Week 13: Anaphylaxis & Shock Flashcards
What is shock?
Shock is a serious disruption of the normal metabolic function resulting from inadequate oxygenation and/or perfusion of the body tissues
What do body cells do in shock?
Normal aeorbic metabolism cannot take place and the body cells switch their reserve capacity to function
What loss is involved in hypovolemic shock?
- blood loss
- fluid loss
What can blood loss be from?
- trauma
- gastrointestinal or obstetric haemorrhage
- AAA
What can fluid loss be from?
- burns
- gastrointestinal loss
- severe dehydration
- diabetic ketoacidosis
- pancreatitis
- ischemic bowel
What are symptoms of hypovolemic shock?
- anxiety/agitation
- cool/clammy skin
- confusion
- decreased or no urine output
- generalised weakness
- pale skin colour
- rapid breathing
- sweating/moist skin
Define cardiogenic shock
The inability of the heart to maintain cardiac output necessary to meet body needs, causing extra strain on the heart causes decreased tissue perfusion
What are common causes of cardiogenic shock?
- arrhythmia
- myocardial infarction
- myocarditis
- acute valve failure
- overdue of negatively intropic drugs
What can help cardiogenic shock?
- calcium channel blocker
- beta blocker
What do calcium channel blockers do?
Helps to lower the blood pressure by preventing calcium entering cells of the heart and arteries, reducing the contraction-amlopdine
What do beta blockers help to do?
Slow the heart rate down by blocking the action of hormones such as adrenaline
What are symptoms of a major pulmonary embolism (PE)
- short of breath suddenly
- tachycardia
- tachypnoea
- diaphoresis
- anxiety
- coughing up pink foamy mucus
- vasovagal syncope
What is the treatment for a major pulmonary embolism?
- fluids
- analgesia
- O2 pre-alert
What are the symptoms of a tension pneumothorax ?
- chest pain
- shortness of breath
- tachypnoea
- tachycardia
- reduced air entry
- unequal rise and fall of the chest
- hyper resonate chest
What is the treatment for a tension pneumothorax?
- needle compression
- O2 therapy
- analgesia
What are the symptoms of cardiac tamponade?
- chest pain
- SOB
- tachypnea
- tachycardia
- venous neck distension
- faint/light-headed
- pain in right upper abdomen
What is the treatment for cardiac tamponade ?
- pericardiocentesis
What is neurogenic shock?
- spinal shock
Damage to the sympathetic pathways in the spinal cord may result in the loss of control over the size of the blood vessels- causes systemic vascular dilation occurs, with resulting mismatch between circulating volume and circulatory capcity
What can neurogenic shock lead to?
Blood pressure can rapidly increase, yet heart rate may be normal-bradycardic due to sympathetic damage
What can a major cerebral or spinal injury be caused by?
- rtc causing damage to CNS
- sports injuries to spine
- gunshot wounds to spine
- medications affecting autonomic nervous system, which regulates breathing and other automatic body functions
What are symptoms of a major cerebral or spinal injury?
- dizzy/faint
- nausea
- sweating
- vacant gaze
- anxiety
- pallor
What are symptoms of caudal equine syndrome?
- urinary retention
- urinary feral incontinence
- weakness or paralysis of more than one nerve root, which can affect lower extremities
- pain in back and legs (sciatica)
What are toxic causes/ sepsis caused by?
- carbon monoxide (old boilers)
- cyanide (solid crystals or gas)
- hydrogen sulphate
- poisons causing methaemoglobinaemia
- anaphylaxis
What is septic shock?
An overwhelming infection that releases toxins causing arteriolar and capillary dilation, causing a mismatch between circulating blood volume and circulatory capacity
What are symptoms of septic shock?
- pallor
- mottled skin
- <> temp
- > heart rate
- > resp rate
- hypotension
Consider sepsis if …
The patients news score is greater or equal to 5 and/or looks unwell with a history of infection
What are the compensatory mechanisms?
- constriction of peripheral veins
- > RR/HR
- constriction of the arteries supplying non-vital organs
What is neutropenic sepsis?
A reaction to an infection which can happen to patients with low neutrophils in the blood
What must patients be if they have neutropenic chock?
Patients will be isolated until their neutrophil count rises
What are symptoms of neutropenic sepsis?
- tachypnoea
- tachycardia
- hypotension
- high temp
- pleuritic chest pain
- flu sumptoms
- catheter site infection
What is anaphylaxis?
A severe and potentially life-threatening reaction to a trigger such as an allergy
What may trigger anaphylaxis ?
- insect stings
- allergies
- serums
- drugs
- foods
What happens in anaphylaxis ?
- patient exposed to antigen
- antigen-antibody reaction
- release large amounts of histamine causing widespread capillary and arteriolar dilation
- capillaries become weak and leak, can cause oedema
- risk of bronchospasm preventing adequate pulmonary ventilation
- awareness of biphasic reactions
What are the symptoms of anaphylaxis?
- skin reactions, hives/itching/flushes,pale skin
- low blood pressure
- constriction of airway and swollen tongue or throat causing wheezing and trouble breathing
- nausea, vomiting or diarrhoea
- dizziness or fainting
What is within a anaphylaxis assessment?
- determine nature/cause
- airway (clear and patent)
- breathing (rate and depth)
- circulation (rate, quality, regular)
- cap refill
- ACVPU/GCS
- baseline obs
What is the management of anaphylaxis?
- remove trigger is possible
- adrenaline
- consider salbutamol
- consider O2
- consider fluids
What is the dose of adrenaline for anaphylaxis?
- 1mg/1ml concentration
- dose 500mcg
- repeat dose after 5 mins (50mcg)
- no limit
- administered into the vastus laterals located in the lateral part of thigh
