Shock Flashcards
What are the signs of hypoperfusion?
Mottled skin Urine output <0.5ml/kg/hr Serum lactate >2mmol/L Reduced GCS Pallor Cool peripheries Tachycardia Slow cap refill Tachypnoea Oliguria
Give some causes for hypovolaemia
Bleeding - trauma, ruptured AAA, GI bleed
Fluid loss:
- vomiting
- burns
- third space losses - pancreatitis, heat exhaustion
Give some causes for cariogenic shock
ACS
Arrhythmia
Aortic dissection
Acute valve failure
Give some secondary causes for pump failure
PE
Tension pneumothorax
Cardiac tamponade
What can cause a reduction in systemic vascular resistance and lead to shock?
Sepsis
Anaphylaxis
Neurogenic - spinal cord injury, epidural or spinal anaesthesia
Endocrine failure - Addison’s disease, hypothyroidism
Other - drugs - anaesthetics, antihypertensives, cyanide poisoning
What is key in the assessment of a patient in shock?
2 large bore cannulas ECG - rate and rhythm Signs of ischaemia Check JVP - if raised, likely cariogenic shock Check abdomen - trauma, AAA, GI bleed
How are hypovolaemic shock’s treated?
Treat underlying cause
Raise legs
10-15ml/kg crystalloid bolus - if no improvement after 2 boluses then consider ITU
How is haemorrhagic shock managed?
Stop bleeding ASAP
If still shocked after 2L crystalloid or if Class III/IV shock, crossmatch blood:
- FFP with red cells (1:1 ratio)
- aim for platelets >100 and fibrinogen >1 - give platelets and cryoprecipitate
- Tranexamic acid 2g IV
How is shock due to heat exposure managed?
Tepid sponging and fanning
Avoid ice and immersion
Rhesus with IVI - 0.9% saline ± 100mg IV hydrocortisone
Lorazepam 1-2mg IV or chlorpromazine 25mg IM/IV for shivering
Stop cooling when core temp <39 degrees
What is used to categorise haemorrhagic shock into classes?
Blood loss Heart rate Systolic BP Pulse pressure Cap refill Resp rate Urine output Cerebral function
What constitutes a class I haemorrhagic shock?
<750ml or <15% blood loss
Normal HR, systolic BP, pulse pressure, cap refill, reps rate, urine output and cerebral function
What constitutes a class II haemorrhagic shock?
750ml - 1500ml or 15-30% blood loss HR >100bpm Normal Systolic BP Narrow pulse pressure >2s cap refill 20-30 breaths per min 20-30ml/hr Urine output Anxious/hostile
What constitutes a class III haemorrhagic shock?
1500-2000ml or 30-40% blood loss HR 120-140 Low systolic BP Narrow pulse pressure Cap refill >2s >30 breaths per min 5-20 ml/hr urine output Anxious/confused
What constitutes a class IV haemorrhagic shock?
>2L or 40% blood loss HR >140 Unrecordable systolic BP V narrow/absent pulse pressure Absent cap refill >35 breaths per min Negligible urine output Confused/unresponsive
How do you manage anaphylactic shock?
Adrenaline 0.5mg (0.5ml 1:1000) - can repeat every 5 mins
Chlorphenamine - 10mg IV
Hydrocortisone - 200mg IV
Can give IV fluid boluses as req.
