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Emergency Medicine > Treatment of Shock > Flashcards

Treatment of Shock Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Outline how the 4 types of shock are treated…

A

Hypovolaemic - IVFT
Obstructive - Relieve +/- IVFT
Vasodilatory - IVF +/- Vasopressors
Cardiogenic - Antirrhythmics and positive intropes

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2
Q

What type of shock should IVFT not be used for?

A

Cardiogenic

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3
Q

Where does IVFT end up if given slowly?

A

1/4 in IV
3/4 into interstitial
None moves intracellularly as needs a change in Na

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4
Q

What factors affect fluid movement in/out of capillaries?

A

Hydrostatic pressure
Oncotic pressure
Capillary permability

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5
Q

What mainly determines oncotic pressure?

A

Albumin levels in the blood

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6
Q

Which fluid compartment is filled when treating shock? How is this done?

A

IV

Fluid bolus/v fast infusion to prevent absorption into intersitium

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7
Q

What is the maximum volume of fluid you can give to dogs and cats?

A

No more than 1 blood volume
D - 80mL/kg
C - 50mL/kg

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8
Q

Which patients are most at risk of fluid overload?

A 
Cardiac patients
Pulmonary disease
Oliguric/anuric renal failure
Cats 
Hypoalbuminaemia
Sepsis/SIRS
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9
Q

What are the signs of fluid overload?

A

Pulmonary oedema
Peripheral swelling
Jelly-like skin tent
Oedematous conjunctiva

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10
Q

What types of fluid are used to treat shock?

A

Crystalloids
Isotonic - Hartmann’s, CSL, LRS
Hypertonic - 7% NaCl

Colloids
Synthetic - Volulyte

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11
Q

What does Hartmann’s contain? How does it compare to 0.9% NaCl?

A 
Na
K
Cl
Ca
Lactate
0.9% NaCl only contains Na and Cl but at higher levels than Hartmann's
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12
Q

What is the function of lactate in Hartmann’s?

A

Metabolise to bicarbonate -> Treats metabolic acidosis

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13
Q

what can’t be given at the same time as Hartmann’s due to it containing Ca and why?

A

Blood products - Ca chelates with blood preservatives

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14
Q

When are bolus and slow administrations of crystalloids indicated?

A

Bolus
Hypovolaemic shock
Obstructive shock
Vasodilatory shock

Slow
Dehydration/maintenance
Diuresis

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15
Q

What occurs commonly with shock and can it be treated with Hartmann’s?

A

Metabolic acidosis - yes because contains lactate

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16
Q

What are the fluid bolsus doses for dogs and cats?

A

D - 10-20mL/kg
C - 5-10mL/kg
Over 15 minutes <4x
Make sure no additives in fluid!

17
Q

Outline the mechanism of hypertonic saline for treating shock…

A

High conc of Na in blood –> water is drawn into vessels from interstitium

18
Q

When is hypertonic saline indicated and contraindicated?

A

Indicated
Traumatic brain injury
Cerebral oedema
Large dog breed

Contraindicated
Hyper/hypoNa
Dehydration

19
Q

How is hypertonic saline administered in shock?

A

2-4ml/kg over 10m
ONCE
Followed by isotonic

20
Q

When are colloids indicated and contraindicated?

A

Indicated
Sever hypoproteinaemia
Large dog

Contraindicated
Coagulopathy
Renal failure
Sepsis

21
Q

Why aren’t colloids used often/

A

Possible adverse effects
Kidney injury
Coagulopathy
Increased risk of fluid overload

22
Q

How are colloids administered?

A

D - 5-10ml/kg, C - 2.5-5ml/kg
Over 15m
<4x

23
Q

How are IVFT delivered to different sized animals to provide the correct rate? What type of catheter should be used?

A

Med-large - Pressure bag
Small-med - Fluid pump
Cats - Syringe by hand or by driver

Short, wide bore catheter

24
Q

What must be done when treating obstructive shock?

A

Relieve the obstruction

25
Q

How is vasodilatory shock treated?

A

IVFT - isotonic crystalloids
Treat underlying causes
Vasopressors

26
Q

Name four vasopressors used to treat vasodilatory shock…

A

Dopamine
Noradrenaline
Adrenaline
Vasopressin

27
Q

How is cardiogenic shock treated?

A

Treat underlying cause - arrhythmias, +ve intropes

Treat CHF - O2 furosemide, thoracocentesis

28
Q

Give 3 examples of ventricular arrhythmias. What can they occur with?

A 
VPCs
Acclerated idioventricular rhythm (<180bpm)
Ventricular tachycardia
- Cardiogenic shock
- Hypovolaemic shock
- GDV (obstructive shock)
- SIRS/sepsis (vadodilatory)
29
Q

How is ventricular tachycardia treated?

A

Lidocaine IV @ 2mg/kg slow

Emergency Medicine (4 decks)

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