Shock

Question 1

What indicators can help determine presence of and severity of shock

Answer 1

Base deficit, Lactate levels

Question 2

Adjuncts for C

Answer 2

CXR, Pelvic XR, FAST, DPL Catherisation

Question 3

BP target for elderly, what is considered hypotensive

Answer 3

BP >110

hypotensive if <110

Question 4

Lethal triad

Answer 4

Coagulopathy
Acidemia
Hypothermia

Question 5

Risk of massive crystalloid resuscitation in injured patients

Answer 5

Dilution of platelets and clotting - contributes to coagulopathy.

RBC, Platelets and clotting factor transfusion is the best

Question 6

Management options for haemorrhage

Answer 6

Tourniquet - document time of application
Direct pressure with moist sterile gauze/dressing
Reduce and splint fractures
Pelvic binder
Angio-embolisation
Operation

Question 7

What is the benefit of NGT insertion in the context of shock

Answer 7

Reduced gastric distension which stimulates vagus nerve thus causing bradycardia

Reduced risk of aspiration

Question 8

Shock nonresponsive to IVI - potential causes

Answer 8

Occult injury, site of bleeding
- check all four thorax, abdo, pelvis, retroperitoneum again

Neurogenic shock - over-IVI can cause oedema

Question 9

Massive transfusion protocol

Answer 9

10U pRBC in 24h or 4U in 1h

TXA in 3h or 1g in 8h?

Question 10

What is the cause of transient response to fluids

Answer 10

Unidentified site of bleeding

Question 11

Consideration with pregnancy and shock

Answer 11

Due to hypervolemia, mother may have normal obs but underlying foetal hypoxia due to shift in perfusion

Question 12

Blood volume estimate

Answer 12

7% of body weight

Question 13

Causes of failed response to therapy IVI, RBCs etc.

Answer 13

Cardiac tamponade, Tension PTX, Occult bleeding site or fluid loss, Acute gastric distension, MI, Diabetic acidosis, hypoadrenalism, neurogenic shock