Clinical Shock

Question 1

Define shock

Answer 1

A condition characterised by impaired cellular function as a result of a reduction in the effective circulating volume

Question 2

What are the three different types of shock

Answer 2

Hypovolemic - low volume
Cardiogenic - failure of the pump
Distributive - abnormal distribution

Question 3

What is hypovolemic shock

Answer 3

Loss of blood through haemorrhage
Loss of plasma through burns
Loss of fluids through D&V
Severe dehydration

Question 4

What is cardiogenic shock

Answer 4

Reduced ability of the heart to pump effectively
Myocardial infarction
Cardiac arrhythmias
Cardiac tamponade
Lung pathology (tension/PE)

Question 5

What is neurogenic distributive shock

Answer 5

Neurogenic - sympathetic and parasympathetic mechanisms are disrupted.
Body loses venous fine
-Severe head injury
-Spinal injury
-Drug reaction
-Neurological illness

Question 6

What are the three types of distributive shock

Answer 6

Neurogenic
Sepsis
Anaphylaxis

Question 7

What is sepsis distributive shock

Answer 7

Sepsis - damage caused by overwhelming bacterial infection

Question 8

What is anaphylactic distributive shock

Answer 8

An ‘over reaction’ to a benign substance

Histamine and prostaglandin released into general circulation, increases oedema, laryngeal oedema and a fluid shift

Question 9

how can you tell there is internal bleeding in the lungs

Answer 9

Bright red and frothy substance coughed up through the trachea and airways.

HAEMOPTYSIS

Question 10

What are the 4 signs of abdominal organs internal bleeding

Answer 10

Abdominal distension-blood, fluid

Abdominal tenderness- significant if over liver, spleen or renal angles

Generalised Guarding-suggests peritonitis (massive bleeding it perforation)

Pelvic instability- avoid repetitive examination

Question 11

What is haematuria

Answer 11

When urine is a cloudy/smoky colour
Can sometimes see micro clots

Is a sign of Abdominal organ internal bleed

Question 12

What is Grey Turners and what is it a sign of

Answer 12

Sign of haemorrhage of the pancreas

Rashy Bruising of the stomach

Question 13

What is cullens sign and what is it a sign of

Answer 13

Bruising around the belly button

Periumbilical ecchymosis (bruising around umbilicus) or
Blood leaking into abdominal cavity

Question 14

What is a sign of an upper GI bleed

Answer 14

A dark coffee colour is vomitted up. Looks like coffee grounds. Had a pt with this.

Haematesis

Question 15

What is a sign of a lower GI bleed

Answer 15

Black tarry stalls
Offensive smell and tarry colour

MELENA

Question 16

What are the 4 stages the body goes through to compensate for blood loss

Answer 16

Initial stage
Compensatory
Progressive
Refractory

Question 17

What is the initial stage of the body compensating for blood loss

Answer 17

Cardiac output is decreased, and tissue perfusion is threatened

Question 18

What is the compensatory stage of the body compensating for blood loss

Answer 18

The body’s homeostatic mechanisms attempt to maintain CO, blood pressure and tissue perfusion

Question 19

What is the progressive stage of the body compensating for blood loss

Answer 19

The compensatory mechanism begin failing to meet tissue needs and the shock cycle is perpetuated

Question 20

What is the refractory stage of the body compensating for blood loss

Answer 20

Shock becomes unresponsive to therapy and is considered irreversible

Question 21

What are the indications of severity for blood loss

Answer 21

Pulse - Initially up but eventually goes down
Resps- Initially up but eventually goes down
Pupils - Dilate as hypoxia develops
Skin - Pale, grey, cyanosis
BP- Drop in BP
GCS - Confusion, lowered GCS

Question 22

How many stages of shock are there

Answer 22

4

Question 23

indications of Stage one of shock (Up to 15% blood loss)

Answer 23

Normal resps
Pallor of skin
Normal capillary refil
Pulse rate above 100
No change in BP

Question 24

indications of Stage 2 of shock (15-30% blood loss)

Answer 24

Pallor, cool, clammy skin
Extended time for Cap refill
Pulse rate above 100
Increased resps (15-30)
Normal systolic but elevated diastolic
Narrowing pulse pressure

Question 25

indications of stage 3 of shock (30% to 40% blood volume loss)

Answer 25

Anxiety, restlessness and agitation
Pulse rate in excess of 120bpm
Resp rate - 30-40
Systolic BP <100mmHg or less

Question 26

indications of the 4th stage of shock (over 40% blood loss)

Answer 26

Moribound appearance
Central cyanosis
Altered level of consciousness
Tachycardia/weak pulse
Resp distress 40 resp rate
Systolic BP of 70mmHg or less