Shock

Question 1

3 components of perfusion triangle

Answer 1

pump (heart)
container (blood vessels)
content (blood)

Question 2

6 types of shock

Answer 2

hypovolaemic
cardiogenic
obstructive

distributive:
septic
anaphylactic
neurogenic

Question 3

4 stages of shock

Answer 3

1. Stage 1 - body is able to cope, no serious effects
   
   2. Stage 2 - compensatory stage
   3. Stage 3 - decompensated
      Stage 4 - Irreversible (exsanguination)

Question 4

causes of hypovolaemic shock

Answer 4

• Burns
  
  • Sweating
  • Diarrhoea
  • Vomiting
  • Haemorrhage
  • post-partum haemorrhaging
• Haemoptysis (coughing up blood)

Question 5

clinical presentation of hypovolaemic shock

Answer 5

• Increased systemic vascular resistance
  
  • Lowered cardiac output
  • Tachycardia
• Cyanosis

Question 6

treatment for hypovolaemic shock

Answer 6

• Check for blood on the floor and four more (abdo, pelvic, L femor, R femor)
  
  • Control the Haemorrhage
  • IV fluids (resus volume)
  • Hypothermia prevention
• Blood transfusion

Question 7

points to consider with blood loss

Answer 7

• Elderly struggle
  
  • Children compensate longer, but deteriorate rapidly
  • Fit people handle it well
• Meds affect response to blood loss, beta blockers may blunt the normal tachycardia

Question 8

what is hypovolaemic shock

Answer 8

low volume of blood/fluid in circulation

Question 9

what is obstructive shock

Answer 9

mechanical interference, problem with venous return, a physical obstruction to the flow of blood

Question 10

causes of obstructive shock

Answer 10

Tension pneumothorax (trauma to parietal pleura, air from atmosphere enters pleural cavity, interpleural pressure increases, prevents inspiration + pushes mediastinum/trachea to contralateral side, mediastinum shift compresses the heart)

Aortic dissection (a tear within the aorta causing the inner + middle layers of the aorta to split)

Pericardial tamponade (fluid build up on pericardium, constricts filling of chambers)

Pulmonary embolism (restricted blood flow, stroke volume decreases, cardiac output decreases, hypotension, hypoxemic hypoxia (low level of 02 in blood), ischaemic, organ failure)

Question 11

treatment of obstructive shock

Answer 11

Treat the cause

- Tension pneumothorax - needle decompression (equalise pressures of pleural cavity)
- Pericardial Tamponade - pericardiocentesis (remove build up of fluid in the pericardium)
- Pulmonary Embolism - heparin (anti-coagulants), thrombolytic drugs (streptokase), embolectomy
- Aortic Dissection - Surgery

Treat the symptoms - oxygen therapy, fluids, vasopressors (adrenaline)

Question 12

clinical presentation of obstructive shock

Answer 12

• Hypotension (constriction of myocardium)

- Muffled/distant heart sounds

Question 13

what is distributive shock

Answer 13

a group of 3 shocks that denotes vessel malfunction, resulting in a decrease in systemic vascular resistance

Question 14

what is anaphylactic shock

Answer 14

severe allergic reaction, cytokine storm

Question 15

what is septic shock

Answer 15

result of severe bacterial infection (anaphylaxis), releases toxins that causes vessels to become leaky + semi permeable

Question 16

what is neurogenic shock

Answer 16

a loss of sympathetic vasomotor tone, due to inhibitions with neurotransmitters

Question 17

describe the generalised process (result) of all types of shock

(9 stages)

Answer 17

systemic vasodilation
hypotension
low BP
inadequate tissue perfusion
generalised/localised hypoxia
ischaemia
necrosis
organ failure
death

Question 18

causes of anaphylactic shock

Answer 18

Extreme sensitivity to a substance, binds to mast cells, degranulation of mast cells, mass release of chemical mediators (primarily histamines)

Question 19

causes of septic shock

Answer 19

result of severe bacterial infection (anaphylaxis), releases toxins that causes increased vascular permeability

Question 20

treatment of anaphylactic shock

Answer 20

• 1:1000 adrenaline, causes bronchodilation and blood vessel constriction
• Anti-histamines

Question 21

clinical presentation of septic shock

Answer 21

Focus on patient history taking, active antibiotic course? Infection management not working?, is the patient vulnerable

- Mottled skin
- Fever (remember cold sepsis)
- Portsmouth sign (when SBP falls below HR) - heart is in overdrive but cardiac output is insufficient - Confusion (especially in elderly, lack of blood supply to the brain)

Question 22

treatment of septic shock

Answer 22

• Blood Testing
  
  • Broad spectrum antibiotic administered within golden hour (benzylpenicillin)
  • Blood gases testing/cultures
• Treat the symptoms (fluids, oxygen therapy etc)

Question 23

causes of neurogenic shock

Answer 23

• Acute spinal cord injury (common)

- Regional analgesia

Question 24

clinical presentation of neurogenic shock

Answer 24

Autonomic blockade, causes unopposed vagal tone, bradycardia

Essentially nerves are unable to communicate with the body, specifically the cardiovascular system, inhibits vasoconstriction + cardiac contractility, causes vasodilation, low BP, low SVR, inadequate tissue perfusion, ischaemia, necrosis, organ failure

Question 25

treatment of neurogenic shock

Answer 25

Vasopressors (adrenaline)
Corticosteroid therapy
Atropine (bradycardia indication)
Fluids

Question 26

what effect does a mass histamine release have on the body

3 main points

Answer 26

• increased vascular permeability, leads to oedema, specifically laryngeal oedema, airway obstruction
  
  • vasodilation (systemic hypotension), low BP, inadequate tissue perfusion, ischaemia, necrosis, organ failure, death
    constriction of smooth muscle (including bronchi) = respiratory distress