Shock overview.

Question 1

What are the different types of shock?

Answer 1

cardiogenic
hypovolaemic
anaphylactic
neurogenic
septic.

Question 2

What are the different categories we can separate shock into?

Answer 2

cold and warm

Question 3

What are the cold shocks?

Answer 3

cardiogenic
hypovolaemic
septic

Question 4

What are the hot shocks?

Answer 4

neurogenic

anaphylactic

Question 5

What do we see in anaphylaxis?

Answer 5

angioedema,
rash,
hypotension,
bronchoconstriction

Question 6

What is the treatment for anaphylaxis and why?

Answer 6

antihistamine - piriton oral if can.
steroids - pred if can, given if swelling and not just rash.
adrenaline - given IV but only if hypo or airway issues.

Question 7

How long do steroids take to work?

Answer 7

1 hour onset, 4hrs maximal.

Question 8

What are the oral steroids?

Answer 8

pred

Question 9

What are the IV steroids?

Answer 9

hydrocortisone and dexamethasone

Question 10

What CRT is seen in warm shocks?

Answer 10

normal

Question 11

Why does warm shock occur and what does this mean for resus?

Answer 11

They have enough fluid, its just in the wrong place, therefore we don’t need fluids, they need vasoconstriction.

Question 12

Why does cold shock occur?

Answer 12

there isn’t enough fluid, so the peripheries shut down to drive blood to the core.

Question 13

How does adrenaline help anaphylaxis?

Answer 13

it mimics the sympathetic system - vasoconstricting, bronchodilating and increasing HR.

Question 14

What is the main colloid used in the hospital now?

Answer 14

albumin,

Question 15

What is another name for hartmanns and what should this remind us of?

Answer 15

ringers lactate, remember it can cause slight acidosis, so probably not great for resus.

Question 16

What is the most common type of shock in the hospital?

Answer 16

septic

Question 17

What does exudative fluid essentially mean?

Answer 17

pus

Question 18

What does transudative fluid essentially mean?

Answer 18

no pus.

Question 19

What might cause cardiac tamponade other than blood?

Answer 19

pus.

Question 20

How can we divide the cause of cardiogenic shock into categories in our heads?

Answer 20

intrinsic and extrinsic

Question 21

What are extrinsic causes of cardiogenic shock?

Answer 21

tamponade
tension pneumo
PE

Question 22

What are intrinsic causes of cardiogenic shock?

Answer 22

MI (delayed cause)

cardiomyopathy - congenital (HCM) and acquired (alcoho and drugs - illicit and steroids)

Question 23

Why do illicit drugs cause cardiomyopathy?

Answer 23

they can result in valve disease.

Question 24

How does cardiogenic shock present?

Answer 24

low BP
cold, shut down peripheries and increased CRT.
cyanosis
increased RR
tachycardia

Question 25

What often goes hand in hand with an increased HR?

Answer 25

increased RR

Question 26

How do we manage caridogenic shock?

Answer 26

ABCDE and treat cause.

Question 27

How do we treat PE shock in A and E?

Answer 27

Altepase and usually 60 mins resus after, while its working.

Question 28

What is spinal shock?

Answer 28

is a combination of areflexia/hyporeflexia and autonomic dysfunction that accompanies spinal cord injury. The initial hyporeflexia presents as a loss of both cutaneous and deep tendon reflexes below the level of injury accompanied by loss of sympathetic outflow, resulting in hypotension and bradycardia

Question 29

What is the difference between spinal shock and neurogenic shock?

Answer 29

spinal shock is potentially reversible ‘bruising’ of the spine.
neurogenic shock is when injury has severed one or both sympathetic chains and is irreversible generally.

Question 30

What is neurogenic shock?

Answer 30

injury has severed the sympathetic chain and so this causes vasodilation and warm shock.

Question 31

How do we treat neurogenic shock?

Answer 31

put on inotropes
ICU
surgical referral.