Term
| what are the 4H's of cardiorespiratory arrest? |
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Definition
- Hypoxia - give o2
- Hypovolemia - give IV fluids
- Hypothermia - especially if pt has been drowning, use a low measuring thermometer to check
- Hyperkalemia - ECG can tell you this. Give calcium chloride.
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Term
what are the 4T's of cardiorepiratory arrest?
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Definition
- Tension pnemothorax - especially if there has been trauma or someone has tried to put in a central venous cathter
- Tamponade (cardiac) - particularly in cases of trauma
- Toxins
- Thromboembolism (coronary or pulmonary) consider thormbolytic drugs but these can take up to 90 mins to work
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Term
| How many cycles of CPR should you attempt between each defibrillation attempt? |
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Definition
2 mins of CPR between each single defibrillation attempt.
Also give adrenaline and amiodarone after the third shock if it is available.
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Term
| in PEA defibrillation is not recommended but what can you do to help? |
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Definition
| Give adrenaline 1mg IV as soon as there is venous access and cx to give CPR. correct any reversible conditions (4H's 4T's) and give adrenaline 3-5 mins during alternating cycles of CPR. |
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Term
| If the pt has cardio respiratory arrest and you know they have had an overdose of calcium channel blockers what can you administer? |
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Definition
| 10ml 10% calcium chloride. You can also give this in hyperkalemia and hypocalcemia. |
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Term
| You have assessed a pt and defibrillation is recommended. What Joules would you deliver the first shock. What would subsequent shocks be delivered at? |
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Definition
150-200 J biphasic for the first shock
150-360 J biphasic for subsequent shocks; or 360 J monophasic. |
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Term
| when is defibrillation indicated? |
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Definition
| Defibrillation is used to rx life threatening arrhythmias when the pt doesn't have a pulse. e.g VF or pulseless VT |
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Term
| what is the difference between mono phasic and biphasic shocks |
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Definition
Monophasic - current only travels in one direction from one paddle to the other.
Biphasic - current travels towards positive paddle then reverses and goes back. This occurs several times. |
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Term
| Which type of defibrillator shocks are associated with less burns? |
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Definition
| Biphasic shocks. They deliver one cycle every 10 milliseconds and are associated with less burns as well as less myocardial damage. |
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Term
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Definition
| when volume of circulatory system is too depleted to allow adequate circulation to tissues of the body |
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Term
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Definition
| Life threatening condition when BP drops to dangerously low level following an infection. This reduces the amount of blood and O2 reaching the body's organ stopping them from working properly. |
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Term
| Define anaphylactic shock |
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Definition
| A severe, potentially life threatening reaction to a trigger such as an allergy. |
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Term
| Dehydration and/or bleeding can predispose to which type of shock? |
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Definition
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Term
| If the pt had a massive MI or some other disease resulting in pump failure, what type of shock might they present with? |
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Definition
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Term
| Massive PE, tamponade or a tension pneumothorax may cause which type of shock? |
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Definition
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Term
| Septic, anaphylactic and neurogenic shock can be classed as distributive shock. In this type of shock is there vasodilation or vasoconstriction apparent? |
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Definition
| There is widespread vasodilation +/- leakage from endothelium. |
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Term
| A heathy adult with 5 litres circulating capacity could lose how much blood without ill effect? |
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Definition
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Term
| What is the earliest sign of hypovolemia in adults and children? |
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Definition
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Term
| What are the 3 stages of hypovolemic shock? |
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Definition
1. compensated
2. progressive/uncompensated
3. irreversible shock. |
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Term
| What happens in compensated shock? which stage of shock is this? |
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Definition
This is stage one.
Baroreceptor reflexes cause increase in myocardial contractility, tachycardia and vasoconstriction.
This maintains CO and BP and causes release of vasopressin, aldosterone and renin. |
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Term
| Describe what happened in stage 2 uncompensated shock |
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Definition
| Here there is myocardial depression, failure of vasomotor reflexes and failure of microcirculation. There is also an increase in capillary permeability, sludging and thrombosis. this results in cellular dysfx and lactic acidosis. |
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Term
Which stage of shock is this describing?
There is failure of vital organs with inability to recover. |
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Definition
| Irreversible shock, the final stage. |
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Term
| what test could help you distinguish hypovolemic shock from cardiogenic shock? |
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Definition
| USS. The vena cava can be assessed for adequate filling and echo can show any pump failure. |
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Term
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Definition
Life threatening organ dysfunction due to a dysregulated host response to infection.
pts with infections and 2 or more elements of SIRS meet the diagnostic criteria for sepsis
body temp out of 36-38
HR >90 bpm
RR >20bpm
WCC <4 or >12 x10^9 |
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Term
| How can pts with septic shock be clinically identified? |
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Definition
| In the absence of hypovolemia they have a vasopressor requirement to maintain MAP of 65mmHg or > and serum lactate greater than 2 mmol/L |
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Term
| What ages are at particular risk for sepsis? |
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Definition
| Elderly >75 years and the very young <1 year |
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Term
| Name some instrumentations, surgery and health states that increases chances of getting sepsis |
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Definition
Illegal unhygienic abortion
indwelling line/catheter
breach of skin integrity e.g. burns
DM
immunocompromise
high dose steroids, chemo
IVDU
pregnancy |
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Term
| Does alcohol abuse increase your chances of getting sepsis? |
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Definition
Yes it does.
