Shock

Question 1

What is shock?

Answer 1

Tissue Hypoperfusion due to Circulatory Failure

Question 2

What does inadequate perfusion result in?

Answer 2

Systemic Acidosis (pH

Question 3

what signs would immediately make you consider shock?

Answer 3

Mottling

Glasgow Coma Score

Question 4

how can shock be confirmed?

Answer 4

Lactate Levels
even 0.75mmol/L higher than normal carries a worse prognosis
>2mmol/L arguably diagnostic
>4mmol/L significant mortality

Question 5

What are the 4 mechanisms that affect MAP (and therefor shock)

Answer 5

Heart rate and Volume combine to determine Cardiac Output.

Systemic Vascular Resistance and Cardiac Output Determine MAP

Question 6

What types of shock would give you cool clammy peripheries and why?

Answer 6

Cardiogenic, hypovolaemic and obstructive. Systemic vascular resistance increases to compensate for

Destributive shock is the exception- vasodilation causes warm, red peripheries

Question 7

what can be a sign of obstructive shock?

What are the potential causes?

Answer 7

raised Jugular Venous Pressure and Distended Neck Veins may be prominent

PE
Cardiac tamponade
Tension pneumothorax

Question 8

What are the causes of hypovolaemic shock?

Answer 8

Haemorrhage- Blood on the floor (trauma) and four more (Intrathoracic, Abdominal Viscera, Pelvic Fracture, Long Bone Fracture)

Dehydration- Vomiting, Diarrhoea, diabetic ketoacidosis

Question 9

causes of distributive shock

Answer 9

Inflammatory- Sepsis- Antibiotics
Neurogenic- Spinal Cord Damage and loss of Sympathetic Vasomotor Tone- Neurosurgery
Iatrogenic- Spinal Anaesthesia and Epidural Anaesthesia- Vasopressors

Give all vasopressors- Noradrenaline

Question 10

Describe history examination diagnosis and management of shock

Answer 10

view graphs at end of lecture