Shock and Sepsis Handout

SHOCK = Inadequate tissue perfusion. Shock is the effect manifested from a cellular level. SEPSIS = SIRS (systemic inflammatory response syndrome) + source of infection
Types of shock Hypovolaemic o Reduction in circulating volume o Haemorrhagic (rupture AAA/laceration) or severe dehydration o Weak, thready pulse, cool o Mx = ABCDE +fluid resuscitation, stop haemorrhage Cardiogenic o Pump failure Stages of Hypovolaemic Shock o 1111 o Tachycardic, cool to touch o Mx: ABCDE + Rx cause e.g. ACS treatment,pericardiocentesis

SEPTIC o Pathogenic toxins and inflammatory mediators lead to loss of vascular tone + loss of peripheral vascular resistance. This causes low BP and inadequate tissue perfusion. o C/F: warm, flushed patient, tachypnoeic tachycardic, bounding pulse,low BP o SIRS (Present if 2 of the following, HR>90, Temp <36 or >38, RR>20 or PaCO2 <4.3kPa, WCC <4 or >12 ) o severe sepsis (sepsis + end organ dysfunction) o septic shock (persistent hypotension despite adequate fluid resuscitation (or use of inotropes/vasopressors) o Mx = ABCDE + BUFALO (blood cultures, hourly urine output, fluids, antibiotics, lactate, oxygen). o Consult local guidelines for antibiotic choice. If unclear source give broad spectrum e.g. Tazocin/Co-amoxiclav (Azetreonam + metronidazole for penicillin allergic)
Anaphylactic o Type 1 hypersensitivity reaction, IgE mediated + histamine release. o C/F: patient is flushed and peripherally warm. Bronchospasm, Angioedema, Urticaria, Rash, Erythema, wheeze o Mx = Adrenaline 5mg (5mls 1 in 1000), 10mg IV Chloramphenamine, 200mg IV hydrocortisone Spinal Shock: - results from loss of sympathetic tone but aetiology is from trauma of the cord or a spinal anaesthesia. Low BP and vasodilation of arterioles and venous pooling.

Investigations and Management

A assess; is it patent? Do they need adjuncts? B RR, Saturations. High flow oxygen. CXR. ABG C - HR, BP, CRT, JVP, Cannula, Bloods + cultures, fluid challenge (250 500ml colloid or 500-1000ml crystalloid stat),
catheter, Clinical Signs

D - GCS, PEARL, end-organ perfusion. Blood glucose E - Abdominal exam, surgical wounds, cannula sites, rash. Search for a cause; get a more in depth history.
Culture wounds, urineanything you can see! GET SENIOR HELP EARLY!!!!!!!!!!!!