Ch13: Shock

Question 1

what is shock

Answer 1

inadequate cellular perfusion

Question 2

perfusion

Answer 2

the circulation of blood to tissues to meet the cells’ needs and remove waste

Question 3

perfusion triangle

Answer 3

heart
vessels
blood

Question 4

how does the body compensate for hypoperfusion?

Answer 4

it redirects blood flow from organs that can withstand more time without oxygen such as skin and intestines

Question 5

how to calculate pulse pressure

Answer 5

systolic – diastolic pressure

Question 6

what does a wide pulse pressure tell us?

Answer 6

the heart is working harder, arteries have become less flexible or both. very high pulse pressures may indicate heart disease

Question 7

what are sphincters in the capillary bed controlled by?

Answer 7

autonomic nervous system

Question 8

factors affecting adequate perfusion

Answer 8

1) adequate blood flow
2) adequate gas exchange and oxygenation of the blood
3) adequate glucose level
4) adequate removal of waste

(think ab aerobic respiration)

Question 9

which part of the nervous system controls the flight or flight response?

Answer 9

sympathetic (part of autonomic peripheral NS)

Question 10

3 causes of shock (hint: perfusion triangle)

Answer 10

1. pump failure - cardiogenic shock, and obstructive shock (like pulmonary embolism, cardiac tamponade, tension pneumothorax)
2. poor vessel function + excessive vasodilation - distributive shock like sepsis, anaphylactic shock, neurogenic shock, psychogenic shock)
3. low fluid volume - hypovolemic shock (including hemorrhagic and non-hemorrhagic shock)

Question 11

4 types of shock

Answer 11

cardiogenic
obstructive
distributive (sepsis, anaphylactic, neurogenic, psychogenic)
hypovolemic (hemorrhagic and non-hemorrhagic)

Question 12

how does cardiogenic shock –> pulmonary edema

Answer 12

cardiogenic shock damages heart muscle so it does not pump as well. because of the less efficient pumping, blood is backed into the pulmonary vessels. this pressure pushes fluid into the alveoli, causing pulmonary edema and inefficient oxygenation (tachypnea, crackles, rales).

*note: edema = excessive fluid build up

Question 13

myocardial contractibility

Answer 13

ability of the heart to contract

Question 14

preload

Answer 14

the pressure increase as blood fills the heart during diastole

Question 15

blood enter the heart in diastole –> stretch walls + preload –> ? myocardial contractibility

Answer 15

increases myocardial contractibility

Question 16

afterload

Answer 16

the pressure/force of the heart when pumping out the blood (systole)

Question 17

consequences of increased afterload

Answer 17

heart overworks –> heart failure in the long term (similar to the idea of wide pulse pressure)

Question 18

factors that lead to cardiogenic shock

Answer 18

low cardiac output (stroke volume x HR)
high preload
low preload
poor myocardial contractility

Question 19

pericardial effusion

Answer 19

fluid going into pericardial sac

Question 20

pericardial tamponade / cardial tamponad

Answer 20

excessive build up of fluid in pericardial sac, preventing blood from filling up ventricles

Question 21

signs and symptoms of cardiac tamponade

Answer 21

BECK TRIAD
1) jugular vein distention
2) muffled heart soudns
3) narrowing pulse pressure (why? because heart cannot pump properly in systole and and there is A LOT of preload pressure during diastole because of resistance from fluid in pericardial sac when blood tries to flow into the ventricles)

Question 22

pulmonary embolism

Answer 22

fluid bulid up

Question 23

signs of neurogenic shock

Answer 23

no sweat below injury site
hypothermia
hypotension
skin pink, warm and normal

Question 24

signs of anaphylactic shock

Answer 24

skin:
- flushed, itchy or burning sensation on face and upper part of face
- pallor
- cyanosis
- hives
- edema on face, lips

circulatory system:
- vasodilation
- drop in BP
- BP barely palpable

respiratory system:
- stridor
- itching or sneezing in nasal passages
- tightness in chest with dry cough
- dyspnea
- bronchi constriction
- secretion of mucus into lower airway
- cessation of breathing

other:
- abdominal cramping
- nausea
- vomiting
- altered mental status
- dizziness
- fainting and coma

Question 25

Compensated shock

Answer 25

early stages of shock where the body's homeostasis is still able to compensate for changes

Question 26

signs of compensated shock

Answer 26

anxiety restlessness feeling of impending doom weak, thready pulse clammy skin pallor cyanosis at lips shallow, rapid breathing nausea or vomiting CRT > 2 seconds marked thirst narrowing pulse pressure

