Shock

Question 1

what is shock?

Answer 1

syndrome of inadequate tissue perfusion to meet metabolic requirements

Question 2

what does normal perfusion require?

Answer 2

cardiac function
vascular bed capacity
circulating blood volume

Question 3

markers of perfusion

Answer 3

BP
consciousness (brain perfusion)
UO (renal perfusion)
lactate

Question 4

classification of shock

Answer 4

• hypovolaemic
• cardiogenic
• obstructive
• distributive
• endocrine

Question 5

causes of hypovolaemic shock

Answer 5

acute haemorrhage

fluid-depleted states (dehydration, burns)

Question 6

how does hypovolaemic shock caused reduced perfusion?

Answer 6

reduced SVR
reduced cardiac pre-load
reduced CO

Question 7

what is cardiogenic shock?

Answer 7

reduced CO either due to reduced contractility (SV) or reduced HR

Question 8

causes of cardiogenic shock

Answer 8

ischaemic dysfunction
cardiomyopathies
valvular damage
dysrhythmias

Question 9

what is obstructive shock?

Answer 9

mechanical obstruction to normal CO

Question 10

direct causes of obstructive shock

Answer 10

PE

air/ fat/ amniotic fluid embolism

Question 11

restriction to cardiac filling causes of obstructive shock

Answer 11

cardiac tamponade

tension pneumothorax

Question 12

what is distributive shock?

Answer 12

disruption to normal vascular autoregulation and profound vasodilatation

Question 13

causes of distributive shock

Answer 13

sepsis
anaphylaxis
acute liver failure
spinal cord injuries

Question 14

causes of endocrine shock

Answer 14

severe uncorrected hypothyroidism
Addison’s
thyrotoxicosis

Question 15

systems to reverse shock

Answer 15

release of pituitary hormones
cortisol
glucagon

Question 16

how can shock lead to DIC and reperfusion injuries?

Answer 16

haemodynamic changes can lead to inappropriate activation of coagulation system

Question 17

presentation of cardiogenic shock

Answer 17

cold 
clammy
hypotension
chest pain
oedema

Question 18

presentation of distributive shock

Answer 18

raised JVP
pulsus paradoxus
signs of cause
hypotension

Question 19

presentation of anaphylactic shock

Answer 19

vasodilation
erythema
oedema
bronchospasm
hypotension

Question 20

presentation of hypovolaemic shock

Answer 20

blood loss
tachycardia
increased RR
reduced UO and GCS
hypotension

Question 21

management of shock

Answer 21

ABCDE
establish wide bore IV access
direct pressure/ tourniquet
fluids

Question 22

what to be aware of when giving fluids in shock?

Answer 22

beware of overload as susceptible to pulmonary oedema due to microvascular dysfunction

Question 23

what is the fluid challenge?

Answer 23

rapid administration of fluid with assessment of response

Question 24

choice of fluids

Answer 24

• crystalloids (water and salts, need large amounts)
• colloids (anaphylaxis risk due to proteins present)
• blood

Question 25

pharmacological management of shock

Answer 25

adrenaline (alpha and beta agonist)
NA (alpha agonist)
ADH
dopamine
dobutamine

Question 26

mechanical support options

Answer 26

balloon pumps, LVADs, RVADs

ECHMO

Question 27

side effects of resuscitation

Answer 27

oedema
ARDs
bowel oedema
need to do de-escalation to remove excess fluid