Chapter 12: Shock

Question 1

Describes a state of collapse and failure of the cardiovascular system.

In the early stages, the body attempts to maintain homeostasis.

As shock progresses, blood circulation slows and eventually ceases.

Answer 1

Shock (hypoperfusion)

Question 2

The circulation of an adequate amount of blood to meet the cells’ current needs.

Answer 2

Perfusion

Question 3

First organ to be affected by lack of oxygen.

Answer 3

Brain

Question 4

Cardiovascular system consists of three parts:

Answer 4

Pump (heart)
Set of pipes (blood vessels or arteries)
Contents (the blood)

Question 5

These three parts can be referred to as the “perfusion triangle.”

Answer 5

Heart
Blood Vessels
Blood

Question 6

The difference between the systolic and diastolic pressures is:

signifies the amount of force the heart generates with each contraction.

Answer 6

Pulse pressure

A pulse pressure less than 25 mm Hg may be seen in patients with shock.

Question 7

Perfusion requires more than just having a working cardiovascular system.

Answer 7

Adequate oxygen exchange in the lungs
Adequate nutrients in the form of glucose in the blood
Adequate waste removal, primarily through the lungs

Question 8

Damage from shock occurs because of..

Answer 8

insufficient perfusion of organs and tissues.

Question 9

1. Is caused by inadequate function of the heart, or pump failure.
2. A major effect is the backup of blood into the lungs. (congestive heart failure)
3. The resulting buildup of pulmonary fluid is called pulmonary edema.

Answer 9

Cardiogenic shock

Question 10

The presence of abnormally large amounts of fluid between cells in body tissues, causing swelling.

Answer 10

Edema

Question 11

Pulmonary edema leads to:

Answer 11

Impaired respiration, which may be manifested by:
An increased respiratory rate
Abnormal lung sounds (wet sounds called rales)

Question 12

Cardiogenic shock develops when:

Answer 12

The heart cannot maintain sufficient output to meet the demands of the body.

Question 13

Caused by a mechanical obstruction that prevents an adequate volume of blood from filling the heart chambers.

Three of the most common examples:
Cardiac tamponade
Tension pneumothorax
Pulmonary embolism

Answer 13

Obstructive Shock

Question 14

Collection of fluid between the pericardial sac and the myocardium (pericardial effusion) becomes large enough to prevent ventricles from filling with blood.
Caused by blunt or penetrating trauma
Signs and symptoms are referred to as Beck triad.

Answer 14

Cardiac Tamponade

Question 15

Caused by damage to lung tissue
The air normally held within the lung escapes into the chest cavity.
The lung collapses, and air applies pressure to the organs, including the heart and great vessels.

Answer 15

Tension pneumothorax

Question 16

A blood clot that blocks the flow of blood through pulmonary vessels
If massive:
Can result in complete backup of blood in the right ventricle
Leads to catastrophic obstructive shock and complete pump failure

Answer 16

Pulmonary embolism

Question 17

Results when there is widespread dilation of small arterioles, small venules, or both.

The circulating blood volume pools in the expanded vascular beds and tissue perfusion decreases.

Answer 17

Distributive shock

Question 18

Occurs as a result of severe infections in which toxins are generated by bacteria or by infected body tissues.
Toxins damage vessel walls, causing increased cellular permeability.
Vessel walls leak and are unable to contract well.
Widespread dilation of vessels, in combination with plasma loss through the vessel walls, results in shock.

Answer 18

Septic shock

Question 19

Usually the result of high spinal cord injury.

Muscles in the blood vessel walls are cut off from the nerve impulses that cause them to contract.

Causes include: 
Brain conditions
Tumors
 Pressure on the spinal cord
 Spina bifida

Answer 19

Neurogenic shock

Question 20

Occurs when a person reacts violently to a substance to which he or she has been sensitized.
Sensitization means becoming sensitive to a substance that did not initially cause a reaction.
Each subsequent exposure tends to produce a more severe reaction.

Answer 20

Anaphylactic shock

Question 21

Anaphylactic shock

Four categories of exposure include:

Answer 21

Injections (tetanus antitoxin, penicillin)
Stings (wasps, bees, hornets, ants)
Ingestion (fish, shellfish, nuts, eggs, medication)
Inhalation (dust, pollen, mold)

Question 22

Develops within minutes or even seconds of contact with substance
Second phase reaction can occur 1 to 8 hours after initial reaction.
Signs are very distinct.
Cyanosis (blue discoloration of skin) is a late sign.

Answer 22

Anaphylactic shock

Question 23

Signs of shock:

Answer 23

Decreased BP
Increased HR
Flush skin
Wheezing (no albuterol for allergen related)
Swelling

Question 24

Caused by a sudden reaction of the nervous system.
Produces temporary, generalized vascular dilation
Results in fainting (syncope)
Some causes are serious and others are not.

Life-threatening causes include irregular heartbeat and brain aneurysm.
Non–life-threatening events include receipt of bad news or experiencing fear or unpleasant sights (such as blood).

Answer 24

Psychogenic shock

Question 25

The result of an inadequate amount of fluid or volume in the circulatory system.

	a. There are hemorrhagic causes and nonhemorrhagic causes.
	b. Injuries involving bleeding may result in hemorrhagic shock, while vomiting and diarrhea may result in nonhemorrhagic hypovolemic shock.

Occurs with severe thermal burns.

	a. Intravascular plasma is lost.
	b. Plasma leaks from the circulatory system into the burned tissues that lie adjacent to the injury.

Dehydration, the loss of water or fluid from body tissues, can cause or aggravate shock.
Fluid loss may be a result of severe vomiting and/or diarrhea.

Answer 25

Hypovolemic shock

Question 26

An abnormally low number of red blood cells is called…

Answer 26

Anemia

Question 27

Occurs because blood is unable to deliver adequate amounts of oxygen to the tissues.

Answer 27

Hypoxia

Question 28

Certain types of poisoning may affect the ability of cells to metabolize or carry oxygen:

Answer 28

Carbon monoxide poisoning

Cyanide poisoning

Question 29

The stages in the progression of shock:

Answer 29

Compensated shock: early stage when the body can still compensate for blood loss
Decompensated shock: late stage when blood pressure is falling
No way to assess when effects are irreversible

Question 30

Early stage when the body can still compensate for blood loss

Answer 30

Compensated shock

Question 31

Late stage when blood pressure is falling

Answer 31

Decompensated shock