Recognition and management of shock trauma 2

Question 1

Discuss the Specific modifications to the ALS protocol for obstetric patients.

Answer 1

Choices of drugs may be limited
Chronic opioids- fatal withdrawals
NSAIDS- decreased renal blood flow
Midazolam near the time of delivery- neonatal depression
Nurse on the left side to increase venous return from the inferior vena cava
Early delivery

Question 2

Describe the Considerations that need to be made when caring for a paediatric in a critical care environment?

Answer 2

Surface area to volume ration leads to >heat loss, insensible fluid loss
>Risk of dehydration/ hypothermia
metabolic rate
>Risk of hypoglycemic events

Fluid requirements based on body weight
ABG’s and electrolyte values

• The child’s primary care giver is included in all planning of care
• Consider and anticipate the specific needs of critical ill infants and children that is age and developmentally appropriate
• Identify age appropriate parameters.
• Identify psychological and emotional care required for child and their family
• Expect for emergency treatment, parent of legal guardians need to consent to all aspects of medical care

Question 3

When a person is in shock, impairment in cellular metabolism is caused by:

a. The release of toxic substances.
b. Free-radical formation.
c. Inadequate tissue perfusion.
d. Lack of nervous or endocrine stimulation.

Answer 3

c. Inadequate tissue perfusion.

Question 4

One consequence of switching from aerobic to anaerobic cellular metabolism during shock states is:

a. decreased ATP production.
b. Cellular dehydration.
c. Cellular alkalosis.
d. Free-radical formation.

Answer 4

a. decreased ATP production.

Question 5

During shock states, glucose uptake is usually:

a. Enhanced.
b. Normal.
c. Impaired.
d. Energy intensive.

Answer 5

c. Impaired.

Question 6

A 50-year-old male was admitted to the intensive care unit with a diagnosis of acute myocardial infarction. He is being treated for shock. His cardiopulmonary symptoms include low blood pressure, tachycardia and tachypnoea. His skin is pale and cool. The primary cause of his shock is most likely:

a. Rapid heart rate.
b. Decreased cardiac contractility.
c. Increased capillary permeability.
d. Decreased afterload due to vasodilation.

Answer 6

b. Decreased cardiac contractility.

Question 7

An 82-year-old female was admitted to hospital with confusion and severe hypotension. Her body’s compensatory mechanisms are increased heart rate, vasoconstriction and movement of large volumes of interstitial fluid to the vascular compartment. What kind of shock do you suspect?

a. anaphylactic
b. hypovolaemic
c. neurogenic
d. septic

Answer 7

b. hypovolaemic

Question 8

A 27-year-old male is admitted to a neurologic unit with a complete C-5 spinal cord transection. On initial assessment, he is bradycardic, hypotensive and hyperventilating. He appears to be going into shock. The most likely mechanism of his shock is:

a. Hypovolaemia caused by blood loss.
b. Hypovolaemia caused by evaporative fluid losses.
c. Vasodilation caused by gram-negative bacterial infection.
d. Vasodilation caused by a decrease in sympathetic stimulation.

Answer 8

d. Vasodilation caused by a decrease in sympathetic stimulation.

Question 9

Neurogenic shock can be caused by any factor that inhibits the:

a. Parasympathetic nervous system.
b. Sympathetic nervous system.
c. Somatic nervous system.
d. Thalamus.

Answer 9

b. Sympathetic nervous system.

Question 10

A 15-year-old male who is allergic to peanuts inadvertently eats something containing peanuts. He then goes into anaphylactic shock and develops:

a. Bradycardia decreased arterial pressure and oliguria.
b. Bronchoconstriction, hives, oedema and hypotension.
c. Hypertension, anxiety and tachycardia.
d. Fever, hypotension and pustular rash.

Answer 10

b. Bronchoconstriction, hives, oedema and hypotension.

Question 11

The onset of anaphylactic shock is usually:

a. mild.
b. Immediate and life-threatening.
c. Delayed by several hours.
d. Delayed by 24 hours.

Answer 11

b. Immediate and life-threatening.

Question 12

A 20-year-old female is being admitted to hospital with fever and septic shock. Which set of clinical manifestations would you expect her to exhibit?

a. bradycardia, palpitations, confusion, truncal rash
b. severe respiratory distress, jugular venous distention, chest pain
c. low blood pressure, tachycardia, generalised oedema
d. reduced cardiac output, increased systemic vascular resistance, moist cough

Answer 12

c. low blood pressure, tachycardia, generalised oedema

Question 13

When the inflammatory response seen in septic shock becomes overwhelming, it can lead to…

a. Hypertension
b. Widespread tissue hypoxia
c. Widespread tissue hypoxia and necrosis
d. Vasoconstriction with compensatory bradycardia
e. Vasoconstriction with compensatory tachycardia

Answer 13

c. Widespread tissue hypoxia and necrosis

Question 14

The most common cause of multiple organ dysfunction syndrome (MODS) is:

a. Myocardial infarction.
b. Pulmonary disease.
c. Septic shock.
d. Autoimmune disease.

Answer 14

c. Septic shock.

Question 15

Septic shock is most commonly caused by what class of microorganism?

a. Bacteria
b. fungi
c. viruses
d. All of the above

Answer 15

a. Bacteria

Question 16

The acronym SIRS represents, which of the following?

a. Shock Inflammatory response Syndrome
b. Sympathetic Inflammatory Response Syndrome
c. Systemic Inflammatory Response Syndrome
d. Systematic Inflammatory Response Syndrome

Answer 16

c. Systemic Inflammatory Response Syndrome

Question 17

Interleukins are…

a. Released by macrophages and lymphocytes in response to bacterial toxins
b. Enzymes involved in haemostasis
c. Released from mononuclear phagocytes and platelets in response to endotoxin
d. Secreted from thalamus in response to endotoxin
e. Produced from nuclear killer cells in response endotoxin

Answer 17

c. Released from mononuclear phagocytes and platelets in response to endotoxin

Question 18

In multiple organ dysfunction syndrome, complications such as hypotension stimulate what system?

a. The autonomic nervous system
b. The sympathetic nervous system
c. The parasympathetic nervous system
d. The peripheral nervous system
e. None of the above

Answer 18

c. The parasympathetic nervous system

Question 19

Describe the clinical manifestations of septic shock.

Answer 19

Ineffective tissue delivery 
Inappropriate vasodilation 
Normal or increased CO
Hypovolemic due to vasodilation 
Cell death
Hyperthermia and fever
Warm, flushed skin
Pounding pulses