Hemorrhaging Shock

Question 1

What is shock?

Answer 1

Inadequate organ perfusion and delivery of nutrient necessary for normal tissue and cellular function. Initially it may be reversible but life-threatening if not treated properly

Question 2

What are the general features of shock?

Answer 2

(Many due to compensatory responses)

• Cold, sweaty, clammy skin (due to increase sympathetic) **
• Rapid and weak pulse: tachycardia and a small SV
• Rapid and shallow respiration’s
• Often altered consciousness (drowsiness), confusion, irritability, weakness and collapse

Question 3

What are the physical features of shock?

Answer 3

Blood pressure:
Systolic< 90 mmHg
Diastolic <60 mmHg

• decreased pulse pressure: although (MAP may be normal)
• decreased urine output: (Oliguria < 30 ml/hr)

Question 4

What is the basis which shock is classified?

Answer 4

Low stroke volume (decreased CO) vs vasodilation (decreased TPR)

Question 5

How is hypovolemic shock treated?

Answer 5

IV fluids

Question 6

How is cardiogenic shock treated?

Answer 6

Inotropes, diuresis

Question 7

How are obstructive shocks treated?

Answer 7

Relieve obstruction

Question 8

How are septic, anaphylactic and neurogenic shocks treated?

Answer 8

IV fluids, pressors

Question 9

What forms of shock are measured with low stroke volume?

Answer 9

Hypovolemic

Cardiogenic

Obstructive

Question 10

Which shocks are measured by vasodilation/distributive?

Answer 10

Septic

Anaphylactic

Neurogenic

Question 11

What causes septic shock?

Answer 11

Endotoxins

Question 12

What causes anaphylactic shock?

Answer 12

Allergic reaction

Question 13

What causes neurogenic shock?

Answer 13

Disruption of the case motor control, loss of sympathetic

Question 14

What causes obstructive shock?

Answer 14

Obstruction to blood flow- major pulmonary embolism

Mechanical obstruction-cardiac tamponade, tension pneumothorax

Question 15

What causes cardiogenic shock?

Answer 15

Pump failure- MI, arrythmias

Question 16

What causes hypovolemic shock?

Answer 16

Reduced blood volume-hemorrhage, burns, pancreatitis (3rd spacing)

Question 17

How is preload in the measured in thr right atrium?

Answer 17

RAP/CVP

Question 18

How is pump function measured?

Answer 18

Cardiac output/index

Question 19

How is afterload measured for shock?

Answer 19

SVR/TPR

Question 20

How is tissue perfusion measured in shock?

Answer 20

MvO2

Question 21

What are the characteristics of hypovolemic shock?

Answer 21

decreased preload (R)/RAP/CVP)

Very decreased preload (L) (PCWP/LVEDP)

Decreased cardiac output/index

Increased afterload (SVR/TPR)

Decreased tissue perfusion

Question 22

What are the characteristics of cardiogenic shock?

Answer 22

Increased preload(R)(RAP/CVP)

Increased preload(L)(PCWP/LVEDP)

Decreased pump function (cardiac output/index)

Increased afterload(SVR/TOR)

Decreased tissue perfusion (MvO2)

Question 23

What are the characteristics of obstruction due to obstruction of blood flow?

Answer 23

Increased preload(R)(RAP/CVP)

Decreased preload (L) (PCWP/LVEDP)

Decreased pump function

Increased afterload (SVR/TPR)

Decreased tissue perfusion

Question 24

What are the characteristics of mechanical obstruction shock?

Answer 24

Increased preload (R) (RAP/CVP)

Increased preload (L)(PCWP/LVEDP)

Decreased pump function

Increased afterload

Decreased tissue. Perfusion