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Haematology > Shock > Flashcards

Shock Flashcards

1
Q

What is shock?

A

Tissue perfusion is inadequate for its metabolic needs. Decreased O2 delivery, increased O2 consumption or inadequate O2 utilization.

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2
Q

What does normal tissue perfusion rely on?

A

Cardiac Function
Capacity of vascular bed
Circulating blood volume

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3
Q

How do you test perfusion?

A

BP used as surrogate
Lactate
Urine output

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4
Q

What are the different forms of shock?

A 
Hypovolemic
Cardiogenic
Distributive
Obstructive 
Endocrine
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5
Q

What are some causes of hypovolemic shock?

A

Acute haemorrhage
Dehydration
Burns

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6
Q

What physiological changes does hypovolemic shock cause?

A

Volume depletion reduces SVR

Volume depletion reduces preload (amount heart is stretched) thus reducing CO.

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7
Q

What are some symptoms of hypovolemic shock?

A 
Pallor
Tachycardia
Tachypnoea
Hypotension
Confusion
Altered consciousness
Thirst
Decreased urine output
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8
Q

WHat are some causes of cardiogenic shock?

A

Ischemia
Cardiomyopathy
Valve problems
Dysarrhythmias

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9
Q

What are some causes of distributive shock?

A

Septic
Anaphylaxis
Acute liver failure
SC injury

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10
Q

Describe distributive shock

A

‘Hot shock’- profound vasodilation and lack of regulation. Poor perfusion despite increased CO.
Has regional perfusion differences.

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11
Q

Give some causes of obstructive shock

A

Pulmonary embolism
Air embolism
Tension pneumothorax
Cardiac tamponad

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12
Q

Describe obstructive shock

A

Mechanical obstruction to flow.

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13
Q

Give some causes of endocrine shock

A

Uncorrected hypothyroidism
Addisonian crisis
Thyrotoxicosis

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14
Q

Describe the neuroendocrine response to shock

A 
Pituitary
-Adrenocorticotrophic Hormone
-ADH
Cortisol
-Fluid retention
-Antagonises insulin
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15
Q

What causes cellular ischemia in shock?

A

Inflammation

Vasoconstriction and oedema

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16
Q

How does vasoconstriction and oedema cause cellular ischemia?

A

Direct cytotoxic damage

Worsens ischemia

17
Q

How does inflammation cause cellular ischemia

A 
Cytokine release 
Platelet activating factor 
Lysosomal enzymes 
Adhesion molecules 
Endothelium derived mediators 
Imbalance between antioxidents and oxidents
18
Q

What can lead to haemodynamic changes in shock?

A

Vascular abnormalities

Microcirculatory abnormalities

19
Q

How can you monitor shock?

A 
Exam: Pale, Cold, Prolonged cap refil
Urine output- Kidney function
Neurological- Cerebral Hypotension
Biochemical- Acidosis, Lactate
Blood pressure
Cardiac Output- Thermodilution with a PA catheter
20
Q

What should you aim for in treating shock?

A

Re-establish sufficient perfusion

21
Q

How should you treat shck?

A

ABCDE
Wide bore IV access
Treat underlying cause
Pharmacology- In severe cases/when fluid doesn’t work
Mechanical- Balloon pump (for cardiogenic)

22
Q

What fluids can be given in shock?

A

Crystalloids
Colloids
Blood

23
Q

What is the aim of giving fluids in shock?

A

Increase preload

24
Q

How should fluid be given in shock?

A

Rapid fluid replacement- but don’t overload (more susceptible to pulmonary oedema). 300-500ml over 10-20 minutes.

25
Q

What are some good and bad points of crystalloids?

A

Good: convenient, cheap, safe.
Bad: Need large volumes.

26
Q

What are some good and bad points of colloids?

A

Good: Cheapish, reduces volumes required
Bad: Can cause anaphylaxis

27
Q

What are some good and bad points of blood transfusion?

A

Good: Oxygen carrying capacity, stays in circulation
Bad: Scarce and many risks.

28
Q

What drugs can be given in shock?

A 
Noradrenaline- alpha agonist
Adrenaline- Mainly beta agonist
Vasopressin/ADH
Dopamine- Natural precursor of ADH
Dobutamine/Dopexamine
29
Q

How should shock management be de-escalated?

A

Remove extra fluids once shock over- diuretics, dialysis

Haematology (12 decks)

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