Question 27

signs of decompensated shock

Answer 27

BP falling declining mental status labored, irregular breathing ashen, cyanotic skin thready or absent peripheral pulse dull eyes, dilated pupils poor urinary output

Question 28

how to deal with a patient with suspected shock

Answer 28

1) primary assesment 2) history taking - more abt chief complaint 3) secondary assessment 4) reassessment *same as patient assessment without scene size-up

Question 29

primary assessment of patient with suspected shock

Answer 29

1. scan for bleeding 2. assess LOC 3. airway 4. breathing 5. circulation - both distal & central pulses, mental status, CRT

Question 30

what to look for in history taking

Answer 30

SAMPLE signs & symptoms (chief complaint) allergies meds past med history (e.g. anticoagulants?) last oral intake events leading up to injury

Question 31

what is secondary assessment for

Answer 31

uncover injuries that were not found in primary assessment

Question 32

general emergency medical care for shock patients

Answer 32

1. check for bleeding; manage by applying pressure and tourniquet if needed 2. ABCs 3. spinal motion restriction if there is possibility of spinal injury 4. if there is enough time, splint any fractures or broken bones 5. consider calling ALS backup 6. reassessment every 5 mins for unstable patients

Question 33

potential causes of cardiogenic shock

Answer 33

inadequate heart function something abnormal with electrical impulses disease of muscle tissue disease/injury

Question 34

signs and symptoms of cardiogenic shock

Answer 34

chest pain cyanosis cool clammy skin weak pulse BP low pulmonary edema anxiety crackles

Question 35

how to treat cardiogenic shock

Answer 35

administer high-flow oxygen (e.g. NR mask) assist ventilations if needed position comfortably consider ALS

Question 36

causes of obstructive shock

Answer 36

obstruction of cardiac muscle leading to decreased CO: pulmonary embolism pericardial tamponade tension pneumothorax

Question 36

how to treat obstructive shock

Answer 36

administer oxygen ALS assist, rapid transport for pericardial tamponade: the only thing can be done is provide oxygen to prevent hypoxia. blood needs to be drained from pericardial sac but that is an ALS skill so CONSIDER ALS ASSIST

Question 37

symptoms of obstructive shock

Answer 37

dyspnea cyanosis rapid, weak pulse rapid, shallow respirations decreased lung compliance jugular vein distention cyanosis Beck triad (cardial tamponade): muffled heart sounds, narrowing pulse pressure, JVD

Question 37

cause of septic shock

Answer 37

severe infection

Question 37

symptoms of sepsis

Answer 37

fever tachycardia low BP

Question 37

how to treat septic shock

Answer 37

it is a complex condition to take care of because it needs antibiotics so what an EMT can do is ADMINISTER OXYGEN!! assist ventilations keep patient warm consider ALS

Question 38

what causes neurogenic shock

Answer 38

damaged cervical spine that causes excessive vasodilation

Question 39

symptoms of neurogenic shock

Answer 39

bradycardia low BP no sweating below site of injury signs of neck injury

Question 40

how to treat neurogenic shock

Answer 40

secure airway administer oxygen consider ALS preserve body heat rapid transport *the most important thing is maintaining good blood flow bc neurogenic shock patients usually have enough blood but extreme vasodilation

Question 41

what is anaphylactic shock

Answer 41

shock caused by life-threatening allergic reaction

Question 42

symptoms of anaphylactic shock

Answer 42

burning, itching skin constriction of airways vascular dilation edema coma rapid death

Question 43

how to treat anaphylactic shock

Answer 43

administer oxygen identify cause assist with epinephrine injection consider ALS

Question 44

what is psychogenic shock?

Answer 44

lack of blood flow to brain causing syncope/fainting

Question 45

treatment for psychogenic shock

Answer 45

determine duration of unconsciousness patient supine position record vital signs and initial mental status transport promptly assess and observe for any sign of head injury

Question 45

symptoms of psychogenic shock

Answer 45

normal or low BP rapid pulse

Question 45

what causes hypovolemic shock

Answer 45

loss of blood volume = 1) fluid in blood or 2) the whole blood

Question 45

signs of hypovolemic shock

Answer 45

low BP rapid, weak pulse increased RR change in mental status cyanosis cool, clammy skin

Question 46

treatment for hypovolemic shock

Answer 46

control external bleeding secure airway assist with breathing administer oyxgen rapid transport consider ALS

Question 46

nitroglycerin is usually administered for chest pain because it dilates the arteries. should it be given for cardiogenic shock?

Answer 46

NO. blood pressure is already low, nitroglycerin will exacerbate it