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CSB337 > Shock and hypovolaemia > Flashcards

Shock and hypovolaemia Flashcards

1
Q

Describe the impact of trauma on the coagulation cascade

A

Trauma causes metabolic stasis, reducing perfusion to cells that provide energy; ATP pumps aren’t active so the mitochondria aren’t burning off substrates. They can’t produce heat and thermogenesis is compromised. People go cold (to ambient room temp) quickly , and at 35 degrees clotting factors are halved.

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2
Q

What is the volume, percentage, and symptoms of a class I haemorrhage?

A
  • Up to 750mL
  • 15%
  • HR <100, normotensive, capillary refill <2, RR 14-20, normal mental state
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3
Q

What is the volume, percentage, and symptoms of a class II haemorrhage?

A
  • 750-1500mL
  • 15-30%
  • HR >100, normotensive, capillary refill >2, RR 20-30, mildly anxious
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4
Q

What is the volume, percentage, and symptoms of a class III haemorrhage?

A
  • 1500-2000mL
  • 30-40%
  • HR >120, hypotensive, capillary refill >2, RR 30-40, anxious and confused
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5
Q

What is the volume, percentage, and symptoms of a class IV haemorrhage?

A
  • > 200mL
  • > 40%
  • HR >140, hypotensive, capillary refill >2, RR >35, confused/lethargic, will see peri-arrest symptoms
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6
Q

What is the definition of shock?

A

A state of poor perfusion where cellular oxygen demand is not by supply; metabolic stasis. This results in insufficient ATP generation, anaerobic metabolism, and cellular acidosis.

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7
Q

What is the Fick principle and what are the three steps?

A
  • Loading of O2 onto RBC in lungs
  • Delivery of oxygenated RBC to tissue cells
  • Offloading of O2 from RBC to tissue cells
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8
Q

What are the causes of hypovolaemic shock?

A
  • Haemorrhage
  • Dehydration
  • Severe burns
  • DKA
  • Sweating
  • Peritonitis
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9
Q

What is the ‘third space’?

A

Space in the body where fluid does not normally collect or where any collection is physiologically non-functional

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10
Q

What is the definition of hypovolaemic shock?

A

Insufficient circulating volume

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11
Q

What is the definition of cardiogenic shock?

A

Failure of the heart to pump effectively

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12
Q

What are the causes of cardiogenic shock?

A
  • CA
  • MI
  • Arrhythmias
  • Cardiomyopathy
  • Congestive heart failure
  • Valve issues/rupture
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13
Q

What is the definition of obstructive shock?

A

Mechanical block to hearts’ outflow

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14
Q

What are the causes of obstructive shock?

A
  • Pulmonary embolus
  • Cardiac tamponade
  • Tension pneumothorax
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15
Q

What is the definition of distributive shock?

A

‘Relative hypovolaemia’ - dilated blood vessels.

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16
Q

What are the causes of distributive shock?

A
  • Anaphylaxis
  • Septic shock (infection)
  • Neurogenic (loss of vasomotor tone)
  • Overzealous nitrate administration
17
Q

What are the stages of shock?

A

Pre-shock, compensated, decompensated, and irreversible.

18
Q

Describe and name symptoms of the first stage of shock

A

Initial stage; VSS drifts up to the upper limit of normal parameters

19
Q

Describe and name symptoms of the second stage of shock

A

Body is compensating for blood/fluid loss.

  • Tachycardia
  • Vasoconstriction
  • Weak pulse
  • Cool clammy skin
  • Anxiety/ALOC
  • Thirst
  • Weakness
20
Q

Describe and name symptoms of the third stage of shock

A

Body’s mechanisms fail.

  • Loss of radial pulse
  • Hypotension
  • Loss of consciousness
  • Bradypnoea
  • Systolic and diastolic get closer together
21
Q

Describe and name symptoms of the fourth stage of shock

A

Compensation failure, cellular death.

  • Acidosis
  • Cellular breakdown
  • Na/K pump failure (Na causes cellular swelling, K causes arrythmias)
22
Q

What is the key issue in shock?

A

Tissue ischaemic sensitivity (survival without oxygen)

23
Q

Describe general shock management

A
  • Airway
  • High concentration oxygen
  • Assist ventilation
  • Consider requirements for chest decompression
24
Q

Describe hypovolaemic shock management

A
  • Control bleeding
  • Elevate lower extremities if injuries allow (chest/abdo/pelvic injuries go down)
  • Large bore bilateral IV lines
  • Maintain body temperature
25
Q

Describe cardiogenic shock management

A
  • Supine or head and shoulders elevated
  • Aspirin 300mg
  • IV adrenaline (CCP) and cautious fluids to a BP 90mmHg
  • If crackles in lungs develop, mx as per APO
26
Q

Describe obstructive shock management

A

Rx underlying cause

  • Pulmonary embolus
  • Tension pneumothorax
  • Cardiac tamponade
27
Q

Describe distributive shock management

A

Anaphylactic shock
- Adrenaline, antihistamines, fluids
Neurogenic shock
- Atropine, minimal fluids

28
Q

What are the possible complications of fluid infusions?

A
  • No O2 carrying capacity
  • Hb dilution
  • Clotting factor dilution
  • Increases haemorrhage
  • Dislodges clots
  • Cools patients
  • Excess results in APO
  • Coagulopathy

CSB337 (12 decks)

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