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FCP - Emergency Week > Shock > Flashcards

Shock Flashcards

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1
Q

Triage

A
  • Process of quickly examining patients who are taken to decide which ones are the most seriously ill and must be treated first
  • Process of examining problems in order to decided which ones are the most serious and must be dealt with first
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2
Q

What is shock?

A

Inadequate cellular energy production
Most commonly secondary to poor tissue perfusion
Leads to critical decrease in oxygen delivery (DO2) compared to oxygen consumption in tissues (VO2)

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3
Q

What are the parameters to assess a state of shock?

A

Mentation
Membrane colour
Capillary refill time
Extremity temperature
Pulse

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4
Q

Mentation in shock

A

Inadequate delivery of oxygen and glucose to the brain results in loss of normal mental state
Alert and normally responsive
Depressed and obtunded
Stuporous or semi-comatose
Comatose

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5
Q

Mucous membrane in shock

A

○ Normal colour is salmon pink
Cats and horses usually paler than dogs
○ Pale to white colour is caused by depletion of volume or haemoglobin
○ Red colour suggests poor perfusion and vasodilation as in sepsis
Blood trapped in capillary beds

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6
Q

Capillary refill time in shock

A

○ Normally <2 seconds
Buccal mucosa refills slightly slower than gingival
○ CRT determined by pre-capillary sphincter tone, increases in tone lengthening CRT and decreases in tone shortening CRT
Vasoconstriction caused by an increase in sympathetic tone can cause CRT to be > 2 seconds as can hypovolaemia
□ Such as in response to a decrease in circulating blood volume in shock
Vasodilatation is characteristic of SIRS & sepsis and can result in a shortened CRT

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7
Q

Extremity temperature in shock

A

Cold extremities
Marked improvement once treatment starts

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8
Q

Pulse evaluation in shock

A

○ NO information about blood pressure
○ Pulses are the difference between systolic and diastolic pressure
Estimate of stroke volume
○ Compensated (EARLY) hypovolaemia reveals a taller and narrower pulse profile than normal reflecting a slightly decreased pulse volume
Hyperdynamic or bounding
○ More severe hypovolaemia progresses - decompensated hypovolaemic shock
Global tissue perfusion is severely compromised
Increased heart rates (170–220 bpm in dogs)
Femoral pulse profile is short and narrow
□ Weak or thready (C) and metatarsal pulses are absent

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9
Q

SIRS

A

Systemic Inflammatory Response Syndrome
Involves 2/4 of the clinical signs in dogs
Involved 3/4 of the clinical signs in cats

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10
Q

SIRS Temp criteria

A

Dogs - <38.1 or >39.2
Cats - <37.8 or >40.0

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11
Q

SIRS Heart rate criteria

A

Dogs - >120
Cats - <140 or >225

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12
Q

SIRS resp rate criteria

A

Dogs - >20 or PaCO2 <32mmH
Cats - >40 or PaCO2 <32mmHg

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13
Q

SIRS WBCC criteria

A

Dogs - <6 or >16; >3% bands
Cats - <5 or >19

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14
Q

Sepsis Definition

A

Meets criteria for SIRS + indication of infectious agent

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15
Q

Severe sepsis definition

A

Criteria for sepsis + organ dysfunction, hypoperfusion or hypotension

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16
Q

Refractory (Septic) Shock/SIRS Shock defintion

A

○ Subset of severe sepsis
○ Hypotension despite adequate fluid resuscitation
○ Not improving after receiving medication that should improve cardiac contractility
Inotropes
Vasopressors

17
Q

Multiple Organ Dysfunction Syndrome (MODS)

A
  • Presence of altered organ function in an acutely ill patient
    ○ Homeostasis cannot be maintained without intervention
  • Usually occurs just before death
18
Q

Types of shock

A

Hypovolaemic
Cardiogenic
Distributive
Metabolic
Hypoxaemic
Cryptic
Combination of multiple

19
Q

Hypovolaemic shock and examples

A

Decrease circulation blood volume
○ Fluid loss from intravascular space
○ Trauma
○ Haemorrhage

20
Q

Cardiogenic shock and examples

A

Decreased forward flow from the heart
○ Congestive heart failure
○ Cardiac dysrhythmias
○ Cardiac tamponade
○ Drug overdose
Anaesthetic agents
Beta-blockers
Calcium channel blockers

21
Q

Distributive shock and examples

A

Loss of systemic vascular resistance
○ Sepsis
○ Obstruction (saddle thrombosis, heartworm)
○ Anaphylaxis

22
Q

Metabolic shock and examples

A

Deranged cellular metabolic machinery
○ Hypoglycaemia
○ Cyanide toxicity
○ Mitochondrial dysfunction
○ Cytopathic hypoxia of sepsis

23
Q

Hypoxaemic shock and examples

A

Decreased oxygen content in arterial blood
○ Anaemia
○ Severe pulmonary disease
○ Carbon monoxide toxicity
○ Methaemoglobinaemia

24
Q

Cryptic shock and examples

A

Normal global circulation but poor microcirculation (in capillary beds)
○ SIRS
○ Sepsis

25
Q

What re the most common manifestations of shock?

A

Loss of intravascular volume - Hypovolaemic shock
Maldistribution of vascular volume - Distributive and cryptic shock
Failure of cardiac pump - Cardiogenic shock

26
Q

Clinical presentation of shock

A

Internal or external blood loss
Loss of other bodily fluids
Decreased cardiac output
Increased SNS activity
Vasoconstriction
Increased contractility
Increased HR

27
Q

What happens in hypovolaemic shock?

A
  • Extreme vasoconstriction and changes in microcirculation
    ○ Mobilisation of fluid from interstitial and extracellular spaces to IV space
    ○ Start to see signs of dehydration
  • Decreased renal circulation
    ○ Activates RAAS
    ○ Further upregulates SNS
    ○ Na and H2O retention due to increased production of aldosterone and ADH
28
Q

Initial signs of shock

A

COMPENSATED SHOCK
○ Mild to moderate depression
○ Tachycardia with normal to prolonged CRT
○ Cool extremities
○ Tachypnoea
○ Normal blood pressure
○ Pulse quality normal

29
Q

Ongoing signs of shock

A

DECOMPENSATED SHOCK
○ Compensatory mechanisms inadequate and fail
○ Pale mucous membranes (red in sepsis)
○ Poor peripheral pulse quality
○ Depressed mentation
○ Fall in blood pressure

30
Q

Hyperdynamic phase

A
  • Tachycardia
  • Fever
  • Bounding peripheral pulses
  • Hyperaemic mucous membranes secondary to cytokine (Nitric Oxide) mediated peripheral vasodilatation
  • Also referred to as vasodilatory shock
31
Q

Progression to sepsis

A
  • Due to cytokine effects on the myocardium
    ○ Decreased Cardiac Output
    ○ Signs of Hypoperfusion
    • Clinical signs
      ○ Tachycardia
      ○ Pale/ icteric mucous membranes
      ○ Prolonged CRT
      ○ Significantly reduced mentation
    • Hypodynamic shock
      ○ Organ dysfunction and death
32
Q

What is the shock organ in dogs?

A

GIT

33
Q

What is the shock organ in cats?

A

Lungs

34
Q

What is the first thing to fail in sepsis for most species?

A

Microcirculation

FCP - Emergency Week (13 decks)

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