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Surgery > Shock > Flashcards

Shock Flashcards

1
Q

Definition of shock

A

Hypoxia at cellular level

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2
Q

Most common type of shock is

A

Hypovolemic shock

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3
Q

What kind of injury can never give rise to hypovolemic shock?

A

Isolated head injury/isolated head bleed 

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4
Q

Bleeding nature, when there is transaction of the artery

A

Vasospasm ; less bleeding

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5
Q

Bleeding nature, when there is laceration of the artery

A

Vasospasm opening increases therefore more bleeding

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6
Q

How does patient present when the bleeding source is venous in nature,

A

Gradual ooze - more time for body to compensate- late presentation

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7
Q

How does reactionary hemorrhage a occurs?

A

It occurs 4 to 24 hours after surgery due to increase in BP or slippage of knot (grannies knot🪢 )

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8
Q

What is the earliest indicator of hypovolemia?

A

tachycardia(release of adrenaline and noradrenaline)

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9
Q

Best indicator to determine the amount of fluid required in shock

A

PCWP > CVP
Because PCWP will give us a idea about left sided heart pressure and CVP gives idea about right sided heart pressure.

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10
Q

Best indicator of fluid resuscitation in shock

A

Urine output ; in adults >0.5 ML/KG/HR. children >1 ML/KG/HR.

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11
Q

What is the most sensitive in GIT to hypovolemic insult

A

Gastric mucosa (stress, ulcers)

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12
Q

Best end point of fluid resuscitation

A

MVOS

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13
Q

Best clinical endpoint

A

Urine output

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14
Q

Accurate measurement of MVOS can be done by drawing blood from a catheter in the

A

Right atrium

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15
Q

What is a normal value of MVOS?

A

50-70 %

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16
Q

High MVOS seen in

A

Septic shock

17
Q

Modified shock index is equal to

A

HR/MAP ( MOST SENSITIVE INDICATOR )

18
Q

RAPE rate overpressure difference=

A

= PR/ PP .
< 3 stable Patient.
>3 decompensated hemorrhagic shock.

19
Q

Complications of massive blood transfusion

A

• Hypothermia.
• Citrate is the anticoagulant used
Chelates Ca & Mg
-> Hypocalcaemia, hypomagnesemia
- citrate toxicity.
• Hyperkalaemia/ HypoKalaemia:
* Hyperkalaemia: Stored RBCs can lyse -> K* release.
Acidosis increases K*.
* Hypokalaemia: RBCs, after transfusion, can actively take in K+
• metabolic alkalosis : Due to citrate toxicity
Later on metabolic acidosis is seen.
• Blood transfusion reactions : Febrile (mc) anaphylactic reaction
•TACO & TRAIL

20
Q

MCC of death in massive blood transfusion is

A

Coagulopathy

21
Q

How to overcome coagulopathy

A

Ratio of PRBC : FFP : Platelets should be 1:1:1 should be maintained

22
Q

Scores that help in deciding massive blood transfusion

A

ABC score
TASH score

23
Q

Blood substitutes

A

1st generation: Perfluorocarbon.
2nd generation: stroma-free Haemoglobin.
• Next-generation:
Polyethylene glycol (PEG) hemoglobin.
• Hemospan A/K/A MP4OX - PEG conjugated human hemoglobin.
Pyridoxylated hemoglobin polyoxyethylene conjugate (PHP)

24
Q

In head injury there is

A

Bradycardia + Hypertension (cushing reflexes)

25
Q

In neurogenic shock there is

A

Bradycardia + Hypotension

26
Q

Inflammation markers are

A

IL-1 , IL-6 , TNF-α

27
Q

Parameters of SIRS

A

•Temprature <36 c or > 38°C
• WBC (< 4000 or >12000 or
>10% band forms in Peripheral smear.)
•RR > 20/min (or) pCO2 <32mmHg
• PR > 90 /min
Any 2 Parameters are present: SIRS.

28
Q

Sepsis =

A

SIRS + known foci of infection

29
Q

Sepsis =

A

SIRS + known foci of infection

30
Q

Septic shock=

A

Sepsis + hypotension (which fails to respond to fluid)

31
Q

SOFA SCORE

A

Sequential (sepsis related ) organ failure assessment score
SOFA >= 2 + known foci of infection : sepsis

32
Q

qSOFA SCORE

A

• SBP < 100 mmHg.
• Altered mental status.
• RR > 22/ min (tachypnea).
A score of >=2 : poor outcome.

33
Q

During the first 6 hours of resuscitation, the goals of initial resuscitation of sepsis induced hypoperfusion should include all the following as a part of a treatment protocol:

A
  1. CVP :8 - 12 mmig.
  2. MAP: > = 65 mmHg.
  3. urinary output : >=0.5ml/kg/hr.
  4. MVOS: >=65%
  5. Normalize lactate.
34
Q

Which metabolic abnormality is seen in massive blood transfusion

A

Metabolic acidosis

35
Q

The capillary refill time is prolonged in all type of shock except

A

Septic shock

36
Q

Definition of massive transition

A

Massive transfusion (MT) is defined as the replacement by transfusion of 10 units of pRBCs in 24 hours or more than 4 units of pRBCs in one hour.

37
Q

In patient with head injury with solution is contraindicated

A

5% dextrose

38
Q

Which fluid is given in severe head injury

A

Hypertonic saline

39
Q

Fogarty catheter is used in

A

Acute limb ischemia

Surgery (30 decks)

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