Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3MB Haematology > Shock > Flashcards

Shock Flashcards

1
Q

When does shock occur?

A

When there is insufficient tissue perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is septic shock?

A

Infection that triggers a particular Systemic Inflammatory Response Syndrome (SIRS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Characteristics of septic shock

A

Body temperature outside 36 oC - 38 o C
HR >90 beats/min
Respiratory rate >20/min
WBC count >12,000/mm3 or < 4,000/mm3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Patients with infections and ______ elements of SIRS meet the diagnostic criteria for sepsis

A

2 ore more elements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Those with organ failure have severe sepsis and those with refractory hypotension have..

A

Septic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The overall hallmarks of septic shock are..

A

Excessive inflammation, coagulation and fibrinolytic suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Key areas for attention in septic shock

A

Prompt administration of antibiotics
Haemodynamic stabilisation
Modulation of the septic response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

In surgical patients, the main groups with septic shock include..

A

Anastomotic leaks, abscesses and extensive superficial infections such as necrotising fasciitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The average adult blood volume comprises 7% of body weight. Thus in the 70 Kg adult this will equate to..

A

5 litres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T or F: Average adult blood volume changes in children and is slightly lower in the elderly

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Blood loss of <750ml is classed as class __ of haemorrhagic shock

A

One

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Blood loss of 750-1500ml is classed as class __ of haemorrhagic shock

A

Two

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Blood loss of 1500-2000ml is classed as class __ of haemorrhagic shock

A

Three

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Blood loss of >2000ml is classed as class __ of haemorrhagic shock

A

Four

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The main groups with haemorrhagic shock include..

A

Trauma
Tension pneumothorax
Spinal cord injury
Myocardial contusion
Cardiac tamponade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When assessing trauma patients it is worth remembering that in order to generate a palpable femoral pulse an arterial pressure of _________ is required

A

> 65mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Once bleeding is controlled and circulating volume normalised the levels of transfusion should be to maintain a Hb of _______ in those with no risk factors for tissue hypoxia and Hb of _____ for those who have such risk factors

A

Once bleeding is controlled and circulating volume normalised the levels of transfusion should be to maintain a Hb of 7-8 in those with no risk factors for tissue hypoxia and Hb 10 for those who have such risk factors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Neurogenic shock often occurs following a..

A

Spinal cord transection (usually at a high level)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Neurogenic shock results in..

A

Decreased sympathetic tone or increased parasympathetic tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does neurogenic shock relate to Starling’s law?

A

There is a decrease in peripheral vascular resistance mediated by marked vasodilation. This results in decreased preload and thus decreased cardiac output. There is decreased peripheral tissue perfusion and shock is thus produced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In neurogenic shock, peripheral vasodilators/ vasoconstrictors are used to return vascular tone to normal

A

Vasoconstrictors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

In medical patients, the main cause of cardiogenic shock is..

A

Ischaemic heart disease

23
Q

In the traumatic setting, the main cause of cardiogenic shock is..

A

Direct myocardial trauma or contusion

24
Q

In cardiogenic shock, evidence of ECG changes and overlying sternal fractures or contusions should raise the suspicion of..

A

Injury

25
Q

In cardiogenic shock, ________________ should be used to determine evidence of pericardial fluid or direct myocardial injury

A

Transthoracic echocardiography

26
Q

When cardiac injury is of a blunt nature and is associated with cardiogenic shock the right/left side of the heart is the most likely site of injury with chamber and or valve rupture

A

Right

27
Q

Surgial Tx for right side injury/chamber or valve rupture in cardiogenic shock

A

Cardiopulmonary bypass
Some may require intra-aortic balloon pump as a bridge to surgery

28
Q

Life-threatening, generalised or systemic hypersensitivity reaction

A

Anaphylactic shock

29
Q

Most important drug in anaphylactic shock?

A

Adrenaline - can be repeated every 5 minutes if necessary

30
Q

The best site for IM injection is the..

A

Anterolateral aspect of the middle third of the thigh

31
Q

Common identified causes of anaphylaxis

A

Food (e.g. Nuts) - the most common cause in children
Drugs
venom (e.g. Wasp sting)

32
Q

What three things does normal tissue perfusion rely on?

A

Cardiac Function
Capacity of vascular bed
Circulating blood volume

33
Q

Surrogate markers for normal perfusion

A

Blood pressure
Consciousness (Brain perfusion)
Urine output (Renal perfusion)
Lactate (General tissue perfusion)

34
Q

What is Hypovolaemic shock?

A

Acute haemorrhage - “Fluid deplete” states
Severe dehydration, burns

35
Q

Physiology of Hypovolaemic shock?

A

Volume depletion – leading to reduced SVR

Reduced volume returning to heart – reduced pre-load and hence reduced CO

36
Q

In cardiogenic shock, if due to MI, suggests that >40% of ___ is involved

A

LV

37
Q

Examples of obstructive shock

A

Direct obstruction to cardiac output (PE, Air/Fat/Amniotic fluid-embolism)

Restriction of cardiac filling (Tamponade, Tension pneumothorax)

38
Q

Examples of Distributive shock

A

Septic, anaphylaxis, acute
liver failure, spinal cord injuries

39
Q

Physiology of distributive shock

A

Due to disruption of normal vascular autoregulation, and
profound vasodilatation. Poor perfusion – despite increased cardiac output

40
Q

What is Endocrine shock?

A

Severe uncorrected hypothyroidism, Addisonian
crisis – both reduced CO and vasodilation

41
Q

Most common cause of shock

A

Distributive (septic)

42
Q

What does the neuroendocrine response release?

A

Pituitary hormones – adrenocorticotrophic hormone, anti-diuretic hormone, endogenous opioids
Cortisol – fluid retention, antagonises insulin
Glucagon

43
Q

The inflammatory response is often followed by secondary..

A

Immune suppression, leaving predisposition to secondary infection

44
Q

Function of nitric oxide?

A

Regulation of blood flow, coagulation, neural activity and immune function

45
Q

Where is nitric oxide produced?

A

Produced in minute (picomolar) concentrations in
endothelial and other cells by cNOS

46
Q

T or F: Inflammation pathways activiate nitric oxide’s inducible
isoform iNOS in vessel smooth walls leading to
1000 fold increase in NO production

A

True

47
Q

Haemodynamic changes

A
48
Q

Gold standard for monitoring cardiac output

A

Thermodilution with a PA catheter – rarely used outside specialist units

49
Q

Fluid challenge

A

300-500ml over 10-20 mins

50
Q

Fluid choices

A

Crystalloids - need significantly larger volumes
Colloids - can cause anaphylaxis
Blood - will stay in circulation but scarce and has multiple risks

51
Q

Drugs used if fluid management does not work

A

Adrenaline (Epinephrine)
Noradrenaline (Norepinephrine)
Vasopressin (ADH)
Dopamine
Dobutamine/Dopexamin

52
Q

Next step if both fluids and drugs don’t work

A

Mechanical support options
* In cardiogenic shock: balloon pumps, L-VADs,R-VADs
* In severe cases – VA-ECMO

53
Q

Consequences of resuscitation

A

Volume delivered never remains intra-vascular
Extra-vascular overload, in an intra-vascularly “dry” patient
Sub-cutaneous oedema obvious
Less obvious – “wet” lungs/ARDS, bowel oedema

54
Q

De-Escalation / “De-Resucitation”

A

Spontaneous, Diuretic, Dialysis

3MB Haematology (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions