Shock Flashcards
what is the frank starling law of the heart?
SV increases in response to inc volume of blood in the ventricles
bleeding from everywhere….
DIC
normal MABP
70-100mmHg
how to calculate MABP
1/3 systolic + 2/3 diastolic
metabolic signs of shock?
acidosis
high lactate
urine output of what should make you think shock?
<0.5ml/kg/h
skin appearance of shock?
mottled
clammy
lactate >_ of normal is a sign of shock
1
normal lactate?
0.5-1
why do you get cool, clammy peripheries in cardiogenic shock?
SVR increases to get blood back to the heart so less in the peripheries
cause of cardiogenic shock
arrhythmia poisoning MI cardiomyopathy valve failure
what would you expect to be raised in obstructive shock and why?
JVP
obstructed cardiac outflow causes back up into the RHS circulation
causes of obstructive shock
cardiac tamponade
tension pneumo
PE
causes of cardiac tamponade
aortic dissection
trauma
Tx PE
anticoagulation
thrombolysis
end diastolic volume measures…
the filling of the ventricles
why does RR go up in shock
trying to get rid of acidosis by blowing off CO2
describe the peripheries in distributive shock? why?
warm, red peripheries
vessels are abnormally vasodilated
non GI causes of dehydration?
epithelial loss by burns
renal/cellular loss eg DKA, addisonian crisis
causes of distrubutive shock
inflammatory eg sepsis/SIRS from pancreatitis/anaphylaxis
Tx distrubutive shock
antibiotics
vasopressors eg adrenaline
supportive
Tx neurogenic shock
neurosurgery
vasopressors
alpha stimulation causes…
vasoconstriction
beta stimulation causes…
inotropic stimulation
why do you get SoB in a type 1 hypersensitivity reaction?
constriction of bronchial SM by histamine causes wheeze
what does histamine do to the heart?
increases contractility and inotropic effects by Ca influx
4 pharmacological steps for a patient with an allergic transfusion reaction?
- adrenaline IV
- chlorampherimine
- salbutamol
- IV steroids
what does chloramphenamine do?
blocks histamine and stops it exerting effects
why are corticosteroids useful in anaphylaxis?
block leukotrienes
ABO incompatibility is a type _ hypersensitivity reaction?
2
what causes haematuria in ABO incompatibility
patient IgM binds to antibodies on the donor red cells
complement activate
membrane attack complex triggered
red cell lysis by intravascular haemolysis
cytokine release causes an inc/dec in temp
inc
what kind of jaundice is caused by intravascular haemolysis
prehepatic
there is an increase in ____ pressure in fluid overload
hydrostatic
what blood treatment commonly causes transfusion associated lung injury?
plasma rich products eg FFP and platelets
