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Big Surgery > Shock > Flashcards

Shock Flashcards

1
Q

What is the definition of shock?

A

Inadequate peripheral tissue perfusion which leads to decreased oxygen and nutrient provision for tissue cells

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2
Q

What are the 4 stages of shock?

A
  1. Initial
  2. Compensatory
  3. Progressive
  4. Refractory
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3
Q

What is the initial state?

A
  1. Hypoxia which leads to decreased ATP produced by the mitiochondria
    - this damages the cell membranes and they start to leak into the extra-cellular fluid
    - anaerobic respiration occurs and pyruvic acid and oflactic is produced
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4
Q

What is the compensatory state?

A
  • neural, hormonal, biochemical mechanisms occur to reverse the initial stage
  • hyperventilation occurs to get rid of the carbon dioxide to corrector the pH
  • cushings reflex (increased blood pressure) because increase in adrenaline(increases heart rate) and noradrenaline(causing vasoconstriction)
  • the renin-angiotensin axis which conserves fluid
  • this is all to divert fluid to the heart, brain and lungs
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5
Q

What is the progressive state?

A
  • compensatory mechanisms fail
  • anaerobic metabolism continues and there is potassium effluent and and sodium influx
  • metabolic acidosis leads to blood pooling in the capillaries
  • the increase of hydrostatic pressure and histamine release leads to leakage of fluid and protein into the surrounding area
  • prolonged vasoconstriction leads to vital organ compromise
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6
Q

What is the refractory state?

A
  1. Vital organs fail and shock cannot be reversed
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7
Q

What are the 6 types of shock?

A
  1. Hypovolaemic
  2. Cardiogenic
  3. Neurogenic
  4. Obstructive
  5. Septic
  6. Anaphylactic
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8
Q

What is hypovolaemic shock?

A
  • Decreased volume circulating through the blood

- causes include haemorrhage, ruptured ectopic pregnancy, burns, acute pancreatitis

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9
Q

What is cardiogenic shock?

A
  • inability of the heart to pump effectively

- associated with myocardial infarction, cardiomyopathy, arrythmias

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10
Q

What is neurogenic shock?

A

-trauma to spinal cord leading to loss of motor and autonomic reflexes

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11
Q

What is obstructive shock?

A

The flow of blood is stopped so this impedes circulation

  • cardiac tamponade
  • tension pneumothorax
  • pulmonary embolism
  • aortic stenosis
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12
Q

What is septic shock?

A

Severe sepsis and hypotension that cannot be reversed with fluids

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13
Q

What is the criteria for septic shock?

A
  1. Systolic BP of less than 90 mmHg or mean arterial BP of less than 60 mmHg
  2. Tachypnoea>20 breaths per minute
  3. WCC of less than 4000 cells or more than 12000 cells
  4. HR>90 beats per minute
  5. Temp: >38 degrees and <36 degrees
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14
Q

What does the pneumonic OVERS mean?

A
  1. Oxygen administration and airway
  2. Volume resus: crystalloids and colloids
  3. Early antibiotic administration
  4. Rapid source identification and control
  5. support major organ dysfunction
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15
Q

When should we start AB treatment if the patient is in septic shock?

A

At least an hour into the sepsis

  • broad spectrum
  • do blood culture before you administer AB
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16
Q

What is the management for Hypovolaemic shock?

A
  1. Full blood count-Haematocrit
  2. U&E
  3. Creatinine
  4. Troponin T(cardiac enzymes)
  5. Arterial blood gas(metabolic acidosis)
  6. CVP line to check fluid resus
  7. Give fluid-1L crystalloid over 1 hour
17
Q

What is the management for cardiogenic shock?

A
  1. ECG

2. Troponin T

18
Q

What is the Mx for obstructive shock?

A
  1. Tension pneumothorax-insert 14G cannula in the 2nd intercostal space midclavicular line
  2. Cardiac tamponade: 500ml normal saline IVI, IV dopamine infusion 5mcg/kg/min, pericardiocentesis
  3. Pulmonary embolism: FBC,U&E,ECG,ABG, Pain relief, fluid resus and inotropic support, IV 5000U of heparin bolus, gold standard=pulmonary angiogram
19
Q

What is cardiac tamponade/pericarditis?

A

Fluid or effusion surrounding the heart presenting with

  • muffled heart sounds
  • jugular venous distension
  • diffuse ST elevation
  • hypotension
20
Q

What is the management of neurogenic shock?

A
  1. Manage the site of trauma
  2. Do neuro exam
  3. Do C-spine X-ray up to C7/T1 for swimmers view/open mouth view if C1/2 injury
  4. Thoracivc and lumbar spine X-ray
  5. CT scan
  6. MRI scan later
  7. Fluid resus and compare and titrations according to urine output
  8. Use vasopressors if the fluid resus is not working
  9. Refer to neuro/ortho
21
Q

What is the management of anaphylactic shock?

A
  1. Stop the allergen
  2. Gastric lavage and activated charcoal if drug was ingested
  3. Obtain airway by intubation
  4. Give fluids-hartmans solution of normal saline 2L
  5. Give adrenaline
  6. Give glucagon if adrenaline has failed or if adrenaline is contra-indicated-IHD, pregnancy, severe HPT
    IV/IM 0,5-1mg
  7. Give an anti-histamine- Promethazinee 25mg IM/IV
  8. Cimetidine 200/400mg IV bolus if above does not work
  9. Salbutamol
  10. Hydrocortisone (corticosteroid) 200-300 mg IV bolus
22
Q

What is the management of septic shock?

A
  1. Identify site of infection
  2. FBC, U&E,Creatinine,ABG,ECG,CXR, Urine C/S
  3. Rapid infusion 1-2L crystalloids and CVP line insertion
  4. Give antibiotics- 3rd generation cephalosporin- 1g IV ceftriaxone or quinolone (ciprofloxacin 200 mg)
23
Q

What is a CVP line?

A
  • can be placed at 3 different points: jugular, subclavian and femoral
  • can be used to give fluids, medication, chemotherapy and for longer operations
24
Q

Give an example of an aminoglycoside

A

-gentamycin

25
Q

Give an example of a quinolone

A

-ciprofloxacin

26
Q

Define angioedema?

A
  • edema of the deeper layers of the skin
  • usually non-pruritic
  • can be/without numbness and pain
27
Q

What is urticaria?

A

-oedematous and pruritic plaques with raised edges and a pale center

Big Surgery (21 decks)

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