Shock

Question 1

What is the average adult blood volume?

Answer 1

5 litres

Question 2

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

Answer 2

i. <750ml
ii. <15%
iii. <100
iv. no change
v. 14-20
vi. >30ml
vii. Normal

Question 3

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

Answer 3

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

Question 4

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

Answer 4

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

Question 5

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

Answer 5

i. Blood loss - >2000ml
ii. Blood loss % - >40
iii. HR - >140
iv. BP - reduced
v. RR - >35
vi. UO <5ml
vii. Sx - Lethargic

Question 6

What arterial pressure is required for a palpable femoral pulse

Answer 6

65

Question 7

What is the management of haemorrhagic shock

Answer 7

Fluid replacement w blood

Correct electrolyte abnormalities

Question 8

What is anaphylactic shock

Answer 8

Type I IgE mediated hypersensitivity reaction

Question 9

What is the presentation of anaphylactic shock?

Answer 9

itch
sweaty 
D+V
Erythema 
Urticaria
Oedema
Wheeze
Cyanosis
Raised hr
Low BP

Question 10

What is the management of anaphylactic shock

Answer 10

1. ABCDE
2. Call for help, lie pt flat and raise pts legs
3. Adrenaline IM
4. Establish airway, high flow O2, IV fluids, chlorphenamine, hydrocortisone

Question 11

Explain the doses of drugs used in adults, children and <6 yrs and how they are given in anaphylactic shock

Answer 11

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

Question 12

What IV fluids are given in anaphylactic shock

Answer 12

500-1000ml

CHild: crystalloid 20ml/kg

Question 13

What is a common cause of neurogenic shock?

Answer 13

spinal cord transection (damage)

Question 14

How does neurogenic shock happen?

Answer 14

1. Interruption of the autonomic NS leads to reduced sympathetic tone or increased parasympathetic tone
2. Leads to reduced peripheral vascular resistance mediated by marked vasodilation
3. Reduced preload + reduced CO (starlings law)
4. Reduced tissue perfusion = SHOCK

Question 15

What is the treatment of neurogenic shock ?

Answer 15

peripheral vasoconstrictors to return vascular tone to normal

Question 16

What is SIRS

Answer 16

Systemic inflammatory response syndrome

involves cytokine cascades, free radical production and release of vasoactive mediators

Question 17

What are the criteria for SIRS

Answer 17

Temp: >38 or 36
HR > 90
RR >20 or PaCO2 <32
WBC >12000 or <4000

Question 18

What is sepsis

Answer 18

SIRS + source of infection

Question 19

What is septic shock

Answer 19

severe sepsis w hypotension despite adequate fluid resuscitation

Question 20

What is the management of sepsis

Answer 20

1. Blood cultures
2. Urine outpute
3. Fluids
4. Abx
5. Lactate
6. Oxygen (94% or more)

Question 21

What is cardiogenic shock

Answer 21

inadequate tissue perfusion primarily due to cardiac dysfunction, can occur suddenly or after progressively worsening HF

Question 22

What are causes of cardiogenic shock?

Answer 22

tension pneumothorax
MI
valve destruction 
cardiac tamponade 
aortic dissection
PE
Myocarditis
Arrhythmias

Question 23

What is the treatment of cariogenic shock caused by MI

Answer 23

prompt revascularisation via:

1. thrombolysis
2. acute angioplasty balloon or PCI (stents)

Question 24

Go over the algorithm of cardiogenic shock

Answer 24

ok lol