Also males are more prone than females to develop severe sepsis but the mortality in females is higher than men. |
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Term
| What are the red flag for Sepsis by NICE |
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Definition
SBP <90mmHg or >4mmHg fall from baseline
HR >130bpm
O2 sats <91%
RR >25 bpm
Lactate >2mmol
Responds only to voice or pain/unresponsive |
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Term
| In sepsis what happens to glycemic control? |
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Definition
| It becomes bad. If you test blood glucose it is likely to be hyperglycaemic. |
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Term
| Name 3 complications of sepsis |
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Definition
1. DIC
2. adrenal failure -eg. haemorrhage secondary to meningococcus Waterhouse-Friederichsen syndrome
3. Multiorgan failure e.g. cardiorespiratory failure |
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Term
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Definition
3 IN 3 OUT
IN - IV fluids, ABx, high flow O2
OUT - bloods, urine output, lactate |
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Term
| In which type of pts with sepsis might there be no symptoms of a specific infection and the body temperature may be low or normal rather than high? |
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Definition
Very young
Very old
Immunocompromised |
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Term
| What ix would you do for sepsis? |
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Definition
FBC- look for anemia, neutropenia, neutrophilia, thrombocytopenia.
urinalysis - infection
renal fx- extent of dehydration
LFTs - hypoalbuminemia likely to be present
Blood cultures - at least 2 are required.
Clotting
Lactate
Radiology
ABG |
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Term
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Definition
An infection that triggers a particular SIRS.
Characterised by body temp outside 36-38
HR >90bpm
RR >20 bpm
WBC >12 or <4 x10^9 |
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Term
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Definition
An inflammatory state affecting the whole body. It is frequently a response of the immune system to infection
the criteria
Body temp out of keeping with 36-38
HR >90bpm
RR >20 bpm
WCC <4 or >12 x 10^9
if two or > of the above are met with/without infection, the pt is diagnosed with having SIRS. |
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Term
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Definition
| Patient with SIRS and acute organ dysfunction. |
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Term
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Definition
Sepsis with organ failure.
In order to have sepsis, the patient must fulfil 2 or more SIRS criteria and be proven to have an infection. |
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Term
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Definition
Sepsis with refractory hypotension
Make sure you know the definition of sepsis |
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Term
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Definition
Life threatening medical condition where the lungs cannot provide enough oxygen for the rest of the body.
symptoms include
severe SOB
rapid shallow breathing
tiredness, drowsiness or confusion |
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Term
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Definition
Life threatening medical condition where the lungs cannot provide enough oxygen for the rest of the body.
symptoms include
severe SOB
rapid shallow breathing
tiredness, drowsiness or confusion
feeling faint |
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Term
| What is the difference between SIRS, sepsis, severe sepsis and septic shock? |
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Definition
In SIRS you have 2 or more of the SIRS criteria but do not need to have a proven infection.
If you can prove there is an infection with 2 or > SIRS criteria you have sepsis
If you have sepsis plus organ dysfunction you have severe sepsis
And if you have sepsis plus refractory hypotension then you have septic shock.
SIRS criteria
body temp not keeping between 36-38
RR >20
HR >90
WCC <4 or >12 x 10^9 |
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Term
| In SIRS you can have WCC <4 or >12 or the presence of >10% immature neutrophils. What are immature neutrophils also known as? |
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Definition
Band forms.
Band forms >3% is called bandemia or left shift |
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Term
| What is the mortality from sepsis? |
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Definition
Severe sepsis has a mortality rate in excess of 40%
in those admitted to ITU mortality ranges from 6% with no organ damage to 65% in those with 4 or more organ failure |
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Term
| In treating sepsis what should you aim to keep the MAP and CVP at? |
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Definition
MAP >65mmHg
CVP 8-12 cm H2O |
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Term
| in surgical patients which 3 groups of pts are most likely to get septic shock? |
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Definition
those with
1. anastomotic leaks
2. abscesses
3. extensive superficial infections such as necrotising fasciitis |
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Term
How much of the adult body weight does blood compromise of?
Is this the same in children and the elderly? |
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Definition
7%. So in a 70 kg adult, this will equate to 5 litres of blood.
In children it is 8-9% of body weight and slightly lower in the elderly. |
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Term
| how many classes of hemorrhagic shock are there? |
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Definition
4
Class 1 - blood loss <750ml. <15%
Class 2 - blood loss 750-1500ml. 15-30%
Class 3 - 1500-2000ml. 30-40%
Class 4 >2000ml blood loss. >40% |
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Term
| in pts suffering from trauma, the most likely cause of shock is? |
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Definition
Haemorrhage.
However other types of shock may be also present including
tension pneumothorax
Spinal cord injury
Myocardial contusion
Cardiac tamponade |
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Term
| When assessing trauma in patients, it is worth remembering that in order to generate a palpable femoral pulse, you need an arterial pulse of... |
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Definition
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Term
| When does neurogenic shock most likely occur? |
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Definition
Following a spinal cord transection usually at a high level. This interrupts the ANS. The result is decreased sympathetic tone or increased parasympathetic tone, the effect of which is decreased PVR mediated by vasodilation.
This causes decreased preload thus decreased CO (Starling's). there is decreased tissue perfusion and thus shock is evident.
Peripheral vasoconstrictors are used to return vascular tone to normal. |
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Term
what term am I defining?
a severe life threatening, generalised or systemic hypersensitivity reaction. |
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Definition
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Term
| Where is the best site for IM injection in anaphylactic shock? |
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Definition
| The anterolateral aspect of the middle third of the thigh. |
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Term
| Give me some signs of hypoxia in pts |
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Definition
SOB
Tachypnoea
Tachycardia
Sweating
Wheezing
Colour change
Confusion
Coughing |
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