Module 3: Shock and Special Populations

Question 1

What are the 4 types of shock?

Answer 1

• Hypovolaemic—resulting from a loss of intravascular volume

• Cardiogenic—resulting from pump failure, due to a problem with myocardial
contractility, heart rate or rhythm or valvular apparatus

• Obstructive—resulting from any impedance to flow in the major vessels

• Distributive—resulting from a loss of vasomotor tone (i.e. resistance) in the
arterioles and the venules. Distributive shock results from a drop of pressure
due to the drop in arteriole resistance and a reduction in venous return due
to the loss of tone in the post-capillary venules.

Question 2

What are the treatment goals for a patient in shock?

Answer 2

• Minimisation of the severity and duration of the dysfunctional microcirculatory response in the first minutes and hours after injury might
prevent complications.

• Early control of bleeding and haemostatic resuscitation, incorporating correction of coagulopathy and minimal volume replacement, are likely to improve outcomes.

Question 3

How do you decide the treatment option for shock patients?

Answer 3

• What is the cause of the patient’s shock?
• What is the definitive care for the patient’s shock?
• Where can the patient best receive this definitive care?
• What interim steps can be taken to support and manage the patient’s condition whilst transporting to definitive care?

Question 4

What are the three haemorrhage classifications?

Answer 4

Capillary:

• Slow, even flow
• Bright red

Venous:

• Steady, slow flow
• Dark red

Arterial:

• Spurting blood
• Pulsating flow
• Bright red

Question 5

What blood pressure are you wanting in a haemorrhagic shock patient?

Answer 5

Systolic of 80-90mmHg

Question 6

What are the maternal physiological changes?

Answer 6

• Expanded blood volume
• Physiological anaemia
• Increased O2 consumption
• Decreased functional residual capacity of lungs
• Supine position causing reduced venous return to the heart
• Increased gastric contents and acidity
• Delayed gastric emptying with increased risk of aspiration into lungs

Question 7

Give examples of geriatric medications.

Answer 7

Calcium Channel Blockers (Verapamil):
• May prevent peripheral
vasoconstriction
• Accelerate hypovolaemic shock

Beta Blockers (Propranolol, Metoprolol):
• Cause Bradycardia
• An increase tachycardia in
response to shock may not occur
• Rapidly deteriorate with seemingly
no warning

Anticoagulants (Heparin, Warfarin):
• May increase blood loss
• Internal haemorrhage may
progress rapidly

Question 8

What are airway and breathing treatment considerations for bariatric patients?

Answer 8

• Lack of landmarks due to increased adipose tissue
• Airway obstruction in supine patient due to adipose tissue
• Aspiration risk
• Co morbidities eg. Sleep apnoea
• VQ mismatch
• O2 consumption & CO2 production increases
• Decreased gas exchange but increased breathing effort
• Decreased lung compliance

Question 9

What are circulation treatment considerations for bariatric patients?

Answer 9

• Metabolic and cardiac demands higher
• May be unable to palpate pulses due to excess adipose tissue
• High risk for thromboembolism
• Increased Cardiac output & stroke volume
• Poor vascular access

Question 10

What are some challenges in assessing and treating bariatric trauma patients?

Answer 10

• skin folds may mask penetrating injuries
• difficult to auscultate and detect pneumothorax
• difficult to assess for abdominal or bone tenderness
• masses/ deformities difficult to palpate
• use of inappropriate BP cuff size
• difficulty performing log roll