Shock

Question 1

Describe anaphylactic shock?

Answer 1

• Inappropriate vasodilation triggered by an allergen
• Often associated with endothelial disruption and capillary leak

Question 2

Describe Cardiogenic shock?

Answer 2

Hypoperfusion due to inadequate cardiac output

Question 3

Important causes of cardiogenic shock?

Answer 3

• Myocardial infarction
• Pulmonary embolism
• Valvular pathology, aortic dissection, cardiac tamponade

Question 4

Describe the acute management of cardiogenic shock?

Answer 4

• Maintain MAP > 70 mmHg
• Supportive treatments:
  
  • Inotropes
  • Vasopressors
• May require mechanical support
  
  • Intra-aortic balloon pump

Question 5

Describe hypovolaemic shock?

Answer 5

• Haemorrhagic
• Non-haemorrhagic
  
  • HHS
  • Burns

Question 6

Describe Obstructive shock?

Answer 6

• Obstruction to blood flow through the circulation
  
  • Massive PE
  • Cardiac tamponade
  • Tension pneumothorax

Question 7

Describe Neurogenic shock?

Answer 7

• From major CNS injury
  
  • Disrupted brainstem and neurogenic vasomotor control
• eg
  
  • High cervical cord trauma
  • Guillain-Barre syndrome

Question 8

How can high cervical cord injury cause neurogenic shock?

Answer 8

• Disruption of the sympathetic outflow tracts
  
  • => bradycardia + hypotension

Question 9

Howcan Guillain-Barre syndrome cause neurogenic shock?

Answer 9

• Involvement of the autonomic system
  
  • => severe hypo/hypertension

Question 10

What is Septic shock?

Answer 10

• Sepsis with underlying circulatory or metabolic abnormalities
• Sepsis + both of (after fluid resuscitation):
  
  • Hypotension requiring vasopressors to maintain MAP > 65 mmHg
  • Serum lactate > 2 mmol/L