Shock - General Flashcards
1
Q
Clinical definition of shock:
A
- SBP < 90
- MAP < 65
- With evidence of tissue hypoperfusion
2
Q
Examples of tissue hypoperfusion:
A
- Mottled skin
- UO < 0.5 ml/kg/hr
- Lactate > 2
3
Q
Signs of shock:
A
- Low GCS
- Agitation
- Pallor
- Cold peripheries
- Tachycardia
- Slow cap refill
- Tachypnoea
- Oliguria
4
Q
General causes of shock:
A
- Inadequate CO - Hypovolaemia, pump failure
- Loss of SVR - Sepsis, anaphylaxis, neurogenic, endocrine failure
5
Q
Cold & clammy suggests:
A
- Cardiogenic shock
- Fluid loss
6
Q
Warm & well perfused with bounding pulse suggests:
A
- Septic shock
7
Q
Mx septic shock:
A
- Take cultures before ABx - 2 ≈ peripheral blood culture plus, eg, urine, sputum, CSF
- Give ABx w/in 1st hour - Tazocin 4.5g tds + gentamicin 5mg/kg od + vancomycin 1g BD IVI if MRSA
- Fluid bolus of 20mL/kg crystalloid
8
Q
Mx - Hypovolaemic shock:
A
- ID & Rx underlying cause
- Raise the legs.
- Give fluid bolus 10–15 mL/kg crystalloid
- No improvement after 2 boluses - consider ICU
9
Q
Mx - Haemorrhagic shock:
A
- Stop bleeding
- Crossmatch blood - still shocked despite 2L crystalloids or class III/IV shock
- Give FFP alongside packed red cells
10
Q
Mx - Heat exposure (heat exhaustion):
A
- Tepid sponging + fanning
- Avoid ice & immersion
- Resuscitate with high-sodium IVI - 0.9% saline
- ± hydrocortisone 100mg IV
11
Q
What is SIRS?
A
Presence of 2 or more of the fol- lowing features:
- Temperature >38°C or <36°C
- Tachycardia >90bpm
- RR >20 breaths/min or PaCO2 <4.3kPa
- WBC >12≈109/L or <4≈109 /L
12
Q
What is Sepsis?
A
- SIRS occurring in the presence of infection
13
Q
What is severe sepsis?
A
- Sepsis with evidence of organ hypoperfusion - hypoxaemia, oliguria, lactic acidosis, or altered cerebral function
14
Q
What is septic shock?
A
- Severe sepsis with hypotension (systolic BP <90mmHg or MAP ≤ 60)
- Despite adequate fluid resuscitation
- Or the requirement for vasopressors/inotropes to maintain blood pressure
