Shock overview. Flashcards
What are the different types of shock?
cardiogenic hypovolaemic anaphylactic neurogenic septic.
What are the different categories we can separate shock into?
cold and warm
What are the cold shocks?
cardiogenic
hypovolaemic
septic
What are the hot shocks?
neurogenic
anaphylactic
What do we see in anaphylaxis?
angioedema,
rash,
hypotension,
bronchoconstriction
What is the treatment for anaphylaxis and why?
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.
How long do steroids take to work?
1 hour onset, 4hrs maximal.
What are the oral steroids?
pred
What are the IV steroids?
hydrocortisone and dexamethasone
What CRT is seen in warm shocks?
normal
Why does warm shock occur and what does this mean for resus?
They have enough fluid, its just in the wrong place, therefore we don’t need fluids, they need vasoconstriction.
Why does cold shock occur?
there isn’t enough fluid, so the peripheries shut down to drive blood to the core.
How does adrenaline help anaphylaxis?
it mimics the sympathetic system - vasoconstricting, bronchodilating and increasing HR.
What is the main colloid used in the hospital now?
albumin,
What is another name for hartmanns and what should this remind us of?
ringers lactate, remember it can cause slight acidosis, so probably not great for resus.
What is the most common type of shock in the hospital?
septic
What does exudative fluid essentially mean?
pus
What does transudative fluid essentially mean?
no pus.
What might cause cardiac tamponade other than blood?
pus.
How can we divide the cause of cardiogenic shock into categories in our heads?
intrinsic and extrinsic
What are extrinsic causes of cardiogenic shock?
tamponade
tension pneumo
PE
What are intrinsic causes of cardiogenic shock?
MI (delayed cause)
cardiomyopathy - congenital (HCM) and acquired (alcoho and drugs - illicit and steroids)
Why do illicit drugs cause cardiomyopathy?
they can result in valve disease.
How does cardiogenic shock present?
low BP cold, shut down peripheries and increased CRT. cyanosis increased RR tachycardia
What often goes hand in hand with an increased HR?
increased RR
How do we manage caridogenic shock?
ABCDE and treat cause.
How do we treat PE shock in A and E?
Altepase and usually 60 mins resus after, while its working.
What is spinal shock?
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
What is the difference between spinal shock and neurogenic shock?
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.
What is neurogenic shock?
injury has severed the sympathetic chain and so this causes vasodilation and warm shock.
How do we treat neurogenic shock?
put on inotropes
ICU
surgical referral.
