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Phase 1 Medicine > Week 3 - Shock Haemorrhaging and Wounds > Flashcards

Week 3 - Shock Haemorrhaging and Wounds Flashcards

1
Q

Name some clinical parameters of shock

A

Cardiovascular status - heart rate and blood pressure

Respiratory rate

Glasgow Coma Scale

Biochemical markers, urine output, lactate,

Scoring systems e.g SOFA (Sequential Organ Failure Assessment score)

Symptoms - fever, chest pain, abdominal pain, bleeding

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1
Q

Define shock

A

A life threatening, generalised form of acute circulatory failure with inadequate oxygen delivery and utilisation by cells

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2
Q

What are the 4 types of shock

A

Disruptive

Obstructive

Hypovolemic

Cardiogenic

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3
Q

4 causes of obstructive shock

A

Pulmonary embolism - blood clot blocks pleural arteries

Cardiac tamponade - compression of the heart by accumulation of fluid in the pericardial sac

Tension pneumothorax - accumulation of air in pleural space which decreases the venous return to the heart

Aortic dissection - a tear in the internal face of the aorta

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4
Q

What is obstructive shock

A

When obstructions act as barrier to cardiac flow or filling

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5
Q

What is distributive shock

A

When vasoregulation fails and severe peripheral vasodilation occurs. Fluid can also leak from the capillaries.

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6
Q

3 causes of distributive shock

A

Sepsis - (a toxic effect of the inflammation)

Anaphylaxis (massive release of biochemical mediators)

Neurogenic (spinal cord injury cause vagal tone problems) vagal tone = the activity of the vagus nerve

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7
Q

What is hypovolaemic shock

A

Loss of intravascular volume

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8
Q

2 causes of hypovolaemic shock

A

Haemorrhage - secondary to trauma, GI bleeding

Non-haemorrhage - burns, diabetic ketoacidosis (when you don’t have enough insulin to enter the body cells, the body breaks down fat cells for energy, producing ketones which become toxic in your body

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9
Q

Cardiogenic shock

A

When the heart cannot pump sufficient blood for the needs of the body

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10
Q

4 causes of cardiogenic shock

A

Pump failure

Myocardial infection

Arrhythmias

Mechanical

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11
Q

Treatment of distributive shock

A

Fluid, vasopressors (which target peripheral vasodilation), antibiotics (since one of the main causes is sepsis)

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12
Q

Treatment of hypovolaemic shock

A

Fluid, blood, stop loss of blood

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13
Q

Treatment of cardiogenic shock

A

Vasopressors, inotropes (both cause vasoconstriction), fluids

Input from cardiology

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14
Q

Treatment of obstructive shock

A

Thrombolysis

Removing a thrombus through surgery

Look for anything blocking such as a needle?

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15
Q

What happens to the heart rate and respiratory rate during shock

A

HR and RR increase (except from distributive neurogenic shock since vagal tone is affected)

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16
Q

What happens to the blood pressure during shock

A

It DECREASES

17
Q

What can impact the impact that shock has on a person

A

Age i.e elderly have much less physiological reserve (ability to adapt to stressors)

Medications/drug use

18
Q

Explain the steps from intravascular volume loss to DEATH

A

Decreased cardiac output
Impaired tissue oxygenation
End-organ dysfunction
DEATH

19
Q

Why is blood important

A

Oxygen transport

Clotting

Healing and infection

Transport system

Homeostasis

20
Q

How to compensate for haemorrhage shock

A

Increase cardiac contraction (CO) through gently increasing the influx of calcium

Shunting blood from one parti of the body to the other

21
Q

The loss of which blood components are most crucial during blood loss

A

Red blood cells (ability to carry oxygen) and platelets + associated molecules involved in clotting capability.

22
Q

Outline the trauma trial of death

A

Blood clotting problem (coagulopathy) causing increased lactic acid in blood –> acidosis (causing decreased heart performance) –> hypothermia (decreased coagulation) –> blood clotting problem

VICOUS CIRCLE ENSUES IF NOT TREATED

23
Q

What happens to urine output during haemorrhage shock

A

Less pee

24
Q

What happens to mental state upon haemorrhagic shock

A

As more blood is lost

Normal -> Mild anxiety -> Anxious -> Confused

25
Q

What is the mnemonic used to outline emergency treatment to haemorrhagic shock

A

C - atastrophic haemorrhage control
A - irway WITH c-spine control
B - reathing with oxygenation
C - irculation with haemorrhage control
D - isability
E - xposure

26
Q

Give examples of ajuncts involved in gaining an airway

A

oropharyngeal and nasopharyngeal airways, tracheal intubation, rescue airways

27
Q

What is the meaning of ‘blood on the floor + 4 more”

A

There is more blood loss than just that on the floor i.e in the 4 cavities

28
Q

What is intraosseous access

A

A technique which allows clinicians to gain infuse blood, fluid products, medications or obtain blood sample through insertion of needle into the bone marrow cavity

29
Q

How can we stop bleeding

A

Apply pressure

Elevate

Tourniquets

Pelvic binders

Surgical intervention through suture, clamp and pack

Specialised dressings (quikclot)

Interventional radiology - embolisation (minimally invasive treatment that blocks one or more blood vessels or abnormal vascular channel)

30
Q

Which blood infusions are given following haemoorrhagic trauma

A

Packed red blood cells

Fresh frozen plasma

Platelets

31
Q

What does tranexamic acid do

A

unsure - look into this

32
Q

What is abrasion

A

Draggin against an irregular surface can be superficial/deep

33
Q

What steps can be taken to treat abrasion

A

Clean debris
Scrub in theatre if required
Dress

34
Q

Laceration

A

Blunt force trauma

Skin splitting

Tissue bridging

Irregular edges

Levels of depth

35
Q

How to treat lacerations

A

Irrigate and clean

Close using glue, steristrips, staples, sutures

36
Q

Incision

A

Sharp or penetrating trauma
More like a slash - think Glasgow smile
Stabs look less dramatic but beware of depth

37
Q

How to treat incision

A

Clean edges and uniform shape

38
Q

Degloving

A

When skin and its blood supply are torn off
Major trauma
Limbs/digits
Very severe

39
Q

Bites

A

Small entry wound
Can be deep penetration
Foreign body contamination i.e animal teeth full of bacteria
Human blood borne viruses

40
Q

How to treat bites

A

Antibiotics, tetanus, vaccines
Irrigation, delayed closure/nonclosure

41
Q
A

Phase 1 Medicine (37 decks)

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