shock

Question 1

shock is

Answer 1

inadequate tissue perfusion. A clinical state of acute circulatory failure with inadequate oxygen utilization and/or delivery to the cells resulting in cellular hypoxia”

Question 2

is shock reversible

Answer 2

Initially reversible if treatment provided rapidly to prevent
progression to irreversible organ dysfunction.

Question 3

what happen during compensatory phase

Answer 3

the body attempts to maintain
perfusion using its available compensation mechanisms

Question 4

during decompensation phase what happen

Answer 4

During decompensation phase, body is unable to keep up
with demands

Question 5

what is fick principle

Answer 5

1. On-loading of O2 to RBC in the lung
2. Delivery of RBC to tissue cells
3. Off-Loading of O2 from RBC to tissue cells

Question 6

Factors that can affect oxygen delivery to the tissues:

Answer 6

1. Cardiac Output 2. Available Hemoglobin 3.Oxygen Saturation (SpO2)

Question 7

Things that can adversely effect oxygen delivery:

Answer 7

• Hypoxia
• Inadequate circulation
• Inadequate transport medium (e.g., hemoglobin) * Cellular toxins

Question 8

Organ Tolerance to Ischemia

Answer 8

HEART , BRAIN , LUNG -> 4-6min
❑ KIDNEY,LIVER,GI TRACT -> 45-90min
❑ MUSCLE, BONE, SKIN -> 4-6 hours

Question 9

T/F A patient with signs of compensation is already in
shock, not “going into shock”

Answer 9

T

Question 10

next stage after decompensated shock

Answer 10

death

Question 11

shock progression

Answer 11

Compensatory defenses work well to a point…
❑ When defense mechanisms can no longer overcome volume reduction, …BP
going into DECOMPENSATION

Question 12

what is hypovolemic shock

Answer 12

educed intravascular volume * May occur with acute blood volume loss due to
dehydration (loss of plasma)
* Hemorrhage (loss plasma + RBC), upsets the relationship of fluid volume to size of container balance.

Question 13

what are the 2 types of hypovolemic shock

Answer 13

Absolute Hypovolemia (hemorrhagic cause)
Relative Hypovolemia (non-hemorrhagic causes)
eg: GI losses, skin losses, renal losses third-space losses (shifting of fluid into interstitial space)

Question 14

how hypovolemic shock occurs with blood loss

Answer 14

1. Heart stimulated  Cardiac Output through release of epinephrine from adrenal glands
2. Sympathetic system releases norepinephrine to  blood vessel size (to reduce container size)
3. This closes peripheral capillaries leading to anaerobic metabolism at cellular level

Question 15

what is distributive shock

Answer 15

Vascular container enlarges without proportional increase in fluid volume
* Relatively less fluid will be available for size of container.
* The amount of fluid available to the heart as preload decreases
and cardiac output falls.

Question 16

how does distributive shock occurs

Answer 16

Resistance to flow is decreased because of  vessel size leading to  diastolic BP. Net effect is  systolic & diastolic BPs

Question 17

neurogenic distributive shock occurs when

Answer 17

Can occur when a cervical spine injury damages the spinal cord above where the nerves of the sympathetic nervous system exit.
* Because of loss of sympathetic control vessels dilate below level of injury.

Question 18

difference btw neurogenic shock and spinal shock

Answer 18

neuro:Disruption of sympathetic nervous system leading to dilation peripheral arteries
(↓BP, pulse normal-slow, warm dry skin below level, alert oriented, no reflexes)

spina :lnjury to the spinal cord that results in temporary loss of sensory and motor function

Question 19

can spinal and neurogenic shock occurs at the same time

Answer 19

yes

Question 20

what is septic chock

Answer 20

Cytokines, which are locally active hormones
produced by WBC responding to infection cause damage to the wall of the blood vessels, causing peripheral vasodilation and a leakage of fluid from the capillaries into the interstitial space.

