SHOCK

Question 1

Discuss BRASH syndrome

Answer 1

Characterised by

• bradycardia
• renal failure
• AV nodal blocker
• Shock
• Hyperkalaemia

The syndrome is due to a vicious cycle in the setting of medications (av blockers ) hyperkalaemia and renal failure.
Renal failure causes hyperkalaemai and can cause the accumulation of soma AV nodal blockers. Hyperkalaemai synergizes with AV nodal blockers to cause bradyacarida and hypoperfusions
Hypoperfusion in turn worsens renal failure

Question 2

Discuss management of BRASH syndrome

Answer 2

Hyperkalaemia

• calcium gluconate 10% 10mls
• insuling dex
• salbutamol

FLuid
- guided by clinical assessment

Consider dialysis if needed

If refractory to above normal bradycardai treatment

Question 3

Describe the RUSH protocol

Answer 3

1) FAST
2) PLAX
3) APICAL 4 chamber
4) IVC
5) lung
6) Aortic slide

Question 4

List the grades of haemorrhagic shock

Answer 4

GRADE 1
-loss of <15% or <750mls 
-PR >100
-BP normal 
-PP normal or decreased
-cap refill <2
RR 14-20

Grade 2 
-loss 15-30% 750 -1500
-PR >100
-BP normal 
-PP decreased
-Cap refill 2-3 
RR 20-30

Grade 3 
30-40% 1500-2000 mls 
PR >120
-Decresed BP
-Pulse pressure marked down 
-Cap refill 3-4
RR 30-40

Grade 4
>40% >2000
-PR >140
-Decreased BP 
-Decreased PP
-cap refill > 5
RR >40