Trauma and Shock Flashcards
Define shock
Inadequate perfusion to meet metabolic demand
Hypoxia caused by circulatory collapse
Lead to cellular injury and organ failure
What are the different types of shock?
Hypovolaemic shock Obstructive Distributive Cardiogenic Neurogenic
What are the causes of Hypovolaemic shock?
Haemorrhage
Fluid loss
Burns
What are the causes of obstructive shock?
Tamponade
Tension pneumothorax
PE
Assessment of shock
ABC Clinical signs BP, HR, RR, UO Lactate and Base excess ECG, CXR, BM, FBC, U&Es, LFT, CRP Confusion
Why is BP not an accurate marker of shock?
BP is homeostatic
Normal over a wide range or cardiac outputs
What is a better marker?
Lactate
>2 abnormal
>4 significant hypo-perfusion
Treatment of shock?
Two large bore cannula
Oxygen
Fluids (blood)
Exclude anything that needs specialist treatment e.g. arrhythmias
What commonly causes cardiac tamponade?
Penetrating injury to the right ventricle
Why does cardiac tamponade cause shock?
Obstructive
Build up of blood in pericardium
Reduces cardiac output
Management of cardiac tamponade?
Advanced trauma life support - CABCD
C = catastrophic haemorrhage
Rapid left anterio-lateral thoracotomy or clamshell
Classic triad in cardiac tamponade?
Muffled heart sounds, distended neck veins and hypotension
How do you diagnose cardiac tamponade?
Extended FAST scan
USS (mini-echo)
How does a tension pneumothorax cause shock?
Air in pleural space
Lung collapses
Increase in pressure caused tracheal shit compressing heart and reducing cardiac output
What is the lethal trauma triad?
Coagulopathy Hypothermia Acidosis Perpetuating circle Prevent in all causes
What are signs of hypovolaemic shock?
Tachycardia Increased RR Decreased Pulse Pressure Anxious Decreased UO Decreased BP
What is a FAST scan?
Focused assessment with sonography for trauma
What are the steps of damage control resus?
Stop bleeding
Correct and prevent coagulopathy
Prevent hypothermia
Give TXA
How can you stop bleeding?
Tourniquet
Laparotomy
Thorcotomy
What comprises damage control surgery?
Packing Shunting Suture repair Staple off bowel ends Washout Temporary abdo wall closure
Back to theatre for definite surgery
