Module 1: Shock

Question 1

Why is universal screening for domestic violence important in the ED?

Answer 1

• universal screening normalizes these important questions that should be asked
• opens lines of communication
• ED may be only access point in healthcare for individuals who are victims of violence
• patients who are experiencing violence may not necessarily come in for issues related to the violence

Question 2

Barriers to domestic violence screening in the ED:

Answer 2

• language barriers
• privacy issues
• lack of staff training (how to ask)
• patients may not share risk of violence due to shame or fear

Question 3

What are some risk factors for an ectopic pregnancy?

Answer 3

• previous tubal surgery or tubal abnormality
• previous ectopic pregnancy
• in utero DES exposure
• history of PID, chlamydia or gonorrhea
• current IUD use

Question 4

What are the treatment options for an ectopic pregnancy?

Answer 4

• Methotrexate (IM) - requires close monitoring after dose for effectiveness (serial hCG measurements) and strict criteria for use
• Surgical treatment (salpingostomy or salpingectomy)

Question 5

What are the three stages of shock?

Answer 5

compensated, uncompensated, and irreversible

Question 6

What is compensated shock?

Answer 6

The body has activated hormonal and chemical compensatory mechanisms to maintain cardiac output and stroke volume

Question 7

What is uncompensated shock?

Answer 7

The body’s compensatory mechanisms are starting to fail

• O2 supply and demand become imbalanced
• signs of shock begin to show (Vital signs, symptoms…)

Question 8

What is irreversible shock?

Answer 8

Stage at which the amount of cellular damage and cell death is so great that permanent and significant organ damage has occurred and death is inevitable

Question 9

What are some causes of hypovolemic shock?

Answer 9

hemorrhage, burns, trauma

Question 10

What are some causes of obstructive shock?

Answer 10

tension pneumothorax, pericardial tamponade, pulmonary embolism

Question 11

What are some causes of cardiogenic shock?

Answer 11

MI, coronary vessel rupture, chamber injury due to trauma

Question 12

What are some causes of distributive shock?

Answer 12

sepsis, anaphylaxis, neurogenic (spinal cord injury)

Question 13

Vasoconstriction is an early compensatory mechanism of hypovolemic shock. Why does this occur?

Answer 13

decreased BP triggers baroreceptors to activate the sympathetic nervous system, this causes increased sympathetic tone and release of catecholamines (epinephrine and norepinehrine), which result in increased HR, increased venous tone, increased myocardial contraction, and increased cardiac output

Question 14

What is the trauma triad of death?

Answer 14

hypothermia, acidosis, and coagulopathy

Question 15

What does SIRS stand for?

Answer 15

Systemic inflammatory response syndrome

Question 16

What is the SIRS criteria?

Answer 16

HR > 90
RR > 20
Temp < 36 or > 38
WBC > 12 or < 4 or 10% increased band cellls

Question 17

What is the individualized care when deciding how much fluid to resuscitate a patient with?

Answer 17

30 mL/kg

Question 18

What are the benefits of rapid sequence intubation (RSI)?

Answer 18

• when quick securement of airway is needed and you are unsure of when patient ate last

Question 19

What are the 7 P’s of RSI

Answer 19

Prepare
Preoxygenate
Pretreat
Paralysis and Induction
Protection and position
Proof of Position
Post Intubation Care

Question 20

What is the main concern regarding the use of Succinylcholine as a paralytic?

Answer 20

• increased risk of hyperkalemia

- contraindicated in crush injuries, burns, traumas, long codes, and status epileptics

Question 21

Which induction agent would you not want to use in a patient that is hypotensive?

Answer 21

propofol

Question 22

What does BURP stand for and what is the purpose of this technique?

Answer 22

Backwards, upwards, right, and pressure
- the purpose of this technique is to manipulate a patients trachea to occlude the esophagus and better visualize the vocal cords for ET tube placement.