Shock Flashcards
What is shock?
Shock is inadequate organ perfusion leading to inadequate oxygen delivery to tissues and eventually organ failure
What are the main types of shock?
Hypovolaemic Cardiogenic Neurogenic Septic Anaphylactic
What term is used as an umbrella term for septic, anaphylactic and neurogenic shock?
Distributive shock (i.e. there is fluid but not in the right place)
What is the main cause of hypoovolaemic shock?
Blood loss
Give some causes of cardiogenic shock
Acute MI Pulmonary embolism Cardiac tamponade Valvular heart problems Heart failure
What is the main cause of septic shock?
Gram +ve bacterial infection
What causes an anaphylactic shock?
Body reacts to allergen
Give the two main causes of neurogenic shock
Spinal cord injury
Spinal anaesthesia
What happens to cardiac output, blood pressure, heart rate and temperature in hypovolaemic shock?
CO = decreased BP = maintained initially then falls in late stage HR = increased Temperature = normal
What happens to cardiac output, blood pressure, heart rate and temperature in cardiogenic shock?
CO = decreased BP = increased HR = increased Temperature = normal
What happens to cardiac output, blood pressure, heart rate and temperature in septic shock?
CO = increased (initially) BP = decreased HR = increased Temperature = increased
What happens to cardiac output, blood pressure, heart rate and temperature in anaphylactic shock?
CO = decreased BP = decreased (profoundly) HR = increased Temperature = normal
What happens to cardiac output, blood pressure, heart rate and temperature in neurogenic shock?
CO = decreased BP = decreased HR = decreased Temperature = dysregulated
What skin change occurs in hypovolaemic shock?
Skin becomes cool and pale
What skin change occurs in cardiogenic shock?
Swollen and oedematous
What skin change occurs in septic shock?
Skin becomes flushed and warm then cool and pale
What is the main skin change in anaphylactic shock?
Urticaria
What happens to the skin in neurogenic shock?
Becomes vasodilated below the lesion
Anaphylactic shock results from what?
Mast cell degranulation releasing vasoactive mediators such as histamine
What occurs in neurogenic shock?
There is loss of sympathetic outflow in the thoracic spine causing a lack of feedback
How should hypovolaemic shock be treated?
Fluid and blood replacement
How should cardiogenic shock be treated?
Fluid management
Inotropes (dobutamine etc.)
Vasopressors (noradrenaline)
How should septic shock be treated?
Start sepsis 6 bundle
Vasopressors if fluid unresponsive
What is the first line treatment for anaphylactic shock?
Adrenaline
What is the first line treatment for neurogenic shock?
Vasopressors
What are the two main theories for CPR?
Physically pumps the heart
Increases intrathoracic pressure causing a pressure gradient that causes blood flow
What are the reversible causes of cardiac arrest?
4Hs - hypothermia; hyperkalaemia (also hypokalaemia/natraemia/calcaemia); hypoxia and hypovolaemia
4Ts - trauma; tamponade; tension pneumothorax; thromboembolism
What are the main rhythms appropriate for immediate defibrillation?
Pulseless ventricular tachycardia
Ventricular fibrillation
