CIRCULATION assesment in Rapid Primary Survey

Question 1

Definition of Shock

Answer 1

inadequate organ and tissue perfusion with oxygenated blood (brain, kidney, extremities)

Question 2

Name the 4 main types of shock

Answer 2

Hypovolemic
Cardiogenic
Distributive (vasodilation)
Obstructive

Question 3

Name the 4 causes of Hypovolemic shock

Answer 3

Hemorrhage (external and
internal)
Severe burns
High output fistulas
Dehydration (diarrhea, DKA)

Question 4

Name the 5 causes of Cardiogenic shock

Answer 4

Myocardial ischemia
Dysrhythmias
CHF
Cardiomyopathies
Cardiac valve problems

Question 5

Name the 3 causes of Distributive shock

Answer 5

Septic
Anaphylactic
Neurogenic (spinal cord
injury)

Question 6

Name the 5 causes of Obstructive shock

Answer 6

Cardiac tamponade
Tension pneumothorax
PE
Aortic stenosis
Constrictive pericarditis

Question 7

early signs of shock are:

Answer 7

tachypnea, tachycardia, narrow pulse pressure, reduced capillary refill, cool extremities, and
reduced central venous pressure

Question 8

late signs of shock are:

Answer 8

hypotension and altered mental status, reduced urine output

Question 9

Explain the 3:1 Rule on the hypovolemic shock

Answer 9

Since only 30% of infused isotonic
crystalloids remains in intravascular space,
you must give 3x estimated blood loss

Question 10

for the Management of Hemorrhagic Shock you should start ___ LARGE BORE (___-___G) IVs in the ____/_____ vein of each arm

Answer 10

start TWO LARGE BORE (14-16G) IVs in the brachial/cephalic vein of each arm

Question 11

Management of Hemorrhagic Shock .

run ___-___ L bolus of IV ____/_____ (warmed, if possible)

Answer 11

run 1-2 L bolus of IV Normal Saline/Ringer’s Lactate (warmed, if possible)

Question 12

• if continual bleeding or no response to crystalloids, consider:

Answer 12

pRBC transfusion, ideally crossmatched.

If crossmatched blood is unavailable, consider O- for women of childbearing age and O+ for men.

Question 13

Use

in early bleeding…

Answer 13

FFP, platelets or tranexamic acid

Question 14

consider common sites of internal bleeding (____, ____, ____, ____) where surgical
intervention may be necessary

Answer 14

(abdomen, chest, pelvis, long bones)

Question 15

explain the : 4:2:1 rule on fluid resuscitation

Answer 15

• Maintenance: 4:2:1 rule
• 0-10 kg: 4 cc/kg/h
• 10-20 kg: 2 cc/kg/h
• Remaining weight: 1 cc/kg/h