Module 9: Shock

Question 1

What is perfusion?

Answer 1

adequate delivery of blood to all tissues of the body as well as the removal of waste

Question 2

What makes good perfusion?

Answer 2

Healthy heart (pump), flood (fluid), and vessels (pipe)

Question 3

What is shunting?

Answer 3

The blood vessels redirecting blood from less essential areas of the body to more essential

Question 4

Describe the first sign of hypoperfusion

Answer 4

AMS such as confusion and restlessness

Question 5

What are the four categories of shock?

Answer 5

hypovolemic, distributive, cardiogenic, obstructive

Question 6

What is hypovolemic shock?

Answer 6

Loss of fluid like blood, plasma, and water

Question 7

If the body has lost fluid, how would the body initially compensate for the loss?

Answer 7

vasoconstriction and pulse increase
skin becomes pale and moist

Question 8

What are the universal treatments for shock?

Answer 8

maintaining body temp, position of comfort, and oxygen

Question 9

What are the characteristics of distributive shock?

Answer 9

vessels start to dilate, and capillaries begin to leak, causing blood to occupy space between capillary and the cell
neurogenic, psychogenic, anaphylaxis, septic

Question 10

What are characteristics of neurogenic shock?

Answer 10

It is a type of distributive shock, which is characterized by fluid loss

-dilated vessels in spinal cord
-absence of sweating
-loss of body temp control
-low BP
-body is unable to shunt blood
-ventilation may become a problem (think about how brain stem controls ventilation)
-erection may form in XY pts

Question 11

What are the characteristics of psychogenic shock?

Answer 11

sudden dilation of blood vessels
dip in BP
relatively quick recovery

Question 12

What are the characteristics of anaphylactic shock?

Answer 12

autoimmune condition in which body’s senses a threat from an outside source, so it releases chemical mediators. Type of distributive shock.
-the release causes: vasodilation, capillary leaking, bronchioles constriction

Question 13

What types of shock induce brochiole constriction?

Answer 13

anaphylactic shock, induces wheezing

Question 14

Describe dose for epi in anaphylactic shock in children and adults?

Answer 14

adult (>=66 lb): 03mg
children (<66 lb): 0.15mg

Question 15

What is sepsis?

Answer 15

A body’s overwhelming and life threatening response to infection that may lead to death.

Question 16

What is CHART? What is CHART for sepsis?

Answer 16

C: Chief complaint
H: History (recent infections)
A: Assessment (Vital signs that pertain to perfusion: BP, MAP, Respiration. Pulse ox, temperature)
R: Red flags
T: Treatment (fluids, 30mL per kg)

Question 17

What are the two criteria for sepsis?

Answer 17

suspected infection, organ dysfunction

Question 18

Infection + bad vitals=

Answer 18

Sepsis

Question 19

Sepsis+ Shock=

Answer 19

Septic shock

Question 20

What is the most common infection that results in sepsis?

Answer 20

Bacteria

Question 21

Sepsis causes blood vessels to ___ and capillaries to __

Answer 21

dilate, leak

Question 22

When should you lay a patient with cardiogenic shock down?

Answer 22

Never

Question 23

How should an EMT treat a pt with cardiogenic shock?

Answer 23

324 mg aspirin
keep warm
Oxygen

Question 24

Describe the characteristics of cardiac tamponade

Answer 24

Type of obstructive shock
Usually after chest trauma like gsw or puncture
fluid build up in pericardial sac

Question 25

What are the signs of symptoms of cardiac tamponade?

Answer 25

Beck’s triad
-muffled heart sounds
-jugular venous distension (JVD)
-systolic and diastolic begin to narrow

Question 26

Tension pneumothroax characteristics?

Answer 26

Type of obstructive shock
air leaks out of lung into pleural space
shift towards media sternum and pushes onto heart and trachea
is trachea midline? if no possibility of tension pneumothorax

Question 27

Compare pneumothorax to a tension pneumothorax

Answer 27

pneumothorax does not contain a shift

Question 28

What is a pulmonary embolism?

Answer 28

type of obstructive shock
clot travels into pulmonary circulation to prevent gas exchange
signs and symptoms: SOB, tachypnea, chest pain, low pulse ox despite oxygen

Question 29

What are the three stages of shock?

Answer 29

Compensated (SBP above 90)
decompensated (SBP below 90)
Irreversible

Question 30

Neurogenic and psychogenic ___ while anaphylaxis and septic include

Answer 30

vessel dilation
vessel dilation and leakeage

Question 31

A 33-year-old woman presents with a generalized rash, facial swelling, and hypotension approximately 10 minutes after being stung by a hornet. Her BP is 70/50 mmHg and her heart rate is 120 beats/min and she is vomiting. In addition to high-flow oxygen, this patient is in MOST immediate need of:

Answer 31

epinephrine, 0.3mg

Question 32

39-year-old male sustained a large laceration to his leg during an accident with a
chainsaw and is experiencing signs and symptoms of shock. You should first:
1. perform a rapid head-to-toe
2. place pt on oxygen
3. apply direct pressure
4. place a blanket on the pt

Answer 32

3. apply direct pressure

Question 33

Hypovolemic shock occurs when:
1. patient has SBP less then 100 mmHg
2. At least 10% of blood volume i slost
3. Body cannot compensate for rapid blood loss
4. clotting ability is enhance

Answer 33

3. Body cannot compensate for rapid blood loss

Question 34

A patient with neurogenic shock would be LEAST likely to present with:
1. hypotension
2. cool skin
3. tachypnea
4. altered mental status

Answer 34

2. cool skin

Question 35

A 60-year-old woman presents with a BP of 80/60 mm Hg, a pulse rate of 110 beats/min, mottled skin, and a temperature of 103.9°F. She is MOST likely experiencing:

Answer 35

septic shock

Question 36

Anaphylaxis results in
1. vessel dilation
2. symptomatic hypertension
3. capillary leaking
4. constriction of bronchioles

Answer 36

1. vessel dilation
2. capillary leaking
3. constriction of bronchioles