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Haematology > Shock > Flashcards

Shock Flashcards

1
Q

What is shock?

A

A syndrome in which tissue perfusion is inadequate for the tissues metabolic requirement

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2
Q

What does perfusion depend on?

A

Cardiac function
Capacity of vasculature
Circulating blood volume

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3
Q

How do you calculate MAP?

A

CO x SVR

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4
Q

Name the five types of shock

A 
Hypovolaemic 
Cardiogenic 
Obstructive 
Distributive 
Endocrine
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5
Q

Describe hypovolaemic shock

A

Acute haemorrhage

Fluid depeltion - severe dehydration/burns

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6
Q

Describe cardiogenic shock

A

Pump failure, reduced cardiac output

Primarily due to ischaemia induced myocardial dysfunction

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7
Q

Describe obstructive shock

A

Mechanical obstruction
Direct - PE, air/fat/amniotic fluid embolism
Restriction - tamponade, tension pneumothorax

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8
Q

Describe distributive shock

A

Septic, anaphylaxis, acute liver failure, spinal cord injuries
Disruption of normal vascular autoregulation and profound vasodilation

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9
Q

Describe endocrine shock

A

Severe hypothyroidism, addisonian crisis, thyrotoxicosis causes reduced cardiac output and vasodilation

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10
Q

What is the sympathy-adrenal response to shock?

A

Baroreceptors and chemoreceptors
Sympathetic release of noradrenaline/adrenaline
RAAS
Aims to maintain BP and Cardiac output

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11
Q

What is the neuroendocrine response to shock?

A

Release of pituitary hormones - ACTH, ADH, Opioids
Release of cortisol - fluid retention, insulin antagonist
Release of glucagon

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12
Q

What makes up the inflammatory response?

A

Activation of complement
Cytokines - IL/TNF alpha
Platelet activating factor
Lysosomal enzyme - myocardial depression
Adhesion molecules - damage to vessels
Endothelium derived mediators - NO
Imbalance between oxidants and anti-oxidants

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13
Q

What haemodynamic changes occur as a result of shock?

A

Vasodilation –> vasoconstriction
Maldistribution
Microcirculatory abnormalities
Abnormal coagulation (DIC)

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14
Q

What is the main clinical feature of shock?

A

Hypotension

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15
Q

What are the clinical features of cardiogenic shock?

A

Myocardial failure - chest pain, cold/clammy, oedema

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16
Q

What are the clinical features of obstructive shock?

A

Raised JVP, pulses paradoxes, signs of cause

17
Q

What are the clinical features of distributive shock?

A

Pyrexia, vasodilation, rapid capillary refill, anaphylaxis

18
Q

Describe class I hypovolaemia

A

<15% blood loss
Base deficit 0 to -2
Monitor for blood requirement

19
Q

Describe class II hypovolaemia

A

15-30% blood loss
Increased heart rate and reduced pulse pressure
Base deficit -2 to -6
Possible need for blood

20
Q

Describe class III hypovolaemia

A

31-40% blood loss
Increased heart rate, reduced BP, reduced pulse pressure, increased resp rate, reduced urine output and GCS
Base deficit -6 to -10
Need blood

21
Q

Describe class IV hypovolaemia

A

> 40% blood loss
Increased heart rate, reduced BP, reduced pulse pressure, increased resp rate, decreased urine output and GCS
Base deficit -10 or less
Massive transfusion protocol

22
Q

Name the way in which a patient with shock can be monitored

A 
Examination 
Urine Output 
Neurological 
Biochemical 
BP 
Central venous pressure 
Pulmonary artery monitoring 
Pulse contour analysis 
Doppler ultrasound
23
Q

How is all shock managed initially?

A

ABCDE

Wide bore access

24
Q

How is oxygen delivery managed?

A

15 litre non-rebreather initially and then whatever level required for normal SpO2

25
Q

What is the risk of fluids?

A

Fluid overload and pulmonary oedema

26
Q

What is fluid challenge?

A

Assessment of response, not too fast that it causes stress response
300-500ml over 10-20 minutes

27
Q

What are the three main types of fluid?

A

Crystalloid
Colloid
Blood

28
Q

What are examples and issues with crystalloid?

A

Saline, hartmann’s

Rapid loss from circulation to extracellular fluid, requires 3-4 times more than blood lost

29
Q

What are examples and issues with colloids?

A

Gelatines, albumin

Can cause anaphylaxis, reduced volumes but no evidence of benefit

30
Q

What pharmacological treatments can be used in shock?

A 
Adrenaline 
Noradrenaline 
Vasopressin 
Dopamine
Dobutamine
31
Q

Name the mechanical support that can be used in shock

A

Balloon pump
L/R VAD
VA Echo

Haematology (18 decks)

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