Shock

Question 1

1. Define Shock

2. Identify 4 suitable clinical markers of tissue perfusion

Answer 1

1. A syndrome in which tissue perfusion is inadequate for the tissue’s metabolic requirement.
2. Blood pressure, Consciousness (brain perfusion), Urine Output (renal perfusion), Lactate (General tissue perfusion).

Question 2

1. How is Mean Arterial Pressure measured?

2. What are the four main categories of shock?

Answer 2

1. MAP= Cardiac Output x Systemic Vascular Resistance.

2. Hypovolaemic, Cardiogenic, Distributive, Obstructive

Question 3

1. Hypovolaemic shock can be caused by acute ________ or fluid depletion states such as severe _________ and burns. Volume depletion leads to reduced _______ _______ ________. therefore there is reduced _______ thus reduced cardiac output.

Answer 3

1. Haemorrhage, dehydration, Systemic Vascular Resistance, Preload

Question 4

1. Cardiac shock is where there is ________ failure. This is primarily caused by _______ _______.
2. Obstructive shock is where a mechanical obstruction reduces cardiac output. This can be direct obstruction such as an __________ or indirect like cardiac __________ and Tension Pneumothorax.

Answer 4

1. Ventricular/cardiac. Myocardial Infarction

2. Embolism, Tamponade.

Question 5

1. Distributive shock is where there is excessive __________.
2. Identify some possible causes

Answer 5

1. Vasodilatation.

2. Sepsis, anaphylaxis, acute liver failure, spinal cord injuries.

Question 6

1. How is blood pressure monitored in a patient with shock?

2. How is cardiac output measured?

Answer 6

1. Either cuff or arterial line

2. Thermodilution with a PA catheter.

Question 7

1. How is shock managed?

Answer 7

1. Fluids: Crystalloids, Colloids, Blood

If fluids fail then Adrenaline/Noradrenaline/Vasopressin/Dopamine