Shock

Question 1

types of shock

Answer 1

hypovolaemic
septic
neurogenic
distributive
cardiogenic
obstructive
mixed/other

Question 2

examples of hypovolaemic shock

Answer 2

Hemorrhagic (major trauma, gastrointestinal bleeding, ruptured ectopic pregnancy, etc.)

Non-hemorrhagic (vomiting, diarrhea, burns, etc.)

Question 3

examples of cardiogenic shock

Answer 3

Arrhythmogenic (brady- or tachydysrhythmia)

Cardiomyopathic (myocardial infarction, heart failure, etc.)

Cardiotoxicity from medication

Structural (valvular insufficiency, ventricular septal wall defect, etc.)

Question 4

examples of distributive shock

Answer 4

Anaphylactic (IgE mediated allergic reaction)

Septic (pneumonia, pyelonephritis, etc.)

Neurogenic (spinal cord injury)

Toxicologic (vasodilatory medication)

Question 5

examples of obstructive shock

Answer 5

Pulmonary vascular obstruction (pulmonary embolism, venous air embolism, etc.)

Mechanical obstruction (tension pneumothorax, pericardial tamponade, left ventricular outflow tract obstruction, etc.)

Question 6

other types of shock

Answer 6

Cellular poisons (carbon monoxide, cyanide, etc.)

Endocrinologic (adrenal insufficiency, myxedema coma, etc.)

Environmental (hypothermia, etc.)

Toxicologic etiology with cardiac and vasoplegic manifestations (calcium channel blocker, etc.)

Question 7

general signs/symptoms of shock

Answer 7

lethargy/ weakness
altered mental status
chest pain/ dyspnoea

Question 8

features of haemorrhagic hypovolaemic shock

Answer 8

Hypovolemic shock due to hemorrhage is suggested by the report of trauma or bleeding from other source (melena or hematemesis from a gastrointenstinal source, vaginal bleeding from a gynecologic source, etc.).

Question 9

features of non-haemorrhagic hypovolaemic shock

Answer 9

decreased oral intake, diarrhea, vomiting or high ostomy output.

Question 10

cardiogenic/ obstructive shock features

Answer 10

Cardiogenic or obstructive shock may be suggested by chest pain, shortness of breath, recent leg swelling, or syncope.

Question 11

anaphylactic shock features

Answer 11

pruritus, hives, or swelling following exposure to an inciting trigger.

Question 12

septic shock features

Answer 12

signs of infection such as fever, cough, dysuria, abdominal or flank pain, or rigors.

Question 13

physical exam features of a patient with shock

Answer 13

hypotension
tachycardia
altered mental status
thready pulses
tachypnoea
cool, pale, ashen skin
decreased capillary refill and dry mucous membranes
warm extremities in distributive shock
cardiogenic shock: arrhythmias, dependent oedema, new murmurs, JVP raised

Question 14

ultrasonography for shock assessment

Answer 14

intraperitoneal hemorrhage, pneumothorax, or pericardial tamponade, and to assess global cardiac function and intravascular volume status.
Vascular catastrophes such as abdominal aortic aneurysm with rupture may also be identified on bedside ultrasonography.

Question 15

investigations shock

Answer 15

CBC with differential

Electrolytes, BUN, creatinine, glucose

Lactate

Coagulation studies

Hepatic function panel

Calcium

Urinalysis

ECG

Chest radiograph

Pregnancy test (blood or urine)

Blood gas

Question 16

management of traumatic shock

Answer 16

1.5-2L warmed IV crystalloid.
Assess for response.
If inadequate response to fluid then arrange O-negative blood.
Give fully cross-matched blood as soon as possible.
If the patient is severely shocked initiate the massive haemorrhage protocol.