Shock Syndrome

Question 1

Shock syndrome can be characterized as______

Answer 1

decreased tissue perfusion and impaired cellular metabolism

Question 2

Name 4 classifications of shock

Answer 2

1: Cardiogenic
2: Hypovolemic
3: Distributive
4: Obstructive

Question 3

Define cardiogenic shock

Answer 3

Systolic or diastolic dysfunction and compromised cardiac output (CO)

Question 4

What is the most common cause of Cardiogenic shock ?

Answer 4

Massive anterior wall MI (LAD; affects LV)

Question 5

Name 4 early manifestations of cardiogenic shock

Answer 5

Tachycardia
Hypotension
Narrowed pulse pressure
↑ Myocardial O2 consumption

Question 6

What would you look for in a physical assessment of a patient that may have cardiogenic shock ?

Answer 6

Tachypnea, pulmonary congestion
Pallor and cool, clammy skin
Decreased capillary refill time
Anxiety, confusion, agitation 
↑ Pulmonary artery wedge pressure 
Decreased renal perfusion and urinary output

Question 7

Define Absolute hypovolemia

Answer 7

loss of intravascular fluid volume

Question 8

Name some of the causes of Hypovolemia

Answer 8

Hemorrhage
GI loss (e.g., vomiting, diarrhea)
Fistula drainage
Diabetes insipidus
Hyperglycemia
Diuresis

Question 9

How does relative Hypovolemia occur ?

Answer 9

When fluid volume moves out of the vascular space into extravascular space (e.g., intracavitary space)

Question 10

The response to acute volume loss depends on what 3 factors ?

Answer 10

Extent of injury
Age
General state of health

Question 11

Name 4 clinical manifestations of of Hypovolemic shock

Answer 11

Anxiety
Tachypnea
Increase in CO, heart rate
Decrease in stroke volume, PAWP, urinary output

Question 12

Neurogenic shock occurs in response to _____

Answer 12

spinal cord injury or spinal anesthesia

Question 13

At which vertebrae does neurogenic shock often occur ?

Answer 13

T5 or above

Question 14

Neurogenic shock results in ______

Answer 14

massive vasodilation, leading to pooling of blood in vessels, tissue hypoperfusion, ultimately impaired cellular metabolism

Question 15

Name 5 clinical manifestations of neurogenic shock

Answer 15

Hypotension
Bradycardia (no tachycardia bc no sympathetic output)
Inability to regulate body temperature (resulting in heat loss)
Dry skin
Poikilothermia- taking on temperature of environment

Question 16

What is anaphylactic shock ?

Answer 16

Acute, life-threatening hypersensitivity (allergic) reaction

Question 17

What occurs physiologically during anaphylactic shock ?

Answer 17

Massive vasodilation
Release of vasoactive mediators
↑ Capillary permeability

Question 18

Name some of the clinical manifestations of anaphylactic shock

Answer 18

Anxiety, confusion, dizziness
Tachycardia, tachypnea
Swelling of lips and tongue, angioedema
Wheezing, stridor due to laryngeal edema
Flushing, pruritus, urticaria
Respiratory distress and circulatory failure

Question 19

Define sepsis

Answer 19

systemic inflammatory response to documented or suspected infection

Question 20

Name some of the clinical manifestations of septic shock

Answer 20

↑ Coagulation and inflammation
↓ Fibrinolysis
↓ Urine output
Tachypnea/hyperventilation
Altered neurologic status

Question 21

What are the 3 major pathophysiologic effects of septic shock ?

Answer 21

Vasodilation leading to hypotension
Maldistribution of blood flow
Myocardial depression

Question 22

How does obstructive shock develop ?

Answer 22

when there is a physical obstruction to blood flow which occurs with decreased CO

Question 23

Name 2 possible causes of obstructive shock

Answer 23

Restricted diastolic filling of right ventricle from compression
Abdominal compartment syndrome- abdominal pressure compresses inferior vena cava

Question 24

With obstructive shock patient may experience _______, _______ and _______

Answer 24

Decreased CO
Increased afterload
Variable left ventricular filling pressure

Question 25

Shock is characterized into 4 overlapping stages, these are ______, _______, ______ and ______

Answer 25

Initial
Compensatory
Progressive
Refractory

Question 26

What is occurring in the initial stage of shock ?

Answer 26

Usually not clinically apparent

Metabolism changes at cellular level from aerobic to anaerobic

Question 27

What is occurring in the compensatory stage of shock ?

Answer 27

Compensatory mechanisms (Neural, Hormonal and Biochemical)
Attempt to overcome consequences of anaerobic metabolism and maintain homeostasis
Baroreceptors in carotid and aortic bodies activate SNS in response to ↓ BP
Shunting blood from lungs increases physiologic dead space
Impaired GI motility

Question 28

When does the progressive stage of shock begin ?

Answer 28

Begins when compensatory mechanisms fail

Question 29

What is occurring in the progressive stage of shock ?

Answer 29

↓ cellular perfusion and altered capillary permeability
diffuse profound edema
Sustained hypoperfusion
Myocardial dysfunction
Movement of fluid from pulmonary vasculature to interstitium
Fluid moves into alveoli
Mucosal barrier of GI system becomes ischemic

Question 30

How does shock cause acute kidney injury ?

Answer 30

Hypoperfusion leads to renal tubular ischemia

Question 31

How does shock cause jaundice ?

Answer 31

Liver fails to metabolize drugs and waste

Question 32

What is occurring in the refractory stage of shock ?

Answer 32

Exacerbation of anaerobic metabolism
Accumulation of lactic acid
↑ Capillary permeability
Profound hypotension and hypoxemia
Tachycardia worsens

Question 33

What is the Cornerstone of therapy for septic, hypovolemic, and anaphylactic shock ?

Answer 33

volume expansion

Question 34

What is the primary goal of drug therapy in the treatment of shock ?

Answer 34

correction of decreased tissue perfusion

Question 35

Name 2 forms of drug therapy that are used o treat shock

Answer 35

Vasopressor drugs (e.g., norepinephrine) 
Vasodilator therapy (e.g., nitroglycerin, nitroprusside)