Chapter 12

Question 1

shock (…) describes a state of collapse and failure of the … system–> in the early stages, the body attempts to maintain homeostasis
shock can occur because of medical/traumatic events

Answer 1

hypoperfusion; cardiovascular

Question 2

adequate … is required to provide cells with oxygen and nutrients and remove waste products. Any compromise can lead to cellular injury/death
… is a passive process in which molecules move from an area with a higher concentration of molecules to an area of lower concentration –> this is how ox and CO2 cross the walls of the alveoli; the majority of oxygen is carried to the tissues attached to hemoglobin

Answer 2

perfusion; diffusion

Question 3

CO2 can be transported in the blood from tissues back to the lungs in three ways:
- dissolved in the ..
- combined with water in the form of …
- attached to …
carbon dioxide waste products released from cells can combine with water in the bloodstream to form bicarbonate. once it reaches the lungs, it breaks back down into CO2 and water and CO2 is exhaled

Answer 3

plasma; bicarbonate; hemoglobin

Question 4

in cases of poor perfusion (shock), transportation of … out of tissues is impaired, resulting in a dangerous buildup of … that may cause cellular damage

Answer 4

CO2; waste products

Question 5

shock refers to a state of collapse and failure of the cardiovascular system that leads to inadequate … –> to protect vital organs, the body directs blood flow from organs that are more tolerant of low flow (such as the … and …) to organs that cannot tolerate low blood flow (such as the .., …, and …)

Answer 5

circulation; skin; intestines; heart; brain; lungs

Question 6

cardiovascular system consists of three parts:
… (..)
set of … (… or …)
.. (the …)

Answer 6

pump; heart
pipes; blood vessels; arteries
contents; blood

Question 7

the pump, container, and content functions can be referred to as the …–> when a patient is in shock, one or more of the three parts is not working properly

Answer 7

perfusion triangle

Question 8

blood pressure is the pressure of blood within the vessels at any moment in time:
…: peak arterial pressure
…: pressure in the arteries while the heart rests between heartbeats
…. is the difference between the systolic and diastolic pressures

Answer 8

systolic
diastolic
pulse pressure

Question 9

blood flow through the capillary beds is regulated by the ..., circular muscular walls that constrict and dilate --> under the control of the ... nervous system 
these respond to other stimuli such as: 
... 
... 
the need for ... 
the need for ...

Answer 9

capillary sphincters; autonomic; 
heat
cold
oxygen
waste removal

Question 10

perfusion requires more than just having a working cardiovascular system:
adequate … in the lungs
adequate … in the form of glucose in the blood
adequate .., primarily through the lungs

Answer 10

oxygen exchange
nutrients
waste removal

Question 11

mechanisms are in place to help support the respiratory and cardiovascular systems when the need for perfusion of vital organs is increased –> these mechanisms include the … and …
the sympathetic side of the autonomic nervous system, responsible for the fight-or-flight response, will assume more control of the body’s functions during a state of …

Answer 11

autonomic nervous system; hormones; shock

Question 12

the response by the autonomic nervous system causes the release of hormones such as … and … Hormones are triggered when the body senses its … falling, causing an increase in:
..
strength of …
… (in the skin and gastrointestinal tract)

Answer 12

epinephrine; norepinephrine; blood pressure; heart rate; cardiac contractions; peripheral vasoconstriction

Question 13

the three basic causes of shock are
… failure (cardiogenic/obstructive shock)
poor … function (distributive shock)
low … (hypovolemic shock)

Answer 13

pump; vessel; fluid volume

Question 14

(cardiogenic shock) caused by inadequate function of the … (pump failure)
a major effect is the backup of … into the …
the resulting buildup of pulmonary fluid is called …
cardiogenic shock develops when the heart cannot maintain sufficient … to meet the demands of the body

Answer 14

heart;
blood; lungs
pulmonary edema
output

Question 15

(cardiogenic shock) … is the volume of blood that the heart can pump per minute and is dependent on several factors:
heart must have adequate … for the cardiac muscle to contract (myocardial contractility)
the heart must receive adequate … to pump
the resistance to flow in the peripheral circulation must be appropriate

Answer 15

cardiac output
strength;
blood

Question 16

(obstructive shock) caused by a ... that prevents an adequate volume of blood from filling the ... 
three of the most common examples: 
... 
.. 
...

