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ATLS > Shock > Flashcards

Shock Flashcards

1
Q

What are the steps of managing shock?

A
  • Identify the presence of shock
  • Identify the probable cause of shock
  • Initiate treatment
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2
Q

Types of shock?

A
  • Hypovolaemic/haemorrhagic
  • Obstructive
  • Cardiogenic
  • Neurogenic
  • Septic
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3
Q

Most common cause of shock in trauma patients?

A

Haemorrhagic shock

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4
Q

Possible causes of confusion in a trauma patient?

A
  • Shock of any cause
  • Brain injury
  • Stroke
  • Alcohol & drugs
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5
Q

What is cardiac output?

A

HR x SV

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6
Q

What are the determinants of SV?

A
  • Preload
  • Myocardial contractility
  • After-load
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7
Q

What are the determinants of preload?

A
  • Venous capacitance
  • Volume status
  • Venous flow due to pressure differential
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8
Q

Factors reducing preload?

A

Haemorrhage

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9
Q

What is afterload?

A

This is the resistance to the forward flow of blood

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10
Q

What are the early physiological responses to blood loss?

A
  • Increased vasoconstriction - Vital organs
  • Increased HR to preserve cardiac output
  • Increased catecholamines to increase PVR & DBP
  • Shift from aerobic to anaerobic metabolism
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11
Q

Blood loss and compensatory mechanisms ?

A

They maintain normal conditions until 30% of blood volume is lost

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12
Q

Best laboratory indicators for the severity of shock?

A
  • Lactate
  • Base deficit
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13
Q

Other causes of shock & volume resuscitation?

A

Other forms of shock transiently improve with volume resuscitation

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14
Q

What is the normal adult & child blood volume?

A
  • 7% of body weight
  • 7% of ideal body weight in the obese patient
  • 8-9% of body weight in the paediatric group
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15
Q

What is the physiological classification of haemorrhage ?

A

Class 1: Minimal changes - EBL 1 unit of RBC
Class 2: Requiring crystalloid resuscitation
Class 3: Crystalloid & blood required
Class 4: Mass EBL - Death in minutes

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16
Q

Class 1 haemorrhage & physiological changes?

A
  • Blood loss <15%
  • Normal BP, pulse pressure & RR
  • BE 0 to -2
17
Q

Class 2 haemorrhage & physiological changes?

A
  • 15 - 30% EBL
  • Tachycardia & tachypnoea
  • Decreased pulse pressure
  • Subtle CNS signs - Anxiety, agitation
  • UO = 20-30ml/hr
  • BE -2 to -6
  • Crystalloid resuscitation
18
Q

Class 3 haemorrhage & physiological changes?

A
  • EBL 31-40%
  • PRBC, crystalloid & control of bleed required
  • Inadequate perfusion
  • Tachycardia & tachypnoea
  • Significant CNS changes - Confusion
  • Significantly low BP
  • BE -6 to -10
19
Q

Class 4 haemorrhage & physiological changes?

A
  • Significant tachycardia & hypotension
  • Narrow pulse pressure
  • Oliguria
  • Depressed CNS
  • Cold & pale skin
  • BE -10 or more
  • Rapid transfusion & control required
20
Q

What are the usual methods of haemorrhage control?

A
  • Angio-embolization
  • Direct pressure
  • Operation
  • Pelvic binder or sheet
  • Splint fracture
  • Tournique
21
Q

Possible sources of bleeding?

A
  • Floor & 4 more
  • Abdo/pelvis
  • Retroperitonium
  • Thorax
  • Extremities
22
Q

Indicator for adequate resuscitation?

A

UO > 0.5ml/kg/hr (Adult)
UO > 1ml/kg/hr (Child)
UO > 2ml/kg/hr (Infant)

23
Q

Types of response to resuscitation?

A
  • Rapid
  • Transient
  • Minimal
24
Q

Control of haemorrhage?

A
  • Operative
  • Angiographic control - Embolization
25
Q

How to prevent hypothermia with massive transfusion?

A
  • Warm the product to 39 degree
26
Q

What is massive transfusion?

A
  • > 10 units of RBC in 24 hours
  • > 4 units of RBC in 1 hour
27
Q

Occurrence of coagulopathy?

A
  • In >30% of trauma patients
28
Q

Use of tranexamic acid?

A

Increases survival when administered within 3 hours of injury

29
Q

POC testing for coagulation ?

A
  • ROTEM
  • TEG
30
Q

Adjuncts to determine the cause of shock?

A
  • CXR - Haemopneumothorax
  • Pelvic XR
  • FAST - Exclude abdominal or cardiac bleed
31
Q

Factors affecting haemorrhage in elderly?

A
  • Inability to increase HR in response to EBL
  • Increased organ sensitivity to hypoperfusion
  • Pre-existing volume depletion
  • Medications
  • Reduced pulmonary compliance
32
Q

Pregnancy and haemorrhage?

A

It takes a significant amount of blood loss to manifest signs of blood loss . There may be decreased fetal perfusion

33
Q

Medication effects on the shocked patient?

A
  • Beta-blockers or CCB
  • Insulin overdosing
  • Diuretic use - Hypokalaemia
  • NSAIDs - Platelet function + Increase bleed
34
Q

Devices affecting shock?

A

PPM or ICD

35
Q

How to restore end organ perfusion?

A
  • Source control
  • Volume resuscitation
36
Q

Brainstem injury & shock?

A

If brainstem inury is present then this might present as shock - Terminal event

37
Q

Investigation which can be used to identify concealed cause of shock ?

A
  • FAST scan
38
Q

What are the characteristics of class 3 haemorrhage ?

A
  • HR 120-140
  • Decreased pulse pressure
  • UO = 5-15ml/hr (Decreased)
  • Low systolic blood pressure
  • Indicates EBL of 30-40% of blood volume

ATLS (10 decks)

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