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week 3 > shock, haemorrhage and wounds > Flashcards

shock, haemorrhage and wounds Flashcards

1
Q

what is the definition of shock

A

A life-threatening, generalised form of acute circulatory failure with inadequate oxygen delivery and utilisation by cells

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2
Q

what are important features about shock

A

not a specific diagnosis
requires urgent intervention

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3
Q

what normally leads to shock

A

Decreased blood perfusion of tissues
Inadequate blood oxygen
Increased oxygen demand from tissues
- overlap

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4
Q

what are the clinical parameters of shock

A

heartrate + respiratory rate is up
blood pressure can start to drop
glasgow coma score -> concious level starts to drop

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5
Q

what are the biochemical markers of shock

A

blood tests that find elevated levels of lactate + urine output

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6
Q

what is lactate a sign of ?

A

someone who is hypoperfused

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7
Q

what is the SOFA score

A

related to scoring of sepsis

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8
Q

what are the four subcategories of shock

A

obstructive
distributive
cardiogenic
hypovolemic

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9
Q

what is distributive shock

A

failure of Vaso regulation -
problem with control of vasculature as peripheral
Severe peripheral vasodilation
blood circulation is dilated and uncontrolled

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10
Q

what is the main reason for distributive shock is

A

septic shock

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11
Q

briefly describe septic shock

A

the toxic effect of inflammatory response (large number of cytokines)
-> leads to many dilated blood vessels in peripheral system

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12
Q

what are two other types of distributive shocks

A

anaphylaxis and neurogenic

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13
Q

explain anaphylaxis

A

significant allergic reaction which triggers large release of biochemical mediators. for example histamine from mast cells

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14
Q

what does anaphylaxis lead to

A

gross peripheral vasodilation

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15
Q

explain what neurogenic shock is

A

spinal cord injury - problem with autonomic nervous system and vagal tone problems

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16
Q

explain hypovolaemic shock

A

reduction in your circulating blood volume -> loss of intravascular volume

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17
Q

what are the two subcategories of shock

A

haemorrhage
+
non haemorrhage

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18
Q

what are examples of haemorrhage causes

A

trauma
GI bleeding -> eg stomach ulcers

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19
Q

what are examples of non-haemorrhage bleeding

A

burns -> tissue loss / tissue damage
diabetes complications -> diabetic ketoacidosis which causes huge amounts of volume loss

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20
Q

explain cardiogenic shock

A

problems with the heart.
in particular the pump in the heart is failing

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21
Q

what can cause cardiogenic shock

A

heart attack
myocardial infarction

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22
Q

what are problems related to cardiogenic loss

A

arrhythmias -> irregular rhythms of the heart
mechanical problems -> valves of the heart are affected

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23
Q

explain obstructive shock

A

barriers to cardiac flow or filling

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24
Q

what are problems related to obstructive shock

A

pulmonary embolism (clots)in the vasculature of the lungs
cardiac tamponade
tension pneumothorax

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25
Q

what is cardiac tamponade

A

large amount of blood in the pericardial space (around the heart) -> restricts the pumping of the heart

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26
Q

what is tension pneumothorax

A

build up of air around the lungs - causes the lung to collapse

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27
Q

how would you treat distributive shock

A

fluid -> optimise circulatory status
vasopressers -> drugs that improve peripheral vasodilation
antibiotics

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28
Q

how do we treat hypovolaemic shock

A

fluid, giving blood
try to stop the loss of fluid in general

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29
Q

how do we treat cardiogenic shock

A

combination of different types of medicine
fluid
vasopressers
inotropes
cardiologist

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30
Q

what are inotropes

A

drugs that positively improve cardiac output

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31
Q

how do we treat obstructive shock

A

improve obstruction -> putting hole in chest to relieve pressure
preventing clots -> thrombolysis

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32
Q

what can make recognition of shock more complicated

A

people on medication

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33
Q

what is blood

A

majority plasma 55%
45% cells

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34
Q

explain in blood sample where plasma, WBC, RBC are ?

A
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35
Q

what is plasma made up of

A

90% water
7% plasma proteins
other substance

36
Q

of the 45% of blood that is cell how many are rbc

A

99% RBC
rest WBC and platelets

37
Q

why is blood important

A

Oxygen transport
Clotting
Healing & Infection
Transport system
Homeostasis

38
Q

explain oxygen transport

A

Oxygen transport from the lungs via haemoglobin to tissues and returns carbon dioxide

39
Q

explain clotting

A

Clotting and haemostasis via platelet aggregation and the coagulation cascade

40
Q

explain blood as a transport system

A

Transport of nutrients and hormones to all tissues of the body, and waste products to the kidneys, lungs and other organs for excretion

41
Q

explain the role of blood in homeostasis

A

Homeostasis or regulation of the pH and electrolyte composition of body fluids

42
Q

what happens when we lose blood

A

Intravascular volume loss ->
decreased cardiac output -> impaired tissue oxygenation ->end-organ dysfunction ->
death!

43
Q

in order to maintain cardiac output and compensate for a lack of volume what occurs ?

A

the heart will increase heart rate

blood is shunted from visceral/ non vital organs to provide heart with enough blood for vital organs

44
Q

what can happen if shunting of blood occurs for too long

A

those organs such as kidney, liver, skin will die

45
Q

how are the components of blood lost

A

they are all lost equally

46
Q

decreased perfusion can lead to what

A

lactic acidosis

47
Q

lactic acidosis has a negative effect on what

A

clotting -> more bleeding, more shunting and increased heart rate

48
Q

what can lactic acidosis lead to a drop in

A

a drop in body temperature (hyopthermia)

49
Q

what does hypothermia lead to ?

