What is the definition of shock?
Inadequate perfusion of the vital organs
What are the most common causes of shock?
- Cardiac pump failure
- Hypovolaemia
- Systemic vasodilation
- Anaphylaxis
- Obstruction
What is the most common clinical manifestation of shock?
Hypotension
If BP is unrecordable and shock is suspected, what should the immediate action be?
Call 2222 cardiac arrest team!!!
What causes of shock would be suspected with acidosis found on ABG?
Renal failure
Lactic acidosis
DKA
What are the big causes of cardiogenic shock?
- MI
- Aortic dissection
- Arrythmias
- Acute valvualr regurgitation
- Myocarditis
- Drug overdose
What are the big causes of hypovolaemic shock?
- Haemorrhage
- Fluid loss - V/D, polyuria, burns
- Ascites
- Adrenal failure
What are the big causes of systemic vasodilation shock?
- SEPSIS!!!!
- Liver failure
- Drug overdose
- Adrenal failure
What are the main causes of anaphylaxis?
- Food, especially in children
- Drug therapy
- Insect bite/sting
What are the big causes of obstruction causing shock?
- Cardiac tamponade
- Pulmonary embolus
- Tension pnemothorax
What kind of reaction is anaphylaxis?
IgE mediated hypersensitivty reaction
What is anaphylaxis characterised by?
- Sudden onset and rapid progression
2. Life-threatening airway +/- breathing +/- circulatory problems
Which drugs most commonly cause anaphylaxis?
- Antibiotics
- Opioids
- NSAIDs
- IV contrast
- Muscle relaxants and other anaesthetic agents
A patient presents with acute onset stridor, rash, and difficulty breathing. What is your top differential?
Anaphylaxis
What are the main differentials for anaphylaxis?
- Life-threatening asthma attack
- Septic shock
How should anaphylaxis be assessed initially?
Following ABCDE
How should anaphylaxis be managed initially?
- IM adrenaline
- High flow O2 (15L via non-rebreath mask)
- Fluid challenge
What dose of adrenaline is correct for anaphylaxis in adults?
500 micrograms IM of 1:1,000 adrenaline
Where should IM adrenaline be administered?
Anterolateral aspect of middle third of thigh
What dose of adrenaline is correct for anaphylaxis in children?
<6 years - 150 micrograms 1:1000 IM
6-12 years - 300 micrograms 1:1000 IM
12+ years - 500 micrograms unless small or prepubertal (300 micrograms)
Other than IM adrenaline, what other drugs are given for anaphylaxis, and when are they given?
- Chlorphenamine
- Hydrocortisone
After initial resus
What is the very least monitoring that a pt with anaphylaxis should be on?
- Pulse oximetry
- ECG
- BP
How long should a pt who has had anaphylaxis be monitored for?
6-12 hours from onset of symptoms.
What are the classic signs of a type 1 allergic reaction?
Urticaria, itching, angioedema, bronchospasm, and hypotension i.e. classic anaphylaxis. Usually onset is within 30 minutes.
