Name that Shock

Question 1

At this stage, changes occur at the cellular level and compensatory mechanisms are able to maintain tissue perfusion

Answer 1

What is Stage 1 (Pre-shock)

Question 2

Describe nervous system compensatory mechanisms which occur after baroreceptors are stimulated and send impulses to the vasomotor center of the medulla

Answer 2

SNS Activation
Norepinephrine release
decrease CO and BP
increased sweat gland activity
dilation of pupils
increase HR = contractility
vasodilation of cardiac arteries to increase oxygen to the heart
vasoconstriction of vasculature in skin, GI tract, kidneys, venous return, and shunting of blood to vital organs

Question 3

Name the three sub-types of distributive shock

Answer 3

Septic
Neurogenic
Anaphylactic

Question 4

Stroke volume is …

Answer 4

the amount of blood ejected by the heart in one contraction

Question 5

Which symptom is one of the earliest signs of cardiogenic shock?

• 4th heart sound
• cyanosis
• altered mental status
• decreased urine output

Answer 5

Altered mental status

Question 6

When compensatory mechanisms for hypovolemic shock are activated, which two patient findings do you expect to normalize?

• CO & BP
• metabolic alkalosis and O2 sat
• intensity of peripheral pulses and body temperature
• peripheral pulses and HR

Answer 6

CO and BP

Question 7

This type of shock is characterized by massive vasodilation due to a release of histamines in response to an allergic reaction

Answer 7

Anaphylactic Shock

Question 8

You are treating a patient in hypovolemic shock. Which assessment finding indicated you should stop fluid boluses?

• peripheral cyanosis
• tachycardia and hypotension
• crackles throughout the lung fields
• increased O2 saturations

Answer 8

Crackles throughout lung fields

Question 9

A patient with undifferentiated shock has the following vital signs: BP 92/54, HR 64, elevated PCWP
You are reviewing the chart: which order would you question?
- start nipride infusion unless SBP , 90 mmHg
- keep HOB at 30 degrees
- give NS at 250 ml/hr
- begin dobutamine to keep SBP > 90 mmHg

Answer 9

Give NS at 250 ml/hr

Question 10

Which finding is the BEST indicator fluid resuscitation for a patient with hypovolemic shock has been successful?

• PAWP is normal
• MAP is 65 mmHg
• Hemoglobin is within normal limits
• Urine output is 60 mL over the last hour

Answer 10

Urine output is 60 mL over the last hour

Question 11

A patient with cardiogenic shock is cool, clammy, and hemodynamic monitoring reveals a high SVR. Which intervention is appropriate?

• decrease the rate of a prescribed D5W infusion
• increase the rate of a prescribed Nipride infusion
• decrease the rate for the prescribed Nitroglycerine infusion
• initiate a dopamine infusion

Answer 11

Increase the rate of the current Nipride infusion

Question 12

The agents cause which type of shock?

IV contrast, drugs, insect bites/stings, anesthetic agents, vaccines, foods, materials

Answer 12

Anaphylactic shock

Question 13

Name 3 key treatments for anaphylactic shock

Answer 13

A-B-C!
Ensure patient airway
Give oxygen
Medications

Question 14

What type of shock are those medications most likely used in?
Histamine H2 blocker, epinephrine, benadryl, volume expanders, solumedrol, bronchodilatiors

Answer 14

Anaphylactic shock

Question 15

What is the drug of choice in anaphylactic shock?

Answer 15

Epinephrine

Question 16

What type of shock are these meds most likely used?

Levophed, Neo-synephrine, dobutamine, vasopressin

Answer 16

Hypovolemic shock after fluid resuscitation is exhausted

Question 17

This type of shock is characterized by loss of intravascular volume, decreased SV, decreased CO

Answer 17

Hypovolemic shock

Question 18

In this stage of shock, multisystem organ failure is evident, and death is highly probable

Answer 18

Stage 3 : Irreversible Shock

Question 19

Name the shock most associated with these causes:
3rd spacing, diuresis, hemorrhage, burns, GI losses (vomiting, diarrhea, NGT output), diabetes insipidus, diabetic ketoacidosis, addison’s disease

Answer 19

Hypovolemic shock

Question 20

Name the #1 cause of hypovolemic shock

Answer 20

Hemorrhage

Question 21

List key treatments in hypovolemic shock

Answer 21

Medications
Rapid volume replacement
Control bleeding
Oxygen
Hemodynamic monitoring

Question 22

Name 3 causes of cardiogenic shock

Answer 22

Myocardial infarction
Lethal ventricular arrhythmias
end-stage heart failure

Question 23

Inability of the heart to effectively pump blood out to the system resulting in decreased CO

Answer 23

Cardiogenic Shock

Question 24

Which type of shock do these treatments best indicate?

• medication
• IABP
• correction of arrhythmias
• oxygen supplementation
• intubation/mechanical ventilation

Answer 24

Cardiogenic Shock

Question 25

These medications are used to treat which type of shock? dobutamine, dopamine, epinephrine, primacor, nitroglycerin, nipride, cardene, morphine

Answer 25

Cardiogenic shock

Question 26

Massive vasodilation caused by inflammatory response of the body due to an overwhelming infection

Answer 26

Septic Shock

Question 27

What is the hallmark S/S of septic shock?

Answer 27

Hypotension

Question 28

List key treatments in septic shock

Answer 28

- antimicrobial therapy - volume replacement - cultures (blood, urine, sputum) - vasopressors - hemodynamic monitoring

Question 29

What do these have in common? - massive vasodilation - suppression of the SNS - injury or disease to the spinal cord at the T6 level - spinal anesthesia

Answer 29

Neurogenic shock

Question 30

List 3 key treatments/interventions for neurogenic shock

Answer 30

Treat the cause Airway and Ventilation Support Vasopressors

Question 31

These are 3 major effects of which type of shock? - vasodilation - maldistribution of blood flow - myocardial depression

Answer 31

Septic Shock

Question 32

What is the root cause of this phenomena? Even with adequate fluid volume resuscitation there is hypotension and hypovolemia

Answer 32

Vasodilation

Question 33

Name that shock: - Pooling of blood - Decreased venous return - Decreased CO - Hypotension - Byradycardia

Answer 33

Neurogenic Shock

Question 34

This key characteristic of septic shock causes decreased microcirculation and poor oxygen delivery to the tissues = tissue hypoxia

Answer 34

Maldistribution of blood flow

Question 35

Name that shock: ``` Decreased EF Hyperventilation Confusion Decreased UOP increased WBC Hypoactive or no bowel sounds Flush/cool extremities ```

Answer 35

Late-stage septic shock

Question 36

Tension pneumothorax cardiac tamponade pulmonary embolism aortic dissection

Answer 36

Obstructive Shock

Question 37

Which stage of shock is characterized by failing compensatory mechanisms and organ dysfunction

Answer 37

Stage 2 (Shock)

Question 38

What is key to recognition and differentiating the presence of shock?

Answer 38

a good history and physical exam

Question 39

Name that Shock: CVP is low PCWP is low CO is elevated SVR is low

Answer 39

Distributive shock

Question 40

Name that shock: CVP is elevated PCWP is elevated CO is decreased SVR is increased

Answer 40

Cardiogenic Shock

Question 41

Name that shock: CVP is elevated PCWP is low or high CO is decreased SVR is increased

Answer 41

Obstructive Shock

Question 42

Name that shock: CVP is decreased PCWP is low CO is decreased SVR is increased

Answer 42

Hypovolemic Shock