Assessment
Management
Drugs
Lucky dip
100
Four different types of shock
Cardiogenic
Hypovolaemic
Obstructive
Distributive
100
50M presents shocked with chest pain. ECG below. Next step?
Activate cath lab.
100
Dose of adrenaline in anaphylaxis.
0.5mg, 1:1000
100
True/false: shock may occur in presence of normal blood pressure.
True
200
Name 3 physical signs specific to cardiogenic shock.
Cardiac murmur
Cool peripherally
Bibasal creps
Irregular pulse
Orthopnoea
SOB
200
Preferred site for needle decompression of tension pneumothorax?
2nd ICS, MCL.
200
What receptors does noradrenaline work on?
Mainly alpha-1
Some beta-1
200
Name three types of distributive shock.
Septic
Neurogenic
Anaphylactic
300
Name 3 life threatening causes of shock that may be identified on bedside USS
AAA
Haemoperitoneum
Pneumothorax (tension)
Cardiac tamponade
Globally poor cardiac contractility
Surrogate markers of PE - large RV, McConnels sign
300
MAP target for first 5 days following SCI?
>85
300
Features of a high risk PE?
Cardiac arrest
Persistent hypotension:
- SBP <90 sustained for >15min or
- Requiring vasopressor support or
- >40mmHg drop in SBP
300
Apart from HR and BP, what are 3 other markers of tissue hypoperfusion?
Dusky or mottled skin
Delayed cap refill
Altered mental status
Low urine output
Elevated lactate level
400
Neurogenic shock occurs above what spinal cord level?
T6
400
Name 5 biochemical targets in MTP.
pH >7.2
Potassium <5
Ionised calcium >1.1 mmol/L
Platelets ≥ 50 (>100 in head injury)
INR < 1.5
Fibrinogen ~ 2
400
2nd line therapy for hypotension in beta blocker overdose is ______________
High dose insulin euglycaemic therapy (HIET)
400
Other than trauma what are 3 common causes of critical bleeding?
Gastrointestinal bleeding
Ruptured aortic aneurysm
Obstetric haemorrhage
500
Name 4 USS signs that may be seen in cardiac tamponade.
Pericardial effusion
RV collapse in diastole
RA collapse in systole
IVC distension without respiratory variation
500
Name 2 of the 4 NSW ACI clinical criteria for VA ECMO?
Hypotension: systolic BP <90mmHg on inotropes
Lactate >5mmol/L
Echocardiogram: confirmation of low cardiac output
Malperfusion: skin mottling, oliguria >4hr
500
Name the receptors dobutamine acts on.
Beta 1
Beta 2
Alpha 1 in large doses
500
What is the difference between neurogenic and spinal shock?
neurogenic shock: state of hypoactivity of sympathetic nervous system in pts with injury above T6
spinal shock: flaccid areflexia that may occur after spinal cord injury, "concussion" of spinal cord