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Surgery > Shock > Flashcards

Shock Flashcards

1
Q

What is the definition of shock

A

life threatening failure of delivery of oxygen to the tissues

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2
Q

what is the diagnostic triad of shock

A

raised lactate
low blood pressure
signs of reduced perfusion (altered mental state, reduced uring output, reduced cap refill)

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3
Q

what determines blood pressure

A

cardiac output x systemic vascular resistance

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4
Q

what determines cardiac output

A

stroke volume x beats per min

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5
Q

what makes up stroke volume

A

end diastolic volume - end systolic volume

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6
Q

what modulates end diastolic volume

A

preload and compliance

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7
Q

what modulates end systolic volume

A

contractility

afterload

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8
Q

what are the 4 main categories of shock

A

Distributive
Hypovolaemic
Cardiogenic
Obstructive

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9
Q

what is hypovolaemic shock

A

insufficient blood volume in intravascular compartment

decreased cardiac output

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10
Q

what are signs of hypovolaemic shock

A

Leads to hypotension, dehydration, altered mental state, cool peripheries, mottled skin and increased cap refill

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11
Q

why is it important to manually palpate the pulse in hypovolaemic shock

A

pulse may be irregular and the equipment will mismeasure it

also gives you more info on volume, rhythm and character

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12
Q

what are the subtypes of hypovolaemic shock

A

haemorrhagic
anaphylactic
septic

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13
Q

what are the classifications of haemorrhagic shock

A 
1 
<750ml lost 
<100 bpm 
RR 14-20 
>30ml/hr urine output  
Normal BP 
Slightly anxious  
2 
750-1500ml lost 
100-120 bpm  
Normal BP 
Decreased pulse pressure 
20-30RR 
20-30ml/hr urine output 
Mildly anxious  
3 
1500-2000ml lost  
30-40% lost  
120-140 BPM  
Decreased BP 
Decreased pulse pressure  
30-40 RR  
5-15ml/hr urine output 
Anxious/confused  
4 
>2000ml 
>40% 
>140 BPM 
Decreased pulse pressure 
Decreased blood pressure 
>35RR  
Negligible urine output 
Confused/lethargic
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14
Q

what is the treatment for anaphylactic shock (adults)

A 
Remove stimulus 
IM Adrenaline 0.5ml 1:1000 (500mcg) 
IV fluid bolus 500ml 
10mg IM/slow IV chloramphenamine
200mg IM/slow IV hydrocortisone

escalation

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15
Q

what is the treatment for septic shock

A

Sepsis 6 3 in, 3 out

3 in - fluid bolus, oxygen, broad spectrum Abx

3 out - catheter, 2 blood cultures, ABG (lactate)

escalation

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16
Q

what is distributive shock

A

widespread vasodilation due to toxins or loss of sympathetic tone

17
Q

what are the signs of distributive shock

A

general shock triad - raised lactate, low BP, signs of reduced perfusion

warm peripheries, flushed complexion

18
Q

what are the types of distributive shock

A

anaphylactic
septic
neurogenic

19
Q

what causes neurogenic shock

A

spinal cord injury above T61

20
Q

what is the treatment of neurogenic shock

A

fluids
vasopressors - adrenaline
inotropes - adrenaline, dopamine
chromotropes - corrects bradycardia, atropine/dopamine/adrenaline

21
Q

what is cardiogenic shock

A

failure of heart to pump

22
Q

what causes cardiogenic shock

A

MI
cardiomyopathy
arrythmias
neurogenic shock

23
Q

what are signs of cardiogenic shock

A

General shock triad - raised lactate, hypovolaemic, signs of reduced perfusion

Cool and clammy – peripheral vasoconstriction

Commonly overloaded with fluid

Commonly tachy or brady cardic

24
Q

what is obstructive shock

A

blockage of blood flow causing preload, afterload or compliance issues

25
Q

what are some causes of obstructive shock

A 
PE
mediastinal compression of vena cava
aortic dissection 
compression of heart
compression of heart
26
Q

what are the signs of obstructive shock

A

shock triad - lactate, signs of reduced perfusion, hypovolvaemia

peripheral shut down

may be normal fluid status

27
Q

if shock is prolonged, what happens to the heart, kidney, brain, lungs,GI, gut and immune tissue

A 
Heart - MI
Kidney - AKI
Brain - hypoxic brain injury 
Lungs - T1RF leading to ARDS
Gut - bowel ischaemia
immune - immune suppression
28
Q

how should you monitor someone in shock

A

A-E assessment – with regular reassessment

Standard observations  
RR 
SPO2 
HR 
BP 
Temp  
AVPU 
Hourly output monitoring

Urgent investigations
Blood gas
For lactate and acid base - (Repetition may be helpful)
Bloods

If not responding
Admit to HDU/ITU for advanced monitoring

29
Q

how do you manage cardiogenic shock

A

if reversible fix that (e.g. PCI for MI, cardiovert for arrythmia)

HR too high - cardioversion

HR too low - positive chronotropes (atropine, adrenaline)

contractility low - inotropes (positive inotropes increased contractility e.g. NA

avoid fluids

Surgery (7 decks)

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