N.4 Shock

Question 1

Do all animals with dehydration exhibit shock?

Answer 1

No, all animals that have dehydration have some degree of hypovolemia, but they do not all exhibit shock.

Question 2

What is hypovolemic shock?

Answer 2

Hypovolemic shock occurs when there is a decrease in the effective circulating volume.

Question 3

What are the three broad categories of shock mentioned in older references?

Answer 3

• Hypovolemic
• Cardiogenic
• Distributive (vasodilatory)

Question 4

What is the definition of shock?

Answer 4

Shock is defined as the state in which profound and widespread reduction of effective tissue perfusion leads first to reversible, and then if prolonged, to irreversible cellular injury.

Question 5

What are common examples of distributive shock?

Answer 5

• Sepsis
• Systemic inflammatory response syndrome
• Neurogenic shock
• Anaphylactic shock

Question 6

What is a common clinical sign found across all types of shock?

Answer 6

Altered mental status, which can range from obtunded to comatose.

Question 7

What is the primary characteristic of distributive shock?

Answer 7

Distributive shock is characterized by a decrease in systemic vascular resistance.

Question 8

What defines cardiogenic shock?

Answer 8

Cardiogenic shock is defined by the heart’s failure to generate adequate forward flow.

Question 9

What is metabolic shock and what are its examples?

Answer 9

Metabolic shock occurs when oxygen delivery is adequate but oxygen consumption is deranged, with examples including cytopathic hypoxia.

Question 10

How can the clinical signs of shock vary?

Answer 10

The clinical signs of shock can vary based on the underlying cause and whether the shock is compensated or uncompensated.

Question 11

What causes hypoxic shock?

Answer 11

Hypoxic shock is caused by a decrease in arterial oxygen content.

Question 12

What are examples of conditions that can lead to obstructive shock?

Answer 12

• Cardiac tamponade
• Gastric dilatation-volvulus

Question 13

What additional signs may indicate progression from compensated to early decompensated shock?

Answer 13

• Prolonged capillary refill time
• Poor pulse quality
• Cold extremities

Question 14

What is a common measurement finding in shock?

Answer 14

Hypotension is usually revealed upon measurement of blood pressure.

Question 15

What compensatory mechanisms occur as cardiac output and blood pressure decrease in shock?

Answer 15

• Increase in sympathetic tone
• Peripheral vasoconstriction
• Increased heart rate
• Increased respiratory rate

Question 16

What fluids are recommended for blood volume expansion in shock treatment?

Answer 16

• 0.9% NaCl
• Lactated Ringer’s solution
• 0.7% NaCl (hypertonic saline) with hetastarch if not hydrated

Question 17

What happens to urine output as shock worsens?

Answer 17

Initially, urine output may decrease, but as hypotension worsens, it can lead to oliguria.

Question 18

What initial steps should be taken in the therapy of shock?

Answer 18

• Obtain history
• Perform physical examination
• Place a jugular catheter
• Obtain blood for various tests

Question 19

What are the signs of late decompensated or irreversible shock?

Answer 19

• Bradycardia
• Comatose state
• Prolonged capillary refill time
• Weak to absent pulses
• Marked hypothermia

Question 20

What are some clinical signs of compensated shock?

Answer 20

• Pale mucous membranes
• Tachycardia
• Tachypnea

Question 21

What is the recommended action if the hematocrit is below 20%?

Answer 21

Replace red blood cells.

Question 22

What should be done if the pulse is weak or not palpable?

Answer 22

Blood pressure needs to be increased immediately.

Question 23

What should be given if the hematocrit and total protein are very low?

Answer 23

Fresh or stored blood.

Question 24

What can be used to improve contractility and increase cardiac output in severe shock?

Answer 24

Epinephrine.

Question 25

What is the first step in the treatment goals for shock?

Answer 25

Re-establish normal arterial pressure.

Question 26

What should be evaluated if central venous pressure (CVP) has increased but other signs of cardiac output are not normalized?

Answer 26

Cardiac function.

Question 27

What positive inotropic agents can be administered if the electrocardiogram is normal?

Answer 27

• Dobutamine
• Dopamine

Question 28

When should fresh or frozen plasma be administered in shock management?

Answer 28

If hypoproteinemia is present.

Question 29

What should maintenance fluids contain besides KCl?

Answer 29

Maintenance fluids should contain 5% dextrose.

Question 30

What reflects oxygen delivery in a patient?

Answer 30

Oxygen delivery is reflected in the color of mucous membranes, body temperature, respiratory rate, and temperature.

Question 31

What type of antibiotics are indicated in shock due to sepsis?

Answer 31

Broad spectrum antibiotics are indicated especially in shock due to sepsis.

Question 32

What is a common occurrence after aggressive fluid therapy that requires the addition of KCl in maintenance fluids?

Answer 32

Hypokalemia occurs commonly after aggressive fluid therapy.

Question 33

How can arterial pressure be assessed?

Answer 33

Arterial pressure can be assessed by digital palpation.

Question 34

What is a good indicator of cardiac output?

Answer 34

Urine output is a good indicator of cardiac output.

Question 35

What is the most important parameter to optimize in monitoring blood volume?

Answer 35

Blood volume is the most important parameter to optimize.

Question 36

What factors reflect cardiac output besides urine output?

Answer 36

• Capillary refill time
• Body temperature
• Mentation