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TCD 18 - AAA > Shock > Flashcards

Shock Flashcards

1
Q

What is shock?

A

An acute clinical syndrome initiated by ineffective perfusion and cellular hypoxia, resulting in severe dysfunction of organs vita to survival

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2
Q

What is hypovolaemic shock?

A

Reduced intravascular volume

  • Haemorrhage
  • Burns
  • GI losses
  • Dehydration
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3
Q

What is cardiogenic shock?

A

Intrinsic cardiac pump failure

  • MI/ischaemia
  • Arrhythmia
  • Acute valve pathology
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4
Q

What is distributive shock?

A

Marked vasodilation that causes hypotension and malperfusion

  • Systemic inflammatory response syndrome – sepsis, pancreatitis, trauma, burns
  • Neurogenic – spinal cord injury
  • Anaphylaxis
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5
Q

What is obstructive shock?

A

Failure of circulatory flow

  • Tension pneumothorax
  • Pericardiac tamponade
  • Pulmonary embolism
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6
Q

What are the clinical manifestations of hypovolaemia?

A

• Haemodynamic changes
• Narrowing of pulse pressure but maintenance of systolic BP initially
• Effects of circulatory redistribution and signs of organ hypoperfusion:
o Skin
o Oliguria
o Cognitive changes
o Metabolic acidosis

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7
Q

What are the management principles of hypovolaemia?

A
  • Restore tissue perfusion and oxygen delivery to cells as rapidly as possible
  • ABC
  • Administer O2
  • Give IV fluids
  • Treat the cause
  • Resuscitation begins concurrently or ahead of the diagnostic process
  • Aiming to prevent irreversible organ injury and failure
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8
Q

What are the thresholds for a blood transfusion?

A

Without ACS
- 70 g/L

Patients with ACS
- 80 g/L

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9
Q

What are the targets after transfusion?

A

Without ACS
- 70-90 g/L

Patients with ACS
- 80-100 g/L

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10
Q

In a non-urgent scenario, how long is a unit of RBCs transfused over?

A

90-120 minutes

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11
Q

When do you offer platelet transfusions in patients with a platelet count of <30 x 10^9?

A

WHO grade 2 bleeding

  • Haematemesis
  • Melaena
  • Prolonged epistaxis
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12
Q

When do you offer platelet transfusions in patients with a platelet count of <100 x 10^9?

A

WHO grades 3+4

– Bleeding at critical sites

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13
Q

What blood samples do you take in a person who is haemorrhaging

A 
o	FBC
o	U+Es
o	LFTs
o	Calcium
o	PT
o	APTT
o	Fibrinogen
o	Crossmatch
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14
Q

What will a patient need for a major haemorrhage?

A
  • Red cells 4 units
  • FFP 4 units
  • Platelets 1 dose
  • Tranexamic acid
  • Cryoprecipitate
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15
Q

When do you give cryoprecipitate?

A
  • Severe bledding
    AND
  • Fibrinogen <1.5g/L
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16
Q

What is the universal giver?

A

O -ve uncrossmatched blood

17
Q

What do you aim for when managing an ongoing bleed?

A 
o	Fibrinogen >1.5g/L
o	PT ratio <1.5
o	APTT ratio <1.5
o	Hb 80-100g/L
o	Platelets >75 x 10^9/L
o	Lactate <2
18
Q

When do you give thromboprophylaxis?

A

When the haemorrhage is under control as the patient is at risk of thrombosis

19
Q

What is Transfusion associated acute lung injury (TRALI)?

A

Presents as acute respiratory distress syndrome (ARDS) either during or within 6hrs of transfusion

20
Q

How can a massive blood transfusion cause hypocalcaemia?

A

Citrate (a solution which preserves blood products) binds with ionised calcium

21
Q

How can a massive blood transfusion cause hypothermia?

A

o RBCs are stored at 4 degrees
o A decrease in temperature shifts the oxygen dissociation curve to the left, reducing tissue oxygen delivery at a time when it should be optimised

22
Q

How can a massive blood transfusion cause dilutional coagulopathy?

A

o Packed RBCs do not contain coagulation factors or platelets
o Dilution of body’s own clotting factors

23
Q

What is an immediate haemolytic reaction?

A
  • Incompatibility between donor’s RBC antigens and recipients causing complement activation and intravascular haemolysis
  • The most severe are ABO incompatibility
24
Q

What is an delayed haemolytic reaction?

A
  • Antibody reaction to minor RBC antigens (Rhesus)
25
Q

What is DIC?

A
  • Lots of clotting followed by lots of fibrinolysis

* Caused by the release of tissue factor

26
Q

How do you identify DIC?

A
  • Low platelets
  • Prolonged APTT, prothrombin and bleeding time
  • Fibrin degradation products are often raised
  • Schistocytes due to a micro angiopathic haemolytic anaemia

TCD 18 - AAA (4 decks)

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