shock Flashcards
define shock
Acute circulatory failure with inadequate or inappropriately distributed tissue perfusion
(meaning there is inadequate glucose and oxygen for aerobic cellular respiration),
resulting in generalised hypoxia and/or inability of cells to utilise oxygen.
describe blood pressure in shock
Low BP – systolic <90 mmHg
presentation of shock
- Skin is pale, cold, sweaty and vasoconstricted
- Rapid, weak pulse
- Reduced pulse pressure
- Reduced urine output
- Confusion, weakness, collapse and coma
- Capillary refill time (CRT)
is arertial blood pressure a good indicator. ofshock
no because it will be maintained until a very large amount of blood loss
Reduced urine output
how does capillary refill time indicate shock
if it takes more than 3 seconds to turn pink after 5 seconds of compression
this is the earliest and most accurate sign of shock
types of shock
- septic
- hypovalaemic
- anaphylactic
- cardiogenic
- neurogenic
what is septic shock
infection with any organism
acute vasodilation from inflammatory cytokines
what is anaphylactic shock
Type-I IgE-mediated hypersensitivity, release of histamine
what is neurogenic shock
spinal cord injury, epidural or spinal anaesthesia
what is hypovalaemic shock
loss of >20% of body’s blood or fluid supply, severe fluid loss makes it impossible for the heart to pump a sufficient amount of blood around the body
what is cardiogenic shock
happens when your heart cannot pump enough blood and oxygen to the brain and other vital organs
2 types of hypovalaemic shock
- Haemorrhage
- Non-haemorrhagic (fluid loss)
4 haemorrhage causes of hypovalaemic shock
Trauma
GI bleeding
Fractures
Ruptured aortic aneurysms
4 non haemorrhagic causes of hypovalaemic shock
Burns – heat increases permeability of capillaries so more plasma leaks
Severe diarrhoea and vomiting 🡪 dehydration
Intestinal obstruction (fluid accumulates in intestines)
Pancreatitis
cardiogenic causes of shock
Acute MI
Myocarditis
Atrial and ventricular arrhythmias
Bradycardias
Rupture of valve cusp
Obstructive
what is anaemia shock
not enough oxygen carrying capacity
what is cytotoxic shock
cells poisoned
management of shock
- airways patent
- breathing 100%
- circulation - give fluid and blood
- stabilise bp
- supplemental oxygen
what is Systemic Inflammatory Response syndrome (SIRS) defined as
- Temperature of >38˚C or <36˚C
- Tachycardia >90 BPM
- Respiratory rate >/= 20 breaths per minute OR PaCO2 <4.3kPa
- WBC > 12 x 109/L or < 4 x 109/L
what can septic shock occur with
severe burns, trauma and acute pancreatitis
what is severe sepsis
sepsis with dysfunction of one or more organs
signs and symptoms of septic shock
Pyrexia and rigors
Nausea and vomiting
Vasodilation with warm peripheries
Bounding pulse
what investigations for shock
FBC
Serum creatinine
Electrolytes
Blood glucose
Coagulation
Blood gases
Liver biochemistry
complications of septic shock
Coagulopathy
Acute kidney injury
