Week 1 - Shock Flashcards
What is shock?
- A state of insufficient perfusion and oxygen delivery to vital organs and tissues throughout the body
- Life-threatening
- Signs and symptoms vary in patients
Stages of shock.
- Compensatory
- Progressive
- Irreversible
3 types of dysfunction in shock.
- Pump dysfunction (cardiogenic and obstructive shock)
- Pipe dysfunction (anaphylactic, neurogenic and septic shock)
- Tank dysfunction (hypovolaemic shock)
Name 2 categories of infection/sepsis risk factors.
- Patient
2. Treatment
Patient-related infection risk factors include:
- Burns
- Trauma
- Malnutrition
- Leukaemia
- > 70 age
- Debilitating disease (eg. COPD)
- Pregnancy
- Sleep deprivation
Treatment-related infection risk factors include:
- Immunosuppressant drugs
- Artificial airways
- Surgery
- Immobility
Common infection sites for bacteria include:
- Lungs
- Abdomen
- Skin and soft tissue
- Urinary tract
What is the pathophysiology of sepsis?
- Infection
- Inflammatory response
- Increased capillary permeability
- Complement system activation
- WBC and inflammatory mediator release
What is the pathophysiology of SEVERE sepsis?
- Intrinsic and extrinsic coagulation - thrombosis and bleeding
- Bleeding worsens and intravascular coagulation can occur
SIRS symptoms:
- Temp >38 or <36
- RR >20
- HR >90
- WBC >12x10^9/L
- Normal BP
- Normal U/O
- Normal SaO2
- Normal breathing pattern
SIRS diagnosis must include:
> 2 notable symptoms.
Sepsis diagnose must include:
Any combination of notable symptoms.
Sepsis symptoms:
- Confusion
- Hyperthermia or hypothermia
- HR >90
- Low BP
- Low U/O
- Low SaO2
- Tachypneic (RR >20)
- Organ dysfunction (raised liver/renal enzymes)
- Presence of infection
3 main effects of sepsis on the cardiovascular system:
- Vasodilation
- Maldistribution
- Myocardial depression
What is the hyper dynamic phase of sepsis?
- Early phase of sepsis
* Body moderately compensates
What is the hypodynamic phase of sepsis?
- Later phase of sepsis
* Compensatory mechanisms starting to fail
What is the effect of sepsis on the liver?
- Causes damage to hepatocytes due to hypoperfusion resulted in decreased metabolism of substances which manifests as jaundice.
- Decreases coagulation as lover cannot produce coagulation factors, leading to increased risk of bleeding.
What is the effect of sepsis on the kidneys?
- Hypoperfusion resulting in decreased U/O
- Metabolism of drugs and vitaminK
- Causing hyperkalaemia
What is the effect of sepsis on temperature?
Can cause hyper/hypothermia in hypodynamic phase.
What is the effect of sepsis on ECG?
- Sinus tachycardia
- Ventricular ectopy
- Decreased CO
What is the effect of sepsis on LOC?
Early signs include:
• decrease LOC from systemic infection
• poor cerebral blood from maldistribution causes decrease LOC
Name the types of shock.
- Cardiogenic
- Obstructive
- Hypovolemic
- Anaphylactic
- Septic
- Neurogenic
Common cause of cardiogenic shock.
- Heart failing as a pump
* Intrinsic factors
Common cause of obstructive shock.
- Heart failing as a pump
* Extrinsic factors
