Shock

Question 1

What are the different types of shock?

Answer 1

Hypovolemic
Cardiogenic
Anaphylactic
Septic
Spinal
Obstructive
Hypoadrenal

Question 2

What is hypovolemic shock?

Answer 2

Inadequate blood volume within the blood vessels.

Question 3

What are common causes of hypovolemic shock?

Answer 3

External bleeding
Internal bleeding
Vomiting and diarrhoea
Burns

Question 4

What is cardiogenic shock?

Answer 4

Due to inadequate cardiac output as a result of a heart problem. The most common cause is acute myocardial infarction. Usually left ventricular dysfunction.

Question 5

What is anaphylactic shock?

Answer 5

Due to mediators released in response to a severe allergic reaction. Rapid onset multi organ, generalised hypersensitivity syndrome. Histamines cause blood vessels to vasodilate and leak resulting in decreased blood pressure.

Question 6

What is septic shock?

Answer 6

Due to systemic inflammatory state secondary to the immune response to an infection. Causes vasodilation and capillary leak as well as impaired cardiac function.

Question 7

What is spinal shock?

Answer 7

Due to the loss of sympathetic nervous system following spinal cord injury. Results in vasodilation and capillary leak

Question 8

What is obstructive shock?

Answer 8

Due to pulmonary embolism causing inadequate right ventricular function or tension pneumothorax causing inadequate right ventricular filling. These cause pressure on blood vessels which obstruct blood flow and cause shock.

Question 9

What is hypoadrenal shock?

Answer 9

Due to inadequate circulating levels of cortisol. Cortisol usually enhances the vasoconstrictive effects of adrenaline. A lack of it results in vasodilation.

Question 10

What is congential adrenal hypoplasia?

Answer 10

Small adrenal glands - don’t produce enough cortisol. More at risk of hypoadrenal shock.

Question 11

What can cause vasodilation?

Answer 11

Histamines
Toxins released by bacteria
Parasympathetic nervous system (of loss of SNA)

Question 12

What are the three stages of shock?

Answer 12

Compensated
Decompensated
Irreversible

Question 13

What are the compensatory mechanisms the body uses when in shock?

Answer 13

Increased HR
Increased contractility
Increased resp rate
Increased breathing
Diversion of blood
Constriction of blood vessels

Question 14

What happens in decompensated shock?

Answer 14

The SNS cannot ensure constant delivery of oxygenated blood. Tissues begin to release toxic metabolites. These cause vasodilation.
Heart rate cannot maintain perfusion and so blood pressure begins to fall.

Question 15

What are the signs of shock?

Answer 15

Tachycardia
Cold, clammy skin
Prolonged capillary refill
Tachypnoea
Narrowed pulse pressure (diff between systolic and diastolic)
Hypotension
Confusion/altered LOC

Question 16

What are signs of decreased perfusion?

Answer 16

Rapid pulse
Prolonged cap refill time as blood is diverted from the peripheries
Pale, cold, clammy skin

Question 17

What are signs of decompensated shock?

Answer 17

Confusion
Lethargy
Rapid, deep, gasping breaths
Prolonged cap refill
Cold extremities
Mottled skin
Dropping blood pressure

Question 18

What are signs of irreversible shock?

Answer 18

Decreased level of consciousness
Decreasing respiration rate
Cold, mottled skin
No peripheral pulse

Question 19

What cells release inflammatory mediators such as histamine?

Answer 19

Mast cells and basophils

Question 20

What are the respiratory signs of anaphylaxis?

Answer 20

SOB
Chest or throat tightness
Wheeze
Stridor

Question 21

What are the cardiovascular signs/symptoms of anaphylaxis?

Answer 21

Shock
Hypotension
Fainting
Collapse
Altered level of consciousness

Question 22

What are the gastrointestinal signs/symptoms of anaphylaxis?

Answer 22

Persistent or severe nausea/vomiting
Cramping abdominal pain
Explosive diarrhoea

Question 23

What are the skin signs/symptoms of anaphylaxis?

Answer 23

Urticaria
Itch
Flush
Swollen lips/tongue

Question 24

What is urticaria?

Answer 24

Rash that has patches of skin which are red, raised and itchy

Question 25

What is shock?

Answer 25

The global reduction of blood flow (perfusion) to the tissues and organs of the body. It results in the accumulation of metabolites (including acids) in the tissues and organs which causes cellular and organ dysfunction.

Question 26

What is loratadine?

Answer 26

A potent long-acting, non-sedating anti-histamine selective peipheral H1 receptor antagonist

Question 27

What is the action of loratadine?

Answer 27

It blocks the action of histamine by binding to histamine receptor sites. Specifically the H1 receptor sites

Question 28

What does histamine binding to H1 receptors have a role in?

Answer 28

``` Bowel movements Sleep regulation Itching and pain Systemic vasodilation Separation of endothelial cells Bronchospasm (asthma) ```

Question 29

How many known histamine receptors are there?

Answer 29

4

Question 30

Why do we use loratadine?

Answer 30

For patients who have minor allergic reactions that are confined to skin involvement only Or for a prominent itch after treatment for anaphylaxis, provided the systemic signs and symptoms have all resolved

Question 31

Why is loratadine non-sedating?

Answer 31

Because it has a higher affinity for peripheral H1 receptors so does not have as much of an effect on central H1 receptors which control sleep

Question 32

How long does loratadine take to work?

Answer 32

Onset occurs rapidly after oral administration | Symptomatic relief usually occurs 10-20 minutes after administration

Question 33

What are the contraindications for loratadine?

Answer 33

Universals | Restricted to over 1 YOA (not a contraindication)

Question 34

What dose of loratadine do we give?

Answer 34

>12 years - 10mg | 1-11 years 5mg

Question 35

What are the side effects of loratadine?

Answer 35

Fatigue Sedation Headache Dry Mouth

Question 36

When may patients be administered loratadine and not requrie immediate referral to a doctor?

Answer 36

``` No signs of systemic involvement No signs of spreading inflammation No facial or intra oral swelling No signs of blistering or peeling No adrenaline has been administered ```

Question 37

What is an allergy?

Answer 37

Where the immune system has a hypersensitivity to normally harmless environmental substances. This causes the degranulation of mast cells and the release of histamine and other inflammatory mediators

Question 38

What are signs and symptoms of an allergic reaction?

Answer 38

``` Inflammation of conjuctiva (red eyes) Conjunctival swelling Tears Itchy eyes Headache Facial Pain Sneezing Nasal Congestion Runny nose Coughing Bronchospasm WheezingSOB Upper airway swelling (Stridor) Dilation of blood vessels Swelling Increased capillary permeability Fluid loss Abdo pain Bloating Vomiting Diarrhoea Itchy skin Warm red skin Urticaria (red raised itchy bumps) ```