Shock and Fluid management

Question 1

What are the 4 types of shock?

Answer 1

Cardiogenic
Obstructive
Hypovolaemic
Distributive

Question 2

Examples of cardiogenic shock

Answer 2

Myocardial infarction
Myocardial contusion
Myocarditis
Late sepsis
Complete heart block
Beta blocker overdose

Question 3

How does a patient in cardiogenic shock present?

Answer 3

1. tachycardic
2. hypotensive
3. impaired oxygen sats
4. Low volume pulse
5. cool peripheries
6. crackles and signs of chronic heart failure

Question 4

What treatment is given to a patient with cardiogenic shock?

Answer 4

give oxygen, limit IV fluids, give diuretics and start a vasodilator or ionotrope

Question 5

Give an example of Distributive shock

Answer 5

Allergic reaction: anaphylaxis
Sepsis
Neurogenic shock

Question 6

How would a patient in distributive shock appear?

Answer 6

1. Tachycardic and hypotensive
2. High volume/bounding pulse
3. Warm peripherally
4. Bronchial breathing e.g. in CAP

Question 7

Treatment of a patient with distributive shock

Answer 7

Give supplementary oxygen, IV fluids, Antibiotics and vasopressors

Question 8

Potential causes of hypovolemic shock

Answer 8

1.Haemorrhagic (blood loss e.g. ruptured AAA, PPH, GI bleed, trauma)
2. Diarrhoea and vomiting
3. DKA
4. Burns

Question 9

Give a management of hypovolemic shock

Answer 9

fluid bolus of 250-500ml Hartmann’s over 15-30 mins

Question 10

Examples of obstructive shock

Answer 10

1. Tension pneumothorax
2. Cardiac tamponade
3. SVC obstruction
4. Pulmonary embolism

Question 11

Management of obstructive shock

Answer 11

IV crystalloids e.g. Hartmann’s, followed by vasopressors e.g. norepinephrine. If refractory, ass in vasopressin.

Question 12

When should you be concerned about shock?

Answer 12

1. Hypotension
2. Tachycardia
3. Tachypnoea
4. Reduced GCS
5. Potentially cardiac arrest

Question 13

How does hypovolaemic shock present?

Answer 13

• Cold and reduced capillary refill time
• May have dry mucous membranes
  this is due to peripheral vasoconstriction

Question 14

How can Sepsis present?

Answer 14

Patients are often warm and can be pyrexial. They have a normal capillary refill. This is due to vasodilation.

Question 15

Investigations to be ordered in hypovolaemic shock

Answer 15

FBC
U+Es
Clotting factors
VBG
Group and save / X match if haemorrhage
Imaging if trauma - CT head/neck/thorax/abdomen and pelvis

Question 16

What is the new Septic 6 in management of Sepsis?

Answer 16

1. Ensure Senior clinician attends
2. Give O2 if required
3. Obtain IV access and take bloods
4. Give IV antibiotics
5. Give IV fluids
6. Monitor