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2nd year > Shock > Flashcards

Shock Flashcards

1
Q

what are the different types of shock?

A

distributive
obstructive
hypovolaemic
cardiogenic

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2
Q

what is shock?

A

life-threatening disorder of circulatory system

resulting in inadequate organ perfusion and tissue hypoxia, causing metabolic disturbances and irreversible organ damage

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3
Q

shock index - calculation

A

pulse rate/systolic BP

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4
Q

normal shock index

A

0.4-0.7

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5
Q

shock index when shock is present

A

> 1

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6
Q

causes of hypovolaemic shock

A

haemorrhage

non-haemorrhagic fluid loss

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7
Q

haemorrhage causes

A

postpartum
upper GI bleed
blunt/penetrating trauma

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8
Q

non-haemorrhagic fluid loss

A 
diarrhoea 
vomiting
increased insensible fluid loss - burns 
third space fluid loss
renal fluid loss
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9
Q

clinical features of hypovolaemic shock

A 
hypotension
tachycardia 
weak pulse 
cold, clammy, pale extremities 
slow capillary refill
decrease preload
decreased cardiac output 
increased afterload
increased total peripheral resistance
increased systemic vascular resistance
decreased mixed venous oxygen saturation
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10
Q

treatment of hypovolaemic shock

A

fluid resuscitation
management of haemorrhage
possibly blood transfusion

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11
Q

causes of cardiogenic shock

A 
arrhythmias
MI
valve defects 
heart failure 
cardiomyopathy
myocarditis 
drugs 
blunt cardiac trauma
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12
Q

clinical features of cardiogenic shock

A 
hypotension 
tachycardia
weak pulse 
cold, clammy, pale extremities 
slow capillary refill
increased/decreased preload
decreased cardiac output 
increased afterload
increased total peripheral resistance
increased systemic vascular resistance
decreased mixed venous oxygen saturation
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13
Q

treatment for cardiogenic shock

A

diuretics

inotropic therapy

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14
Q

causes of obstructive shock

A 
cardiac tamponade
PE
tension pneumothorax 
constrictive pericarditis 
restrictive cardiomyopathy
large systemic emboli
aortic dissection
aortic stenosis
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15
Q

clinical features of obstructive shock

A 
hypotension
tachycardia
weak pulse
cold, clammy, pale  extremities 
slow capillary refill
increased/decreased preload
decreased cardiac output 
increased afterload/total peripheral resistance
increased SVR
decreased mixed venous oxygen saturation
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16
Q

treatment for obstructive shock

A

decompression

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17
Q

what are the types of distributive shock?

A

septic
anaphylactic
neurogenic

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18
Q

causes of septic shock

A

infection

bacteraemia

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19
Q

clinical features of septic shock

A 
flushed
dry, warm skin
tachycardia 
hypotension
fever 
decreased preload
increased cardiac output 
decreased afterload/total peripheral resistance 
decreased systemic vascular resistance 
increased mixed venous oxygen saturation
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20
Q

treatment of sepsis

A

fluid resuscitation
vasopressors
broad-spectrum empirical antibiotic therapy

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21
Q

causes of anaphylactic shock

A

drug reactions
insect stings/bites
food allergies

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22
Q

clinical features of anaphylaxis

A 
flushed
dry, warm skin 
tachycardia
hypotension 
itchy skin 
hives
bronchospasm
laryngeal oedema
swelling of tongue 
uvula 
angioedema 
decreased preload 
increased cardiac output 
decreased afterload/total peripheral resistance
decreased systemic vascular resistance 
increased mixed venous oxygen saturation
23
Q

treatment for anaphylaxis

A 
fluid resuscitation 
vasopressors
adrenaline 
antihistamines
glucocorticoids
24
Q

causes of neurogenic shock

A

spinal cord injury
traumatic brain injury
cerebral haemorrhage

25
Q

clinical features of neurogenic shock

A 
flushed
dry, warm skin 
bradycardia
hypotension 
neurological deficits
decreased preload
decreased cardiac output 
decreased afterload/ total peripheral resistance
decreased systemic vascular resistance
decreased mixed venous oxygen saturation
26
Q

treatment for neurogenic shock

A

fluid resuscitation
vasopressors
atropine for bradycardia

27
Q

diagnosis of shock

A 
assess HR, BP and oxygen sats 
measure CVP - central venous catheter 
catheterise bladder to monitor urine output 
renal function tests 
ABG
clotting parameters 
LFTs 
electrolytes
28
Q

Renal function tests for shock

A

blood urea nitrogen is raised

creatinine

29
Q

shock electrolytes

A

sodium
potassium
calcium

30
Q

shock ABG

A

lactic acidosis

31
Q

shock LFTs

A

hyperbilirubinaemia

increased AST/ALT

32
Q

what is the end stage of shock?