Answer 16

mechanical obstruction; heart chambers;
cardiac tamponade
tension pneumothorax
pulmonary embolism

Question 17

(distributive shock) 
results from widespread ... of small arterioles, small venules, or both 
the circulating blood volume pools in the expanded vascular beds and ... decreases 
types of distributive shock: 
... shock 
... shock 
... shock 
... shock

Answer 17

dilation; tissue perfusion
septic
neurogenic
anaphylactic
psychogenic

Question 18

… shock results from an inadequate amount of fluid/volume in the circulatory system

Answer 18

hypovolemic

Question 19

(respiratory insufficiency) a patient with a severe chest injury/airway obstruction may be unable to breathe in an adequate amount of …
…. can lead to tissue hypoxia because there are not enough red blood cells to deliver adequate amounts of oxygen to the cells

Answer 19

oxygen; anemia

Question 20

(respiratory insufficiency) certain types of poisoning may affect the ability of cells to metabolize/carry oxygen:
… poisoning
… poisoning

Answer 20

CO; cyanide

Question 21

the stages in the progression of shock:

1. … shock
2. … shock
3. when shock has progressed too far, it is … –> no way to assess when a patient has reached this point; it is imperative to recognize and treat shock early–well before the patient transitions into the decompensated phase

Answer 21

compensated
decompensated
irreversible

Question 22

… may be the last measurable factor to change in shock –> when a drop is evident, shock is well developed. this is particularly true in infants and children, who can maintain their … until they have blood loss that is more than .. their blood volume. by the time it drops in infants and children who are in shock, they are close to death

Answer 22

blood pressure; blood pressure; half;

Question 23

expect shock if a patient has any one of the following conditions: 
multiple severe ... 
... or ... injury 
... injury
a severe ... 
a major ... 
...

Answer 23

fractures
abdominal; chest
spinal
infection 
heart attack 
anaphylaxis

Question 24

primary assessment:
a patient with massive hemorrhage may require a … (or direct pressure dressings) before the airway is opened
if the patient has life-threatening external bleeding it should be addressed …, then the … can be assessed and treated, and then treatments for … provided

Answer 24

tourniquet; first; ABCs; shock

Question 25

primary assessment contd: a rapid pulse suggests ... shock in shock/compensated shock, the skin may be ..., ..., or ... trauma patients with shock, or a suspicious MOI, generally should go to a trauma center

Answer 25

compensated; cool; clammy; ashen

Question 26

secondary assessment: repeat primary followed by a focused assessment perform secondary assessment of entire body if patient: - is a trauma patient with a significant ... or ... - gives you a poor initial ... - has problems shown in primary assessment - has a ... problem but is not .. - has problems that were not noted in primary assessment

Answer 26

MOI; multiple injuries general impression medical; responsive

Question 27

when treating for shock, place blankets ... and ... the patient do not give the patient anything by ...

Answer 27

under; over; mouth

Question 28

treating cardiogenic shock: the patient who is in shock as a result of a ... does not have the power to pump blood throughout the circulatory system ... disease will aggravate cardiogenic shock usually, patients with this shock do not have any injury, but they may be having .... they should not receive nitro bc by definition they are ...

Answer 28

heart attack; chronic lung; chest pain; hypotensive

Question 29

with cardiogenic shock, place the patient in a position that ... as you give high flow oxygen

Answer 29

eases breathing

Question 30

treating obstructive shock: for cardiac tamponade--> increasing ... is priority apply high flow oxygen ... is the only definitive treatment

Answer 30

cardiac output | surgery

Question 31

treating obstructive shock: for tension pneumothorax--> apply ... to prevent hypoxia ... is required to relieve pressure in the chest: this is an ALS skill

Answer 31

high flow oxygen; chest decompression

Question 32

treating septic shock hospital management is required, including administration of ... use standard precautions and transport administer ... and support ventilations use ... to conserve body heat notify a specialized ... if available to meet the patient in the ED

Answer 32

antibiotics high flow oxygen blankets sepsis team

Question 33

``` treating neurogenic shock: emergency treatment: obtain and maintain a proper ... provide ... assist inadequate breathing conserve ... ensure most effective ... possible transport patient to facility capable of managing spinal injuries ```

Answer 33

airway; spinal immobilization ; body heat; circulation

Question 34

treating anaphylactic shock: administer ... promptly transport provide ... and ventilatory assistance a mild rxn may worsen suddenly/over time try to find out what agent caused the rxn and how it was received

Answer 34

epinephrine; high flow ox

Question 35

treating psychogenic shock: in uncomplicated cases of fainting, brain circulation is restored as the patient becomes .. can worsen other types of shock if the patient falls, check for injuries if the patient reports being unable to ... after a fall, suspect another problem all patients with loss of consciousness should be transported to the ED for evaluation even if they appear normal once you arrive on scene

Answer 35

supine; walk

Question 36

treating hypovolemic shock: control all obvious ... keep patient warm recognize ... and provide aggressive support secure and maintain an airway and provide respiratory support

Answer 36

external bleeding; internal bleeding