Week 3 - Shock Haemorrhaging and Wounds Flashcards
Name some clinical parameters of shock
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
Define shock
A life threatening, generalised form of acute circulatory failure with inadequate oxygen delivery and utilisation by cells
What are the 4 types of shock
Disruptive
Obstructive
Hypovolemic
Cardiogenic
4 causes of obstructive shock
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
What is obstructive shock
When obstructions act as barrier to cardiac flow or filling
What is distributive shock
When vasoregulation fails and severe peripheral vasodilation occurs. Fluid can also leak from the capillaries.
3 causes of distributive shock
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
What is hypovolaemic shock
Loss of intravascular volume
2 causes of hypovolaemic shock
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
Cardiogenic shock
When the heart cannot pump sufficient blood for the needs of the body
4 causes of cardiogenic shock
Pump failure
Myocardial infection
Arrhythmias
Mechanical
Treatment of distributive shock
Fluid, vasopressors (which target peripheral vasodilation), antibiotics (since one of the main causes is sepsis)
Treatment of hypovolaemic shock
Fluid, blood, stop loss of blood
Treatment of cardiogenic shock
Vasopressors, inotropes (both cause vasoconstriction), fluids
Input from cardiology
Treatment of obstructive shock
Thrombolysis
Removing a thrombus through surgery
Look for anything blocking such as a needle?
What happens to the heart rate and respiratory rate during shock
HR and RR increase (except from distributive neurogenic shock since vagal tone is affected)
What happens to the blood pressure during shock
It DECREASES
What can impact the impact that shock has on a person
Age i.e elderly have much less physiological reserve (ability to adapt to stressors)
Medications/drug use
Explain the steps from intravascular volume loss to DEATH
Decreased cardiac output
Impaired tissue oxygenation
End-organ dysfunction
DEATH
Why is blood important
Oxygen transport
Clotting
Healing and infection
Transport system
Homeostasis
How to compensate for haemorrhage shock
Increase cardiac contraction (CO) through gently increasing the influx of calcium
Shunting blood from one parti of the body to the other
The loss of which blood components are most crucial during blood loss
Red blood cells (ability to carry oxygen) and platelets + associated molecules involved in clotting capability.
Outline the trauma trial of death
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
What happens to urine output during haemorrhage shock
Less pee
What happens to mental state upon haemorrhagic shock
As more blood is lost
Normal -> Mild anxiety -> Anxious -> Confused
What is the mnemonic used to outline emergency treatment to haemorrhagic shock
C - atastrophic haemorrhage control
A - irway WITH c-spine control
B - reathing with oxygenation
C - irculation with haemorrhage control
D - isability
E - xposure
Give examples of ajuncts involved in gaining an airway
oropharyngeal and nasopharyngeal airways, tracheal intubation, rescue airways
What is the meaning of ‘blood on the floor + 4 more”
There is more blood loss than just that on the floor i.e in the 4 cavities
What is intraosseous access
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
How can we stop bleeding
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)
Which blood infusions are given following haemoorrhagic trauma
Packed red blood cells
Fresh frozen plasma
Platelets
What does tranexamic acid do
unsure - look into this
What is abrasion
Draggin against an irregular surface can be superficial/deep
What steps can be taken to treat abrasion
Clean debris
Scrub in theatre if required
Dress
Laceration
Blunt force trauma
Skin splitting
Tissue bridging
Irregular edges
Levels of depth
How to treat lacerations
Irrigate and clean
Close using glue, steristrips, staples, sutures
Incision
Sharp or penetrating trauma
More like a slash - think Glasgow smile
Stabs look less dramatic but beware of depth
How to treat incision
Clean edges and uniform shape
Degloving
When skin and its blood supply are torn off
Major trauma
Limbs/digits
Very severe
Bites
Small entry wound
Can be deep penetration
Foreign body contamination i.e animal teeth full of bacteria
Human blood borne viruses
How to treat bites
Antibiotics, tetanus, vaccines
Irrigation, delayed closure/nonclosure
