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Week 3 > Shock, Haemorrhage + Wounds > Flashcards

Shock, Haemorrhage + Wounds Flashcards

1
Q

shock definition

A

a life-threatening, generalised form of acute circulatory failure with inadequate oxygen delivery and utilisation by cells
- decreased blood perfusion in tissues

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2
Q

shock clinical parameters

A

cardiovascular status - HR (goes up the greater the degree of shock) (BP may be maintained until later on, when it drops)
respiratory rate (RR)
GCS - Glasgow coma scale
biochemical markers, lactate, urine output
SOFA score (sequential organ failure assessment)
- organ function decreases
elderly tend to have less physiological reserve
medications may affect it
fever, chest pain, abdominal pain, bleeding..

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3
Q

types of shock

A

distributive, hypovolaemic, obstructive, cardiogenic

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4
Q

distributive shock

A

failure of vasoregulation, severe peripheral vasodilation
-sepsis - toxic effect to an inflammatory response
anaphylaxis - massice release of biochemical mediator
neurogenic - spinal cord injury causes vagal tone problems (measure of the PNS control over heart rate)

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5
Q

Hypovolaemic shock

A

loss of intravascular volume
haemorrhage - trauma, GI bleeding
non-haemorrhage - burns, DKA (diabetic ketoacidosis)

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6
Q

obstructive shock

A

barriers to cardiac flow or filling
pulmonary embolism, cardiac tamponade, tension pneumothorax (air building pressure in thorax)

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7
Q

cardiogenic shock

A

pump failure
myocardial infarction

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8
Q

treating distributive shock

A

fluid, vasopressors (target peripheral vasodilation)
antibiotics

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9
Q

treating hypovolaemic shock

A

fluid, blood
stop losses

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10
Q

treating cardiogenic shock

A

balance - vasopressors, inotropes (medication used to stimulate vasoconstriction or increase cardiac contractivity, fluids
cardiologist

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11
Q

cardiac output equation

A

CO = HR x SV

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12
Q

what happens in blood loss

A

intravascular volume loss
decreased cardiac output
impaired tissue oxygenation
affects organ function
ALL COMPONENTS LOST EQUALLY

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13
Q

function of blood

A

oxygen transport
clotting
healing + infection
transport system (nutrients + waste)
homeostasis

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14
Q

Emergency treatment - ATLS

A

Catastrophic haemorrhage control
Airway w/ c-spine control
Breathing w/ oxygenation
Circulation with haemorrhage control
Disability
Exposure

  • emergency imaging
  • secondary survey
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15
Q

airway obstruction treatments

A

adjuncts
intubation - different types

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16
Q

types of haemorrhage

A

abrasion, laceration, incised, degloving, bites

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17
Q

abrasions

A

superficial (epidermal skin loss)
not much bleeding if any

18
Q

treatment of abrasions

A

clean + dress

19
Q

laceration

A

blunt force trauma
skin splitting, tissue breaking, irregular edges/ levels/ depth

20
Q

treatment of lacerations

A

close: glue, steristrips, staples, sutures

21
Q

incised

A

sharp or penetrating trauma (e.g. slash/ stab wounds)

22
Q

treatment for incised

A

clean edges, uniform shape
beware of depth
investigate for underlying damage

23
Q

degloving

A

skin and its blood supply are torn off
major trauma
often with limbs/ digits
more severe injuries

24
Q

bites

A

usually small entry wounds
possibly deep penetration
foreign body contamination
animals?
human blood borne viruses
cat bites are worse than dog bites for infections

25
Q

treatment for bites

A

irrigation. delayed closure/ no closure

26
Q

List some possible causes of breathing issues in shock

A

hemopneumothorax
fracture (flail chest)
cardiac tamponade
contusions - bruising to lungs

27
Q

circulation/ haemorrhage control - symptoms

A

hypovolemic

28
Q

circulation/ haemorrhage control - common locations

A

chest; abdomen; pelvis/ limb fracture

29
Q

circulation/ haemorrhage control - investigations

A

CT scan, FAST scan, theatre

30
Q

circulation/ haemorrhage control - control

A

stop the bleeding
pressure/ elevate/ tourniquets
pelvis binders
surgical - suture, clap, pack
medical - specialised dressings
IR (interventional radiology) - embolization
give blood (balance resuscitation (PRBC, FFP, platelets)
major haemorrhage protocol
tranexamic acid - antifibrotic

31
Q

how many classes of shock are there

A

4

32
Q

what are the volumes of blood loss required for each class of shock

A

I - <750
II - 750-1500
III - 1500 - 2000
IV - >2000

33
Q

what is the blood loss % required for each class of shock

A

I - 0-15%
II - 15-30%
III - 30-40%
IV - >40%

34
Q

what HR is required for each class of shock

A

I - <100
II - >100
III - >120
IV - >140

35
Q

what is the BP (compared to normal) in each class of shock

A

I - normal
II - normal
III - decreased
IV - decreased

36
Q

what is the pulse pressure in each class of shock

A

I - normal or increased
II - decreased
III - decreased
IV - decreased

37
Q

what is the RR in each class of shock

A

I - 14-20
II - 20-30
III - 30-40
IV - >35

38
Q

what is the mental state of a person in each stage of shock

A

I - slightly anxious
II - mildly anxious
III - anxious, confused
IV - confused, lethargic

39
Q

describe the clinical parameters of class I shock

A

<750ml of blood lost
(0-15%)
HR - <100
BP - normal
PP - normal or increased
RR - 14-20
mental state - slightly anxious

40
Q

describe the clinical parameters of class II shock

A

750 -1500ml of blood lost
(15-30%)
HR - >100
BP - normal
PP - decreased
RR - 20 -30
mental state - mildly anxious

41
Q

describe the clinical parameters of class III shock

A

1500-2000ml of blood lost
(30-40%)
HR - >120
BP - decreased
PP - decreased
RR - 30-40
mental state - anxious, confused

42
Q

describe the clinical parameters class IV shock

A

> 2000ml of blood lost
(>40%)
HR - >140
BP - decreased
PP - decreased
RR - >35
mental state - confused, lethargic

Week 3 (3 decks)

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