Shock

Question 1

What is shock

Answer 1

Hypoxia at cellular level

Inadequate tissue perfusion

Question 2

Most common type of shock

Answer 2

Hypovolemic shock

Question 3

Isolated head bleed can lead to shock?

If shock present what will be next step

Answer 3

No it cannot

If hypovolemic shock search for other site of bleeding

Question 4

Which arterial bleed is more severe and why

Answer 4

Transection less bleeding due to vasospasm

Laceration vasospasm leads to opening of artery more bleeding

Question 5

Why is venous bleed presented late

Answer 5

Because it’s a gradual ooze so more time for body to compensate

Question 6

Types of hemorrhage

Answer 6

Primary
Reactionary
Secondary

Question 7

What is reactionary hemorrhage

Answer 7

Occurs 4-24 hrs after surgery

Due to increase BP or slippage/granny knot

Question 8

As per stages of hypovolemic shock in which stage does SBP falls
Features of this class

Answer 8

Class 3 shock 
Percentage blood loss in 30-40% 
Pulse rate increases
Diastolic falls
Respiratory rate increase
Urine output decrease

Question 9

Class 1 Hypovolemic shock

Answer 9

0-15% blood loss (400-500cc)

Vitals are normal
Treatment oral liquid

Question 10

Characteristic of compensated hypovolemic shock

Answer 10

Sympathetic activation due to blood loss( 15-30%)

Leads to tachycardia, peripheral vasoconstriction blood supply to vital organ increase

Question 11

Earliest indicator of hypovolemia

Answer 11

Tachycardia

Question 12

Best indicator to determine amount of fluid required in shock

Answer 12

Pulmonary capillary wedge pressure > CVP

Question 13

Best clinical indicator of fluid resuscitation in shock

Answer 13

Urine output

Question 14

Best end point of resuscitation

Answer 14

Mixed venous oxygen saturation

MVOS

Question 15

Muscle or brain perfusion can be assessed by

Answer 15

NIRS NEAR INFRA RED SPECTROSCOPY

Question 16

Normal value of MVOS
Less than 50% MVOS can be seen un
High MVOS

Answer 16

50-70%
Cardiogenic shock, hypovolemic shock
Septic shock

Question 17

Shock index

What does it indicate

Answer 17

HR/SBP

>0.9 Higher mortality

Question 18

Most sensitive indicator

Answer 18

Modified shock index = HR/MAP

Question 18

Most sensitive indicator

Answer 18

Modified shock index = HR/MAP

Question 19

Parameters to define massive blood transfusion

Answer 19

Replace entire circulating volume in 24 hrs
More than 10 unit blood in 24 hrs
More than 4 unit blood in one hr

Question 20

Most common blood transfusion reaction

Answer 20

Febrile

Question 21

What is TACO
C/F
Treatment

Answer 21

Transfusion ass cardiac overload
Puffiness of face edema
Diuretic

Question 22

Anticoagulant used in blood transfusion is citrate

Effect of citrate on blood ion level

Answer 22

Chelates calcium and magnesium

Hypo calcemia and magnesemia

Question 23

Effect on GIT due to hypovolemic shock

Answer 23

Most sensitive mucosa of git is gastric and leads to steess ulcer

Question 24

Gut perfusion is measured by

Answer 24

Sublingual capnometry Mucosal ph Laser doppler flowmetry

Question 25

ROPE index full form | And its use

Answer 25

Rate over pressure difference =PR/PP Less than 3 stable pt More than 3 decompensated hemorrhagic shock

Question 26

What is TRALI

Answer 26

Transfusion related acute lung injury Develops within 6hrs of transfusion Due to anti hla antibody

Question 27

Most common cause of death in massive blood transfusion | What is terrible triad of trauma

Answer 27

Coagulopathy Hypothermia Acidosis Dilutional coagulopathy

Question 28

How to prevent coagulopathy after massive blood transfusion

Answer 28

PRBC:FFP:PLATELETS 1:1:1

Question 29

Name the score to decide massive blood transfusion

Answer 29

ABC score | TASH Trauma ass severe hemorrhage score

Question 30

What is occult hypoperfusion

Answer 30

Normal cvs parameters and urine output | Low mvos and acidosis

Question 31

Dynamic fluid response in shock | What happens in non responder and transient responder

Answer 31

Bolus of fluid 250-500 cc, CVP rises by 2-5 cm and normalizes in 20 min Non responder no change Transient responder will show rise but return to pre treatment value in 10-15 min

Question 32

Peri operative RBC transfusion criteria | Hb(g/dl)

Answer 32

Less than 6 pt will benefit from transfusion 6-8 only give blood if losses are present More than 8 no indication

Question 33

Bradycardia and hypotension is seen in which type of shock why

Answer 33

Neurogenic shock due to loss of sympathetic tone

Question 34

In anaphylactic shock tachycardia and hypotension is seen | What is underlying pathology

Answer 34

Histamine release which is vasodilator warm extremities pooling of blood And sympathetic tone is normal so tachycardia

Question 35

Systemic inflammatory response syndrome define

Answer 35

Body response to inflammation release of il 16 tnf alpha

Question 36

Parameter for sirs

Answer 36

Temp <36 or >38 Wbc less than 4k more than 12k or 10% band forms in smear Respiratory rate more than 20 Pulse rate more than 90 Any 2 present SIRS

Question 37

Sepsis vs septic shock vs mods

Answer 37

Sepsis - SIRS + Known foci of infection Septic shock sepsis hypotension which fails to respond to fluid Mods failure of 2 or more organs

Question 38

What ia SOFA score and what is its modification

Answer 38

Sequential Organ Failure Assessment Score Sepsis= SOFA score more than 2 and known foci of infections qSOFA is quick sequential organ failure assessment score

Question 39

Parameters of qSOFA

Answer 39

SBP FALLS LESS THAN 100 ALTERED MENTAL STATUS RR MORE THAN 22/MIN

Question 40

New definition of sepsis and septic shock

Answer 40

Sepsis life threatening organ dysfunction caused by dysregulated host response to infection Septic shock need for vasopressor and serum lactate more than 2mmol/L

Question 41

Septic shock mgt | Goal of initial resuscitation of sepsis

Answer 41

First fluids If no response start inotropes and vasopressor ``` In first 6 hrs goal is CVP 8-12 mm Hg MAP > 65 mm Hg MVOS >65% Normalize lactate ```