Shock Flashcards
What is the definition of shock?
Shock is a syndrome characterised by decreased tissue perfusion and impaired cellular response
What are the 4 classifications of shock?
hypovolaemic
cardiogenic
distributive
obstructive
Hypovolaemic shock is?
loss of fluid from circulation
what is distributive shock?
diminished venous return due to arteriole and capillary dilation
What is obstructive shock?
physical obstruction impeding flow
What happens if shock is not treated?
MODS - multipule organ dysfunction
MOFS - multipule organ failure
What are some causes of hypovolaemic shock?
Remembering that Hypovolaemic shock is loss of fluid not only blood
Haemorrhage
Dehydration
Plasma loss
What are some examples of haemorrhage?
ruptured organs
fractures
surgery
postpartum haemorrhage
What are some examples of dehydration?
vomiting diarrhoea NGT suctioning diuresis diaphoresis
What are some examples of plasma loss?
burns
ascites
peritonitis
oedema
How is the severity of hypovolaemic shock classified?
the percentage volume lost rate of volume lost persons age presence of other preexisting problems?
what are the clinical signs of hypovolaemic shock?
resp rate increase
HR increase
BP decrease
what are the 2 types of hypovolaemic shock?
relative and absolute
explain relative hypovolaemic shock?
Give an example
Fluid volume moves out of the vascular space into the extravascular space eg. third spacing or increased capillary permeability like in burns
explain absolute hypovolaemic shock?
Give an example
when fluid is lost through haemorrhage or gastrointestinal loss
(vomiting diarrhoea, fistula drainage, diabetes insipidus or diureses
explain the course of hypovolaemic shock
decreased circulatory volume - decrease venous return - decreased stroke volume - decreased cellular oxygen supply - decreased tissue perfusion
how do we diagnose hypovolaemic shock?
clinical picture/history
blood test
urine studies
chest x-ray
what is the emergency care for hypovolaemic shock?
ABC - airway breathing circulation assess for haemorrhage assess for manifestations of shock seek immediate medical help O2 and IV fluid ASAP Use of explanation and touch to reduce anxiety
what is treatment for hypovolaemic shock?
if there is bleeding apply direct pressure
oxygen supplementation
fluid resuscitation
drug therapy
what is required for fluid replacement therapy with hypovolaemic shock?
establish vascular access with at east 2 large
central line insertion
fluid resuscitation
what fluids do we use for hypovolaemic shock?
crystalloids - isotonic (normal saline, hartmans) Hypertonic (1.8, 3, 5% saline)
colloids - Albumin (5 or 25%)
blood products -packed red blood cells, fresh frozen plasma, platelets