A

more clotting
more bleeding
more acidosis -> trauma triad of death

50
Q

describe class I shoch

A

up to 750ml blood loss
15% of blood lost
pulse rate less than 100
blood pressure is normal
resp rate : 14-20
urine output is more than 30mls/ hour
mental status is normal

51
Q

describe class II shock

A

750ml to 1500ml of blood lost
15-30% of blood lost
pulse rate more than 100
blood pressure is normal
resp rate is 20-30
urine output is 20-30 mls/hr
mild anxiety

52
Q

describe class III shock

A

1500 to 2000ml lost
30-40% of blood lost
pluse rate more than 120
blood pressure decreased
resp rate is 30-40
5-15mls per hour
mental status is anxious

53
Q

explain class IV shock

A

blood loss is more than 200ml
total % of blood is more than 40%
pulse rate is more than 140
blood pressure is decreased
resp rate is more than 40
urine output is negligible
mental status is confused

54
Q

what is the order of importance on how to assess the patient

A

check:
Catastrophic haemorrhage control
Airway with C-Spine Control
Breathing with oxygenation
Circulation with haemorrhage control
Disability
Exposure

55
Q

what are additional procures that can be carried out

A

Emergency Imaging
Secondary Survey
Definitive Treatment -> where are they going after
Trauma Team

56
Q

in trauma case what do we need to check for ?

A

Airway obstruction?
Fractures?
Swelling?
Blood?
Snoring? Stridor?
Visible obstruction?
Unconscious?

57
Q

how would you deal with airway obstruction

A

Adjuncts- open up airway

intubation - tube into throat into larynx where there is inflated balloon

58
Q

how is a patient breathing assessed

A

RR + 02 sats

59
Q

where would we see signs of trauma in breathing

A

Air entry is subdued
abnormal Chest movement
Crepitus
if they are in Pain (huge)

60
Q

trauma to chest can lead to what

A

Haemopneumothorax - air/blood around/in lung
Fractures (flail chest) -> problems with ventilation
Cardiac tamponade
Contusions

61
Q

how can blood be removed from the wrong place eg the lung

A

intercostal drain which expands lungs and removes blood

62
Q

what would be signs of hemorrage ?

A

is he agitated
tachycardic
blood pressure low/high
is it hard for them to breathe

63
Q

in trauma cases what cavities cause the most severe blood loss

A

Chest/Abdo/Pelvis/Limb fractures (long bones)

64
Q

how can we asses signs of hemorrhage

A

Investigations CT scan, FAST scan, ultrasound

65
Q

how is the bleeding normally controlled in haemorrhage patients

A

going theatre

66
Q

what is important if someone is hypovolemic or bleeding

A

to put cannula in and get vascular access

67
Q

what is intraosseous access

A

using drill to push needle into bone usually tibia
deliver 50/100 mils per hour
35.21

68
Q

what is an important step in haemorrhage control ?

A

stopping the bleeding

69
Q

how can stop bleeding quickly

A

apply pressure
elevate
tourniquets

70
Q

what are surgical ways to stop bleeding

A

Suture, clamp, pack

71
Q

what are other medical ways to stop dressing ?

A

Specialised dressings (quickclot) -> has clotting capabilities

72
Q

what is the idea of embolization ?

A

interventional cardiology -> through the use of CT scanning, we can identify vessels that are bleeding and actually embolism or cauterise them

73
Q

what is the purpose of giving blood?

A

to resemble what is being lost

74
Q

in terms of blood what is given immediately, in 15 mins and should in 35 mins

A

o negative
group specfic in 15 mins
full crossmatched given in 35 mins

75
Q

what is the importance of tranexamic acid

A

Tranexamic acid is an antifibrinolytic i.e. stops the breakdown of clot. Improved mortality in trauma.

76
Q

explain an abrasion wound

A

Superficial/Deep
Dragging against an irregular surface
Clean debris
Dress
Bleeding not usually an issue
Theatre to scrub

77
Q

what normally leads to abrasion

A

Loss usually of the superficial epithelium due to scraping. Some skin is missing!

78
Q

explain laceration

A

Blunt force trauma
Skin splitting/tearing , tissue bridging, irregular edges and levels of depth
Has legal/forensic implications
Irrigate, clean

79
Q

how to close laceration

A

Glue, Steristrips, Staples, Sutures

80
Q

what is most common complication of laceration

A

infection

81
Q

explain incised wounds

A

Sharp or penetrating trauma
Slash/stab type
Clean edges, uniform shape
Stabs look less dramatic but beware depth
Investigate for underlying damage (ATLS)

82
Q

what is a puncture wound

A

. A type of incisional wound but unlike the slash type wound previously often has a smaller entry are and greater depth.

83
Q

what is a degloving wound

A

Skin and its blood supply are torn off -> severing its blood supply
Major trauma
Limbs/digits
Often associated more severe injuries

84
Q

explain bites wounds

A

Usually a small entry wound
Possibly deep penetration
Foreign body contamination

85
Q

what normally causes bite wounds

A

Animal
Human Blood borne viruses

86
Q

what can heal bite wounds

A

Antibiotics, Tetanus, Vaccines

87
Q

what is the % of cat and dog bites that get infected

A

. 80% will get infected if not treated. Approx 5% of dog bites will.

week 3 (4 decks)

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