Clinical Shock

Question 1

What are the 3 intact mechanisms that the body needs to function properly

Answer 1

Effective heart (pump)
Intact and functioning blood vessels (pipes)
Adequate volume of blood (fluid)

Question 2

What are the 5 types of shock?

Answer 2

C - cardiogenic
H - hypovolaemic
A - anaphylactic shock
N - neurogenic
T - toxic/septic

Question 3

What are the common causes for cardiogenic shock?

Answer 3

Heart failure
Myocardial Infarction
Myocarditis
Tension Pneumothorax 
Cardiac Tamponade (bleeding into the pericardial sac)

Question 4

What are the common causes of hypovolaemic shock?

Answer 4

Whole blood loss - external/internal bleeding
Plasma loss from burns
Electrolyte/water loss - dehydration (D and V)

Question 5

What are the common causes of neurogenic shock?

Answer 5

High spinal cord injury
Poisons
Fainting

Question 6

What are the common causes of septic shock?

Answer 6

Meningococcal meningitis
Peritonitis
Cardiac conditions (myocarditis)

Question 7

How many stages are there in shock recognition?

Answer 7

4

Question 8

Explain stage 1 of shock

Answer 8

Up to 15% blood volume loss

Normal respirations 15-20
Pallor of skin
Normal capillary refill 
Pulse rate in excess of 100 bpm
No change in systolic or in diastolic blood pressure

Question 9

Explain stage 2 of shock

Answer 9

15% to 30% blood volume loss

Pallor, cool, clammy skin
Extended time for capillary refill
Pulse rate in excess of 100 bpm
Increased respiratory rate (15-30)
Normal systolic, but elevated daisy stolid blood pressure
Narrowing pulse pressure

Question 10

Explain stage 3 of shock

Answer 10

30% to 40% blood volume loss

Anxiety, restlessness and agitation
Pulse rate in excess of 120 bpm
Resp rate 30-40
Falling systolic blood pressure to 100mmHg or less

Question 11

Explain stage 4 of shock

Answer 11

Over 40% blood volume loss

Moribund appearance - waxy mannequin appearance
Central cyanosis
Altered level of consciousness
Marked tachycardia/weak pulse
Signs of respiratory distress (40+)
Systolic blood pressure 70mmHg or less

Question 12

Shock in pregnancy

Answer 12

Cardiac output increases by 20-30% in the first 10 weeks of pregnancy
Average heart rate increases by 10-15 beats per minute
Both systolic and daisy stolid BP falls on average by 10-15mmHg
After week 10 both blood volume (45% increase) and numbers of red cells increase but not in proportion, so the patient becomes relatively anaemic

Question 13

How many rules are there for shock in pregnancy?

Answer 13

3

Question 14

What is rule 1 for shock in pregnancy?

Answer 14

The maternal well-being is essential to the survival of the foetus and thus resuscitation of the mother must always be the priority

Question 15

What is rule 2 for shock in pregnancy?

Answer 15

Compression of the inferior vena cava by the foetus is a serious potential complication during pregnancy and suitable positioning or manual displacement must be employed

Question 16

What is rule 3 for shock in pregnancy?

Answer 16

Signs of shock appear late during pregnancy and hypotension is an extremely late sign. Usually indicating 35% blood loss (stage 3 shock).

Question 17

What is anaphylactic shock?

Answer 17

Anaphylaxis is best described as a severe allergic reaction (hypersensitivity) often affecting the whole body.
Anaphylaxis occurs when patients are exposed to an allergen to which they may become over sensitive

Question 18

What is an Antigen?

Answer 18

It is any substance that the body regards as foreign or potentially dangerous and against which it produces an antibody (immune response)

Question 19

What is an allergen?

Answer 19

It is an antigen to which an individual is hypersensitive

Eg All nuts (main category) are antigens, peanuts (sub category) are an allergen

Question 20

What is an antibody?

Answer 20

It is a protein produced in response to a specific foreign substance (antigen) that destroys or inactivated the foreign substance

Question 21

What is an allergy?

Answer 21

It is an adverse reaction on re-exposure to a substance that does not ordinarily cause adverse symptoms in the average person

Question 22

What is Anaphylactic shock?

Answer 22

It is an extreme and generalised allergic reaction in which widespread histamine release causes oedema, bronchoconstriction, heart failure, circulatory collapse and sometimes death

Question 23

What are the different ways by which you can have anaphylactic shock

Answer 23

Injection - vaccines
Ingestion - food
Absorption - toxins
Inhalation - dust and molds

Question 24

What are the systems Anaphylactic shock can affect?

Answer 24

Respiratory 
Cardiovascular 
Gastrointestinal 
Nervous
And the skin

Question 25

What are the early stages of an allergy?

Answer 25

Itchy rash
Swelling around eyes
Prickly lips
Dry, non productive cough
Restlessness

Question 26

Signs and symptoms for anaphylaxis

Answer 26

Flushed skin
Tachycardia
Chest tightness
Tongue and throat swelling
Wheeze
Hoarseness
Dyspnoea

Question 27

Signs and symptoms for Anaphylactic shock

Answer 27

Stridor
Hypotension
Bronchospasm
Cyanosis
Circulatory collapse
Respiratory collapse
May also include - 
Nausea/vomiting
Abdo cramps
Profuse watery diarrhoea
Abdo distension
Headache
Dizziness
Confusion
Collapse

Question 28

What drugs would you give for anaphylactic shock?

Answer 28

Oxygen - high flow, 15ltr per min
Nebulised salbutamol - only if wheeze on expiration
Adrenaline 1:1000

Question 29

What is the definition of shock?

Answer 29

Inadequate Tissue Perfusion ( not enough oxygen getting to tissue)