Shock Flashcards
What is the average adult blood volume?
5 litres
What are the features of class I haemorrhagic shock? Including: i. Blood loss ii. Blood loss % iii. HR iv. BP v. RR vi. UO vii. Sx
i. <750ml
ii. <15%
iii. <100
iv. no change
v. 14-20
vi. >30ml
vii. Normal
What are the features of class II haemorrhagic shock? Including: i. Blood loss ii. Blood loss % iii. HR iv. BP v. RR vi. UO vii. Sx
i. Blood loss - 750-1500ml
ii. Blood loss % - 15-30
iii. HR - >100
iv. BP - same
v. RR - 20-30
vi. UO - 20-30ml
vii. Sx - Anxious
What are the features of class III haemorrhagic shock? Including: i. Blood loss ii. Blood loss % iii. HR iv. BP v. RR vi. UO vii. Sx
i. Blood loss - 1500-2000ml
ii. Blood loss % - 30-40
iii. HR - >120
iv. BP - reduced
v. RR - 30-40
vi. UO - 5-15ml
vii. Sx - Confused
What are the features of class IV haemorrhagic shock? Including: i. Blood loss ii. Blood loss % iii. HR iv. BP v. RR vi. UO vii. Sx
i. Blood loss - >2000ml
ii. Blood loss % - >40
iii. HR - >140
iv. BP - reduced
v. RR - >35
vi. UO <5ml
vii. Sx - Lethargic
What arterial pressure is required for a palpable femoral pulse
65
What is the management of haemorrhagic shock
Fluid replacement w blood
Correct electrolyte abnormalities
What is anaphylactic shock
Type I IgE mediated hypersensitivity reaction
What is the presentation of anaphylactic shock?
itch sweaty D+V Erythema Urticaria Oedema Wheeze Cyanosis Raised hr Low BP
What is the management of anaphylactic shock
- ABCDE
- Call for help, lie pt flat and raise pts legs
- Adrenaline IM
- Establish airway, high flow O2, IV fluids, chlorphenamine, hydrocortisone
Explain the doses of drugs used in adults, children and <6 yrs and how they are given in anaphylactic shock
Adrenaline: 1:1000, repeat after 5 mins if not improved adult: 500μg (0.5ml) Child: 300μg <6yrs: 150μg
Chlorphenamine:
Adult (>12yrs): 10mg
6-12 yrs: 5mg
<6yrs 2-5mg
Hydrocortisone:
Adult (<12yrs): 200mg
6-12yrs: 100mg
<6yrs 50mg
What IV fluids are given in anaphylactic shock
500-1000ml
CHild: crystalloid 20ml/kg
What is a common cause of neurogenic shock?
spinal cord transection (damage)
How does neurogenic shock happen?
- Interruption of the autonomic NS leads to reduced sympathetic tone or increased parasympathetic tone
- Leads to reduced peripheral vascular resistance mediated by marked vasodilation
- Reduced preload + reduced CO (starlings law)
- Reduced tissue perfusion = SHOCK
What is the treatment of neurogenic shock ?
peripheral vasoconstrictors to return vascular tone to normal
What is SIRS
Systemic inflammatory response syndrome
involves cytokine cascades, free radical production and release of vasoactive mediators
What are the criteria for SIRS
Temp: >38 or 36
HR > 90
RR >20 or PaCO2 <32
WBC >12000 or <4000
What is sepsis
SIRS + source of infection
What is septic shock
severe sepsis w hypotension despite adequate fluid resuscitation
What is the management of sepsis
- Blood cultures
- Urine outpute
- Fluids
- Abx
- Lactate
- Oxygen (94% or more)
What is cardiogenic shock
inadequate tissue perfusion primarily due to cardiac dysfunction, can occur suddenly or after progressively worsening HF
What are causes of cardiogenic shock?
tension pneumothorax MI valve destruction cardiac tamponade aortic dissection PE Myocarditis Arrhythmias
What is the treatment of cariogenic shock caused by MI
prompt revascularisation via:
- thrombolysis
- acute angioplasty balloon or PCI (stents)
Go over the algorithm of cardiogenic shock
ok lol