Question 21

what is psychogenic shock

Answer 21

Mediated through parasympathetic
Nervous system… vagal nerve stimulation produces bradycardia. Can also lead to transient peripheral vasodilation and hypotension. If severe enough:  Cardiac output and then vasovagal syncope

Question 22

type of obstructive shock

Answer 22

mechanical
pericardial tamponade
tension pneumothorax

Question 23

stage of shock

Answer 23

Pre-shock (compensated)
The body’s compensatory mechanisms are able to maintain
some degree of tissue perfusion.

• Shock (decompensated)
  The body’s compensatory mechanisms fail to maintain tissue perfusion (blood pressure falls).
• End-organ dysfunction (irreversible)
  Tissue and cellular damage is so massive that the organism dies even if perfusion is restored

Question 24

As compensatory mechanisms fully engage, what signs and symptoms would you expect to see?

Answer 24

• Tachycardia
• Tachypnea
• Pupillary dilation
• Decreased capillary refill * Pale cool skin

Question 25

When compensatory mechanisms fail, what signs and symptoms would you expect to see?

Answer 25

• Hypotension
• Falling SpO2
• Bradycardia
• Loss of consciousness * Dysrhythmias
• Death

Question 26

pulse, skin BP, LOC in compensated shock

Answer 26

increased, tachy
white, cool, moist
normal
unaltered

Question 27

pulse, skin BP, LOC in decompensated shock

Answer 27

marked increased marked tachy
can progress to brady
white, cold, waxy
decreased
altered from disoriented to coma

Question 28

shock complication

Answer 28

Acute Respiratory Distress Syndrome (lung lining damage) ❑Acute Renal Failure (ischemic reaction)
❑ Hematologic Failure (coagulopathy)
❑ Hepatic Failure (liver ischemic reaction)
❑ Multiple Organ Failure
❑ Failure of 1 major body system
leg: lungs, kidneys, blood clotting, liver)
associated with mortality of 40%.

Question 29

first symptom you would except to find for shock

Answer 29

increase respiratory rate
increase heart rate

Question 30

Second most common physiological response to the development of shock? plus symptom

Answer 30

“Peripheral vasoconstriction”
* Pale skin * Cool skin * Weakened peripheral pulse, flat neck veins

Question 31

As shock progresses – what physiological effects are seen?

Answer 31

• End-organ perfusion falls
  What symptoms would you expect to see? * Altered mental status
• Decreased urine output (ER)

Question 32

s/s progression of shock

Answer 32

Mild anxiety→confusion/altered LOC
* Mild tachypnea → rapid laboured ventilations * Mild tachycardia →marked tachycardia
* Weakened radial pulse → absent radial pulse * Pale or cyanotic skin color
* Capillary refilling time > 2 seconds

Question 33

with which type of shock you would have a lucid LOC

Answer 33

neurogenic

Question 34

with which type of shock you would have a normal cap refil

Answer 34

neurogenic

Question 35

in which type of shock skin temp is warm and dry

Answer 35

neurogenic

Question 36

in which type of shock skin color is pale,cyanotic

Answer 36

cardiogenic and hypovolemic

Question 37

n which type of shock skin color is pale and mottled

Answer 37

septic

Question 38

n which type of shock skin color is pink

Answer 38

neurogenic

Question 39

during shock you need to have a SpO2 of at least

Answer 39

94%

Question 40

in shock if not breathing adequately which device you use

Answer 40

BVM even if breathing

Question 41

how do you transport patient in shock

Answer 41

Trauma patients in shock should be transported supine & neutral unless otherwise indicated

Question 42

effect of elevation of feet in patient in shock

Answer 42

May aggravate impaired ventilatory function by placing weight of abdominal organs on the diaphragm.
* May increase intracranial pressure with traumatic brain injury
* Patients in severe hypovolemic shock don’t get significant autotransfusion of blood to the vital organs from the extremities.
* Both Trendelenburg and shock positions contraindicated with suspected spine injury