Shock 3 - Dx + Mx

Question 1

hypovolaemic shock

Initial management (ABCDE)
Try to identify the ? of the fluid loss, and replace fluid equivalent to the fluid being lost, and titrate to ?/?/?/? ? response.
? boluses (250/500ml) with observation of response should be used, and fluid should ideally be ?.

Answer 1

cause
bp,hr,urine output,cvp
rapid
warmed

Question 2

Hypovolaemic shock

? should be considered if persistently hypotensive.
Permissive ? should be used in ? shock, titrating the systolic blood pressure to ?-?mmHg (95-100 if there is a ? injury).
? acid has also been shown to increase survival in haemorrhagic shock.

Answer 2

ionotropes
hypotension
haemorrhagic
60-70
head
tranexamic

Question 3

There are different categories of haemorrhagic shock;

Class I: ?ml, up to ?% circulating volume.
HR , give ?.

Class II: ?ml - 1500ml, up to ?% of circulating volume.
HR >?, ? pulse pressure (?), consider giving ?.

Answer 3

750
15
100
crystalloids
750
30
100
narrow
vasoconstriction
blood

Question 4

There are different categories of haemorrhagic shock;

Class Ill: 1500ml - ?ml, up to ?% of circulating volume.
HR>?, hypotensive, give ?, consider ? management.

Class IV: >?ml / ?% of circulating volume.
Will need ? management.

Answer 4

2000
40
120
blood
surgical
2000
40
surgical

Question 5

Hypovolaemic shock

In cases of haemorrhagic shock, rapid blood loss or impending haemorrhagic shock then the ? ? protocol should be activated (number?). This will enable the delivery of ? cells, ??? and ? in a 2:1:1 ratio.

Answer 5

major haemorrhage/massive transfusion
2222
packed
FFP
platelets

Question 6

Cardiogenic

Initially ABCDE

IV ? ?-?mg IV for ?/anxiety.
Assess for ? ?, do not give fluids if present.
Consider ?-? ?, ? line (to guide fluids) and ? line.

Answer 6

diamorphine 2.5-5
pain
pulmonary oedema
swan getz catheter
central
arterial

Question 7

Cardiogenic shock

If ? ? ? ?(PCWP) is low, give ?mg ?expander every ?min.
If PCWP is acceptable, then give ionotopic support (e.g. ?) to keep SBP >?mmg.
Consider ‘? dose’ ? via ? line (dilates renal arteries at ? doses to protect the kidneys).

Answer 7

pulm cap wedge pressure
100
plasma
15
dobutamine
80
renal
dopamine
central
low

Question 8

Neurogenic shock

Inhibition of ? outflow from spinal cord, leading to ?.
May be due to ? anaesthesia, or spinal cord injury above ?.
Will present with ? and ? not responding to fluid resuscitation, so consider if there is a mechanism of ? injury.
Treatment is likely to require fluid resuscitation and ?.

Answer 8

sympathetic
vasodilation
epidural
T6
hypotension
bradycardia
spinal
vasopressors

Question 9

Neurogenic shock is often confused with spinal shock;

Spinal shock is a transient ‘?’ of the spinal cord, leading to ? ?, that resolves as the soft tissue ? decreases.
There may be ?, and there will be no ?below the level of injury.

Answer 9

concussion
flaccid areflexia
swelling
priapism - painful, constant erection
reflexes