Shock

Question 1

Definition

Answer 1

CVS collapse resulting in inadequate organ perfusion

BP <90/60 mmHg, tachycardia

Question 2

Types of shock and clinical features, pathology

Answer 2

Hypovolemic - cold moist skin
Cardiogenic - cold moist skin
Anaphylactic - urticarial itchy skin
Septic - warm flushed skin
Neurogenic - warm dry skin

Acute myocarditis

• congestion and oedema
• lymphocytic inflammatory infiltrate

Question 3

Management of hypovolemic shock

Answer 3

Fluid +++
Surgery to stop bleeding
ICU support

Question 4

Management of cardiogenic shock

Answer 4

Fluid + to avoid overloading limited cardiac capacity
Medical emergency: strict bed rest
CCU care

Question 5

Management of paediatric sepsis

Answer 5

1. Oxygen
2. Blood tests: CBC, RLFT, Glu, ABG, culture and sensitivity
3. Fluid +++
4. Empirical antibiotics
5. Consult seniors
6. Inotropics support

Question 6

Pathogenesis - endothelial activation, macrophages and neutrophil activation, multi-organ failure

Answer 6

Endothelial activation

• factor XII –> DIC –> tissue ischaemia
• IL6, IL8, NO, ROS –> dilated leaky vessels

Macrophages and neutrophils activation

• IL1, TNF –> fever
• IL10 –> limits inflammation

Multi-organ failure