
• 200mg IV hydrocortisone

Elevate feet
Consider ITU

Long term- skin prick and epipen

Question 15

What is the management of hypovolaemic shock?

Answer 15

Find underlying cause and treat
Fluid resus- rapid boluses
Ionotropes if hypotensive

Haemorrhagic shock- based on severity

• Class 1= 750ml loss, HR<100, crystalloids given
• Class 2- 750-1500ml loss, HR >100, Narrow pulse pressure, consider blood
• Class 3= 1500-2000ml loss, HR >120, hypotensive, blood and consider surgery
• Class 4= >2000ml loss, surgery

Must activate rapid transfusion protocol

Question 16

What is the management of cardiogenic shock?

Answer 16

IV diamorphine for pain and breathlessness
Look for pulmonary oedema and furosemide if present
Need CCU or ITU for ionotropes and catheter

Question 17

What is the management of neurogenic shock?

Answer 17

Fluid resus
Vasopressors to reverse dilation- noradrenaline
Ionotropes to increase cardiac contractility- dopamine