Shock

Question 1

What is the definition of shock?

Answer 1

Inadequate perfusion of the vital organs

Question 2

What are the most common causes of shock?

Answer 2

1. Cardiac pump failure
2. Hypovolaemia
3. Systemic vasodilation
4. Anaphylaxis
5. Obstruction

Question 3

What is the most common clinical manifestation of shock?

Answer 3

Hypotension

Question 4

If BP is unrecordable and shock is suspected, what should the immediate action be?

Answer 4

Call 2222 cardiac arrest team!!!

Question 5

What causes of shock would be suspected with acidosis found on ABG?

Answer 5

Renal failure
Lactic acidosis
DKA

Question 6

What are the big causes of cardiogenic shock?

Answer 6

1. MI
2. Aortic dissection
3. Arrythmias
4. Acute valvualr regurgitation
5. Myocarditis
6. Drug overdose

Question 7

What are the big causes of hypovolaemic shock?

Answer 7

1. Haemorrhage
2. Fluid loss - V/D, polyuria, burns
3. Ascites
4. Adrenal failure

Question 8

What are the big causes of systemic vasodilation shock?

Answer 8

1. SEPSIS!!!!
2. Liver failure
3. Drug overdose
4. Adrenal failure

Question 9

What are the main causes of anaphylaxis?

Answer 9

• Food, especially in children
• Drug therapy
• Insect bite/sting

Question 10

What are the big causes of obstruction causing shock?

Answer 10

1. Cardiac tamponade
2. Pulmonary embolus
3. Tension pnemothorax

Question 11

What kind of reaction is anaphylaxis?

Answer 11

IgE mediated hypersensitivty reaction

Question 12

What is anaphylaxis characterised by?

Answer 12

1. Sudden onset and rapid progression

2. Life-threatening airway +/- breathing +/- circulatory problems

Question 13

Which drugs most commonly cause anaphylaxis?

Answer 13

• Antibiotics
• Opioids
• NSAIDs
• IV contrast
• Muscle relaxants and other anaesthetic agents

Question 14

A patient presents with acute onset stridor, rash, and difficulty breathing. What is your top differential?

Answer 14

Anaphylaxis

Question 15

What are the main differentials for anaphylaxis?

Answer 15

• Life-threatening asthma attack

- Septic shock

Question 16

How should anaphylaxis be assessed initially?

Answer 16

Following ABCDE

Question 17

How should anaphylaxis be managed initially?

Answer 17

• IM adrenaline
• High flow O2 (15L via non-rebreath mask)
• Fluid challenge

Question 18

What dose of adrenaline is correct for anaphylaxis in adults?

Answer 18

500 micrograms IM of 1:1,000 adrenaline

Question 19

Where should IM adrenaline be administered?

Answer 19

Anterolateral aspect of middle third of thigh

Question 20

What dose of adrenaline is correct for anaphylaxis in children?

Answer 20

<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)

Question 21

Other than IM adrenaline, what other drugs are given for anaphylaxis, and when are they given?

Answer 21

• Chlorphenamine
• Hydrocortisone

After initial resus

Question 22

What is the very least monitoring that a pt with anaphylaxis should be on?

Answer 22

1. Pulse oximetry
2. ECG
3. BP

Question 23

How long should a pt who has had anaphylaxis be monitored for?

Answer 23

6-12 hours from onset of symptoms.

Question 24

What are the classic signs of a type 1 allergic reaction?

Answer 24

Urticaria, itching, angioedema, bronchospasm, and hypotension i.e. classic anaphylaxis. Usually onset is within 30 minutes.

Question 25

Can IV adrenaline ever be given in anaphylaxis?

Answer 25

Yes, but only by an experienced physician and with close cardiac monitoring (e.g. in critical care)

Question 26

What is the median time to cardiac arrest in a severe/fatal anaphylactic reaction?

Answer 26

5 minutes

Question 27

What is the dose of chlorphenamine given in anaphylaxis?

Answer 27

10mg in adult and child over age 12

Question 28

How is chlorphenamine given in anaphylaxis?

Answer 28

IM or slow IV infusion

Question 29

What is the dose of hydrocortisonegiven in anaphylaxis?

Answer 29

200mg in adult or child over 12 years