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INP3 - SALLY > Week 2 - Shock > Flashcards

Week 2 - Shock Flashcards

1
Q

Define Shock

A

state of inadequate tissue perfusion leading to impaired cell metablosim and function

if untreated organ failure > irreversible > death

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2
Q

4 stages of shock

A
  • initial
  • compensatory
  • progressive
  • refractory/ irreversible
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3
Q

initial stage characteristics (2)

A
  • imbalance between demand and supply

- hypoperfusion begins

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4
Q

compensatory stage characteristics (3)

A
  • compensatory mechansims activated
  • decreased cardiac output results in release of adrenaline and noradrenaline > increased heart rate
  • blood flow to heart, lungs and brain maintained (blood flow to kidneys reduced)
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5
Q

compensatory stage signs and symptoms (7)

A
  • decreased consciousness
  • increased RR
  • increased HR
  • decreased BP
  • decreased UO
  • increased BGL
  • cool clammy skin
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6
Q

progressive stage characteristics (5)

A
  • compensatory mechandims fail
  • GIT devoid of blood > increased risk of gastric ulcers and bleeding
  • decreased CO leads to myocardial ischeamia
  • failure of the Na+ and K+ pump > peripheral oedema
  • aggressive management needed to prevent MODS
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7
Q

progressive stage (signs and symptoms) *(9)

A
  • increased RR
  • increased WOB
  • crackles (APO)
  • increased HR
  • decreased blood pressure
  • weak peripheral pulses
  • peripheral oedema (failure of the Na+ and K+ pump)
  • decreased UO
  • delirum
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8
Q

refractory stage characteristics (4)

A
  • death of the cells
  • build up of toxins
  • MODS
  • recovery is unlikely
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9
Q

refractory stage signs and symptoms (3)

A
  • coagulation altered
  • anuria
  • respiratory failure
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10
Q

septic shock (I am remembering this well) just go to book and make sure I remember all the main things

A

good

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11
Q

cardiogenic shock

A

is an inability of the heart to pump blood resulting in decreased CO and BP and leading to tissue hypoperfusion

occurs in 6 - 10% of people post AMI with ST elevation
only 2% without ST elevation
48 hours post AMI
60 - 80% mortality rate despite appropriate treatment

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12
Q

cardiogenic shock causes

- know 5

A
  • AMI
  • arrythimas
  • complications of cardiac surgery
  • cardiac arrest
  • electrolyte imbalance
  • infections
  • electrolyte imabalances
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13
Q

cardiogenic shock signs and symptoms (12)

A
  • increased RR, WOB, HR, BP
  • crackles (due to APO) as there is tissue hypoperfusion
  • weak thready pulses
  • cyanosed extremeties
  • increaded CVP (hypoperfused)
  • distended neck viens
  • peripheral oedema
  • increased cap refill
  • decreased UO
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14
Q

management of cardiogenic shock

A

increase CO and decrease workload of the heart

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15
Q

cardiogenic shock (main interventions and assessments)

A
  • pathology (cardiac enzymes, FBE, U&E)
  • ABG > insert arterial line
  • IV access (cautious fluid administration as haven’t lost any fluid so don’t want to overwork the heart)
  • CVC (to monitor CVP as will be increased)
  • IDC
  • INOTROPES (dopamine or adrenaline) if decreased BP
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16
Q

Complications of cardiogenic shock (6)

A
  • cardiopulmonary arrest
  • dysthrthmia (VT)
  • renal failure
  • MODS
  • stroke
  • death
17
Q

Distrubutive shock

  • what is it?
  • 3 types?
A

intravascular volume is displaced
- decreased venous return due to alteration in blood vessel tone

1) septic shock
2) anaphalytic shock
3) neurogenic shock

18
Q

Define Septic shock

A

infection induced hypotension despite adequate fluid resuscitation with the presence of perfusion abnormalities including lactic acodosis, oliguria and acute alteration in mental status.

19
Q

septic shock risk factors (5)

A
  • age
  • malnutrition
  • chronic medical conditions (COPD, diabities)
  • splenectomy
  • major trauma
20
Q

septic shock clinical manifestations 2 stages (6) & (8)

A

Early (warm) Phase:

  • increased RR
  • decreased BP
  • increased HR
  • thready pulse
  • febrile
  • anxious

Late (cold) phase:

  • lethargic > coma
  • increased RR
  • decreased BP
  • increased HR
  • cool pale skin
  • anuria
  • decreased CVP
  • decreased body temp
21
Q

septic shock management (5)

A
  • find source of sepsis
  • iv fluids
  • IVAB
  • Inotropes
  • BGL control (if too high insulin)
22
Q

septic shock (main interventions) *(6)

A
  • ECG
  • CVP
  • pathology (U&E, FBE)
  • ABG
  • blood, urine and sputum sample
  • inotropes
23
Q

Anaphylactic shock

A

systemic hypersensitivity reaction
(antigen - antibody response)
- sudden, severe and systemic

  • can progress to death within 3 minutes if no treatment, however can take upto 4 hours
24
Q

causes of anaphylactic shock (6)

A
  • bites and stings
  • foods

medications:
- antibiotics (penicillin)
- asprin and NSAIDS
- vitamins (thiamine and folic acid)

blood products

25
Q

anaphylactic shock predisposing factors

A
  • asthma
  • eczma
  • previous ANA shock
26
Q

anaphylactic shock main interventions

A
  • iv access
  • fluid resus stat 1l
  • inotropes
  • antihistamines (controversial)
  • systemic corticosteroids
27
Q

neurogenic shock define

A

imbalance between parasympathetic and sympathetic vascular smooth muscle > resulting in massive systemic vasolidilation

28
Q

neurogenic shock cause

A
  • trauma to spinal cord
  • head injury
  • depressive drugs
  • anastheitic drugs

INP3 - SALLY (9 decks)

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