Shock Flashcards
Anaphylactic shock caused by
Antibiotics like penicillin and cephalosporins
ACE inhibitors
NSAIDS
NMblockers
MonoClonal Antibodies
Radiocontrast agents
Cross tolerance between?
Penicillin and cephalosporins1%
Take penicillin with caution with 3 or 4th generation cephalo
Don’t take with 1 or 2nd
Ashock treatment
Life threatening features
Adrenaline *with oxygen for laryngeal edema
-Adjunctive agents
Inhaled beta 2 agonists
IV fluids in poor response to adr(normal saline)
Antihistamines - H1 and H2 blockers
Corticos
Most important-first line of treatment shock
Adrenaline (IM)
Second dose after 5 minutes
Then IV in refractory
Adrenaline acts through
Alpha to decrease edema (VC)
Beta 2 for broncho dilation
Beta 1 for cardiac properties
Direct inactivation of mast cells (reduced beta receptor Ig E actions)
Decrease histamine and leukotriene
Adjuncts
Inhaled beta 2 agonist like salbutamol
-inhaled adr via nebulizer with oxygen to treat upper airway obstruction caused by the edema
IV fluid(normal saline) in shock or poor response to initial adrenaline
Antihistamines slow onset like corticos
Do nothing for life threatening feature
Diphenhydramine(sedating)
Cetirizine(non sedating)
Plus ranitidine
Patients on beta blocker
Adrenaline not effective
Take glucagon after adrenaline IV and normal saline
As it has ino and chrono effects not mediated through beta receptors
Cardiogenic shock
-decreased cardiac output with tissue hypoxia with adequate intravascular volume
General supportive measures
Vasopressors (nor adrenaline first)0
Isotopes
Mechanical circulatory support
Correct the cause
Possible causes to be corrected in cardiogenic shock
Cardiomyopathies like Acute MI
Dilated Cardiomyopathy myocarditis
Arrhythmia
Aortic or moral insufficiency
Rupture of papillary muscles
Rupture of ventricular free wall aneurysm
First line treatment
IV fluids then initial corticos
Oxygen therapy for any hypoxemia
Other inotropes for cardiogenic shock
Individuals use with guided hemodynamic monitoring
Dobutamine (selective beta 1 and all the inotropy)
Milirinone(phosphodiesterase inhibitors)
Levosimendan (calcium sensitising agents)
Mechanical
Intra aortic balloon pump counter pulsating
Extra Corporeal Membrane Oxygenation
*early revascuarization is the cornerstone of treated of AMI patents with cardioshock
Shock
Decreased oxygen supply
Increased demand
Decreased utilization
No walking no standing
Acute reactions
Airway and Breathing problems
Semi recumbent
Circulatory problems low BP
Flat with or without leg elevation
Normal breathing unconscious or vomiting
Side (recovery position)
Pregnant
Side so mo vena canal compression
Role of corticos
Decrease antibody
Inhibit antigen/antibody run
Stabilise mast cell
Derease tissue response to allergic rxn
Observation for any biphasic reaction 2 - 12 hrs
Vasopressors in cardiogenic shock
First line for any shock either severe hypotension is NA:
Alpha - VC increasing Systolic and diastolic increasing coronary blood flow indirectly improving cardiac function
Weak beta agonist activity
ADH in. Cardiogenic shock
Increases sensitivity to NA
For patients with refractory VD shock
