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PAR2022 - Trauma > Week 3 > Flashcards

Week 3 Flashcards

1
Q

define shock?

A

failure of the circulatory system leading to inadequate organ perfusion and tissue oxygenation

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2
Q

Define perfusion?

A

the ability of the cardiovascular system to provide tissues with adequate blood supply to meet their functional demands and to effectively remove the associated metabolic waste products

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3
Q

what are the 4 types of shock?

A
  • hypovolaemic
  • distributive
  • cardiogenic
  • obstructive
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4
Q

What are the two main causes of hypovolaemic shock?

A
  • haemorrhage

- Dehydration

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5
Q

What type of shock is sepsis a combination of?

A

hypovolaemic
distributive
cardiogenic

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6
Q

What is the main cause of distributive shock?

A

Neurogenic shock

-spinal injuries

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7
Q

What is the main cause of cardiogenic shock?

A

Ischaemia
Valve dysfunction
arrhythmias

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8
Q

What is the main cause of obstructive shock?

A

Pulmonary embolus

Tension pneumothorax

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9
Q

What are keys signs of cardiac tamponade?

A
  • muffled heart sounds
  • Jugular Vein Distension
  • Higher DBP and lower SBP starting to narrow BP
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10
Q

what systems regulate perfusion?

A

Neural:
- ANS (baro and chemo receptors)

Hormonal:
- Renin-angiotensin-aldosterone, adrenal glands

Spenic discharge
Fluid shifts

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11
Q

Where are baroreceptors located?

A

Corotid bifurcations and aortic arch

  • monitor strech on vessel walls
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12
Q

What do chemoreceptors measure?

A

O2, Co2 and H+

Want to blow off co2

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13
Q

what hormones are used in regulating perfuson?

A

adrenaline and noradrenaline
Renin-angiotensin
ADH anti diuretic

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14
Q

How much blood does the spleen hold and how much can it release during shock?

A

300mls.

Can release 2/3 of it to increase blood vol.

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15
Q

What are the types of perfusion fluids?

A

Intravascular - in the vessels
Interstitial - between the cells
Intracellular - in the cells

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16
Q

what is the formula for BP?

A

SVR X CO

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17
Q

What is the formula for CO?

A

HR X SV

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18
Q

What is the formula for SV?

A

EDV - ESV

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19
Q

What kind of shock affects the System vascular resistance?

A

Anaphylactic shock
Neurogenic shock
Septic shock

20
Q

What kinf od shock affects the end diastolic vol?

A

obstructive

hypovolaemic

21
Q

What kind of shock affects end systolic volume

A

cardiogenic

22
Q

What is included in the lethal triad?

ON EXAM

A

Coagulopathy
Acidosis
Hypothermia

23
Q

What is coagulopathy?

A

a condition in which the bloods ability to clot is impaired

24
Q

Aerobic respiration generates how many ATP?

25
Anaerobic respiration in hypoperfusion generates how many ATP?
2 + 2 lactic acid
26
What are key characteristics of hypovolaemic shock?
most common cause of shock Loss of RBCs impairs oxygen transport Shock in trauma is hypovolaemic until proven otherwise
27
What are key characteristics of Distributive shock?
Decreased systemic vascular resistance due to vasodilation | - spinal cord injury os most common cause
28
What are key characteristics of Cardiogenic shock?
Intrinsic - blunt trauma causing muscle damage or dysrhythmia Extrinsic - pericardial tamponade/tension pneumothorax
29
What are injuries associated with haemorrhagic shock?
Traumatic aortic rupture Haemothorax Abdominal organ injury Fractures
30
What type of injury is usually associated with neurogenic shock?
spinal cord injury above T4 - T6 - loss of sympathetic tone - blood vessels dilate - blood return to heart decreases and cardiac output drops - Perfusion and tissue oxygenation are usually maintains - skin remians pink and dry
31
What are injuries associated with cardiogenic shock?
- Pneumothorax - pericardial tamponade (becks triad - low arterial BP, JVD, muffled heart sounds) - Blunt injury to heart - dysrhytmias and ruptures
32
Wjat are the 3 stages of shock?
Compensated Uncompensated Irreversible
33
What VS do the stages of shock look at ?
Same as PSA HR/BP/Skin/CS
34
What are the VS seen in compensated shock?
HR - mild tachy CS - Lethargy, confusion, combative Skin - Decreased cap refil, CPC BP - normal/slightly elevated
35
What are the VS seen in uncompensated shock?
HR - Tachy CS - Confused/unconscious Skin - Decreased cap refil/cold extremeties/cyanosis BP - decerased
36
What are the VS seen in irreversible shock?
HR - bradycardia/severe arrythmias CS - coma Skin - Decreased cap refill/cold extremities/cyanosis BP - Hypotension +++
37
How much blood is lost in the 4 classifications of shock?
Stage 1 = <15% (750mls) Stage 2 = 15-30% (750 - 1500mls) Stage 3 = 30-40% (1500 - 2000mls) Stage 4 = >40% (>2000mls)
38
What is the HR expected to see in the different stage sof shock?
Stage 1 = <100 Stage 2 = >100 Stage 3 = >120 Stage 4 = >140
39
What is the treatment for hypovolaemic shock as per AV CPG's?
1. manage potential mimics (tension pnuemothorax, significant pain, environmental) 2. If SBP over 70 - tolerate hypotension for 2 hours, perpare for deterioration, consult with clinician 3. if SBP under 70 - Normal Saline 250ml IV repeat 250 as required (max 2000mls) Titrate to 70SBP
40
What is the fluid treatment for traumatic head injury?
``` Nomal saline (max 40ml/kg) aim for SBP >120 ``` If SBP <120 after 40ml/kg consult clinician If consult unavailable provide additional 20ml/kg
41
What is the ventilation treatment for traumatic head injury?
if ventilation required 6-7ml/kg Spo2 = >95% EtCO2 = 30 - 35
42
what is the purpose of fluid resuscitation?
to replace lost intravascular volume in the setting of hypotension due to hypovolaemia - normalise tissue perfusion by improving preload
43
What types of fluids do we use?
Crystalloids: - Hartmann's Isotonic crystalloid (similar concentration to extracellular fluid) - Isotonic normal saline Colloids: - Large protein type molecules in water or solution
44
What VS do you aim for with hypovolaemia?
HR <100 | SBP >70
45
What can happen if we give too much fluid?
Haemodilution - dilutes clotting factors and decreases oxygen carrying capacity Raise BP - may dislodge clots and increase internal bleeding Tissue oedema may occur as fluid moves to interstitial space
46
what are the best veins for venipuncture?
ARM: - Medial cubital vein - Medial Cephalic vein UPPER ARM: - Cephalic vein HAND: - Digital dorsal veins - Dorsal metacarpal vein - Dorsal venous network - Cephalic vein - Basilic vein
47
What veins do we have to be careful of with venepuncure?
Basilic veins (nerve and artery underneath)

PAR2022 - Trauma (12 decks)

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