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how would you administer fluids in suspected hypovolaemic shock?
blood giving set in case need to give blood later
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what different signs and symptoms would you see in cardiogenic shock compared to hypovolaemic shock?
cardiogenic: irregular heartbeats, ectopics, AF, CO falls early as heart is ischaemic and so cannot compensate for drop in BP as well
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after giving fluid and oxygen what happens in septic shock?
BP still falls because vessels are dilated and leaky making SVR fall therefore VR and hence SV and so CO falls
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what investigations need to be done in septic shock
culture from blood, wound, catheter, sputum, urine, stoma! ABG
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whats happens post fluid challenge if you think its caridogenic shock?
situation gets worse as heart cannot handle fluid load. RR gets higher and O2 sats get worse
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what are the signs of LVF?
- pulm oedema,
- tachycardia,
- tachypnoea
- breathlessness
- peribronchial cuffing - excess fluid builds up in small airways leads to small patches of atelectasis
- wheeze
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if suspect cardiogenic shock due to LVF then whats the Rx?
diuretic, catheter, ECG look for ischaemia and refer to cardiologist
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What will vital obs be like in septic shock?
- HR: bounding
- peripheries: warm
- cap refill: fast
- RR: high
- UO: reduced
- core temperature: increased
- sweaty
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How do you treat septic shock?
- oxygen hudson mask
- fluid challenge 250mls
- if responds give more fluid
- antibiotics
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In shock what monitoring needs to be done apart from vital obs?
- urine output
- ECG
- listen to chest - fine crackles: pulm oedema (water); coarse crackles: infection (pus porridge)
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