A

DIC

disseminated intravascular coagulation

33
Q

what are the stages of shock?

A

preshock
shock
end organ dysfunction

34
Q

pre shock

A

non progressive phase

activation of compensatory neurohumoral reflexes to maintain vital organ perfusion

35
Q

clinical features of pre-shock

A

peripheral vasoconstriction
cold, clammy extremities
increased capillary refill time
decreased capillary hydrostatic pressure - increased absorption of interstitial fluids into intravascular space to maintain BP
tachycardia - absent in neurogenic shock
no peripheral vasoconstriction in distributive shock
oligouria

36
Q

shock

A

progressive phase

37
Q

clinical features of shock

A

worsening hypotension
hypoperfusion of peripheral tissues
generalised hypoxia
anaerobic metabolism in underperfused organs
lactic acidosis
worsening tachypnoea
precapillary dilation and postcapillary constriction of vessels
pooling and stasis of blood in capillary bed
decreased CO
formation of microthrombi in capillaries
DIC
hypoxic injury
acidosis
cerebral hypoperfusion = altered mental status

38
Q

end organ dysfunction

A

irreversible phase
decompensation
irreversible tissue damage

39
Q

clinical features of end organ dysfunction

A 
cerebral hypoxia
autonomic dysfunction 
myocardial ischaemia - ACS 
decreasec CO
widespread cell necrosis 
bowel ischaemia
40
Q

widespread cell necrosis

A 
release of lysozymal enzymes 
further tissue injury 
worsening of shock 
activation of immune system
release of cytokines 
DIC 
further tissue damage
41
Q

DIC

A

blood clots form in small blood vessels
ischaemia of organs
organ failure
clotting uses up clotting factors and platelets so there is excessive bleeding
clotting activated throughout the body
inhibition of clotting control mechanisms
clotting and bleeding together

42
Q

signs/symptoms of DIC

A 
blood in stool/urine 
headaches - brain bleeds 
bruises 
petechiae 
wound/surgical sites bleeding 
mucosal bleeding 
organ dysfunction 
blackening of skin - ischaemia 
chest pain 
haemoptysis 
difficulty breathing 
heart attack symptoms 
stroke symptoms
43
Q

how to manage shock?

A

warm
lay flat
peripheral IV line using large calibre catheter
intraosseous route if IV unavailable
oxygen therapy
ventilation
monitoring of HR, BP, CRT, RR, urine output and presence of skin mottling

44
Q

target oxygen sats

A

94-98% unless hypercapnic/ type II respiratory failure = 88-92%

45
Q

treating cardiogenic shock

A 
wide bore cannula
crystalloid fluids
reassess haemodynamic status 
examine for fluid overload 
vasopressor if hypotension or continued hypoperfusion despite fluids
46
Q

crystalloid fluid resuscitation

A

0.9% saline or hartmann’s solution

200-250ml over <15 mins bolus

47
Q

target MAP

A

65mmHg if cause of shock is unknown

48
Q

treatment for fluid overload/ pulmonary oedema?

A

loop diuretic
IV furosemide
or vasodilator if systolic BP is over 90mmHg

49
Q

vasopressor

A

causes vasoconstriction
e.g. noradrenaline, metaraminol, dopamine, vasopressin, adrenaline, inotrope - dobutamine if there is impaired cardiac function/CO

50
Q

treatment for haemorrhagic shock

A 
major haemorrhage protocol 
blood products 
reverse anticoagulation 
IV tranexamic acid in trauma 
fluid resus 
hypovolaemic shock = blood products
51
Q

blood products for haemorrhagic shock

A

RBCs
fresh frozen plasma - FFP
1:1 ratio in trauma or 1:2 in non-trauma
platelets
cryoprecipitate or fibrinogen concentrate if low fibrinogen

52
Q

target haemoglobin in haemorrhagic shock

A

7-9g/dL or 70-90g/L

53
Q

What does tranexamic acid do?

A

clot formation

antifibrinolytic

54
Q

how to treat obstructive/ distributive/ non-haemorrhagic shock?

A 
crystalloid fluid resus 
reassess haemodynamic status 
examine for fluid overload 
vasoactive drug - vasopressor/ inotrope 
arterial line and central venous catheter

2nd year (48 decks)

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