SHOCK

Question 1

What is a life-threatening condition of circulatory failure?

Answer 1

Shock

Question 2

What is defined as circulatory insufficiency that creates an imbalance between tissue oxygen supply and demand resulting in global tissue hypo-perfusion.

Answer 2

Shock

Question 3

What is the result of the imbalance between tissue oxygen supply and demand that is seen in Shock patients?

Answer 3

Global Tissue Hypo-perfusion

Question 4

What are the 4 categories of shock?

Answer 4

CHOD

1) Cardiogenic
2) Hypovelemic
3) Distributive
4) Obstructive

Question 5

Hypovelemic shock is caused by decreased intravascular volume secondary to ___________ or ______________.

Answer 5

1) Blood Loss

2) Loss of fluid and electrolytes

Question 6

Cardiac Output =

Answer 6

Stroke volume x Heart rate

Question 7

How does the body maintain Cardiac Output (CO) in the event of decreased stroke volume prior to the development of Hypovelemic Shock?

Answer 7

Increases Heart Rate

Question 8

What occurs when the body is no longer able to maintain cardiac output?

Answer 8

Shock

Question 9

What are common causes of Hypovolemic Shock?

Answer 9

1) Trauma
2) Massive hemorrhage
3) GI Bleed
4) Burns
5) Vomiting or Diarrhea
6) Excessive sweating
7) Hyperosmolar states (DKA)

Question 10

What type of shock can be caused by:

1) Trauma
2) Massive hemorrhage
3) GI Bleed
4) Burns
5) Vomiting or Diarrhea
6) Excessive sweating
7) Hyperosmolar states (DKA)

Answer 10

Hypovolemic Shock

Question 11

Hypovolemic Shock:

What is the cause of a patient that was originally Tachycardic, now has Bradycardia?

Answer 11

The Cardiac Output is too low to supply blood to the heart

Question 12

What is the Systolic BP in a Hypovolemic Shock patient

Answer 12

Systolic BP < 90 mmHg

Question 13

What are common physical findings in a Hypovolemic Shock patient?

Answer 13

1) Tachycardia, decompensate and becomes bradycardic
2) Hypotension (Systolic BP < 90 mmHg)
3) Mental status changes
4) Oliguria (due to decreased blood flow to the kidneys)
5) Cool extremities (due to peripheral vasoconstriction in order to shunt blood back to the heart)
6) Weak pulse
7) Low Jugular Vein Prominence

Question 14

Hypovolemic shock leads to what 3 things?

Answer 14

1) Hypoxia
2) Acidosis
3) End organ damage/failure

Question 15

What is the overall cause of Hypovolemic Shock?

A) Decreased intravascular volume
B) Blood Loss
C) Cardiac Pump Failure
D) Poor right ventricle output

Answer 15

A) Decreased intravascular volume

Hypovolemic shock is caused by decreased intravascular volume SECONDARY TO blood loss or loss of fluid and electrolytes

Question 16

1) Tachycardia/Bradycardia
2) Hypotension
3) Mental status changes
4) Oliguria
5) Cool extremities
6) Weak pulse
7) Low Jugular Vein Prominence

Answer 16

Hypovolemic Shock

Question 17

What EKG finding would be a sign of hypoperfusion in a hypovolemic shock patient?

Answer 17

ST Elevation or Depression

Question 18

What are the labs that should be gotten for a hypovolemic shock patient?

Answer 18

1) Chemistry panel
2) CBC *
3) LFT’s
4) ABG
5) Lactic acid level
6) EKG *

Question 19

What is the goal of treatment for Hypovolemic Shock?

Answer 19

Maintain adequate tissue perfusion

Question 20

What is the treatment of Hypovolemic Shock?

Answer 20

1) Fluid Replacement LR 1-2 Liter bolus (Better if it’s warm)
2) Blood transfusion if losing blood (with PRBC, FFP, and Platelets)

3) Vaso-Suppressors:
a) Norepinephrine 0.02 - mcg/kg/min IV
b) Epinephrine 0.014 -0.5 mcg/kg/min IV
c) Dopamine 1-20 mcg/kg/min IV

Question 21

For every 1 unit PRBC you give your hematocrit should increase ______.

Answer 21

3%

Question 22

Pump failure secondary to AMI, Cardiac contusion,Arrhythmia, Valvular incompetence or stenosis

Answer 22

Cardiogenic Shock

Question 23

What could cause the pump failure in cardiogenic shock?

Answer 23

1) AMI
2) Cardiac Contusion
3) Arrhythmia
4) Valvular Incompetence
5) Stenosis

Question 24

What type of shock?

1) Cardiac Pump Failure =
2) Decreased Intravascular Volume =
3) Reduced Systemic Vascular Resistance =
4) Extracardiac causes of Cardiac Pump Failure =

Answer 24

1) Cardiac Pump Failure = Cardiogenic Shock
2) Decreased Intravascular Volume = Hypovolemic Shock
3) Reduced Systemic Vascular Resistance = Distributive
4) Extracardiac causes of Cardiac Pump Failure = Obstructive

Question 25

1) Hypotension (SBP < 90 mmHg)
2) Mental status changes
3) Oliguria
4) Cool extremities

5) Elevated JVP **
6) JVD **

7) Tachypnea **
8) Pulmonary edema
9) Irregular pulse if arrhythmia

Answer 25

Cardiogenic Shock

Question 26

Labs and studies for cardiogenic shock

Answer 26

1) Chemistry panel
2) CBC *
3) LFT’s
4) ABG
5) Lactic acid level
6) EKG *
7) Transthoracic Echocardiogram (TTE) (Not on hypovolemic shock)

Question 27

What is the focus of initial treatment for Cardiogenic Shock?

Answer 27

Airway stability and improving pump function

Question 28

What is the treatment for cardiogenic shock?

Answer 28

1) Maintain Airway Stability
2) ACLS if cardiac arrest
3) 250 ml of fluid (Much smaller than hypovolemic)
4) Vaso-supressors:
a) Norepinephrine 0.02 - mcg/kg/min IV
b) Epinephrine 0.014 -0.5 mcg/kg/min IV
c) Dopamine 1-20 mcg/kg/min IV

Question 29

What type of shock causes a reduction in Systemic vascular resistance?

Answer 29

Distributive

Question 30

What are the 3 etiologies of Distributive Shock?

Answer 30

1) Septic
2) Anaphylactic
3) Neurogenic

Question 31

What causes the inability to maintain perfusion in Septic shock?

Answer 31

Bacterial Endotoxins

Question 32

What is the most common cause of distributive shock?

Answer 32

Septic Shock

Question 33

What etiology of distributive shock?

1) Caused by a release of bacterial endotoxins
2) Caused by a spinal cord injury
3) Caused by a release of histamines

Answer 33

1) Septic
2) Neurogenic
3) Anaphylactic

Question 34

1) Fever
2) Tachycardia
3) Elevated CBC
4) Hypoperfusion despite volume resuscitation
5) Elevated WBC

Answer 34

Septic Shock

Question 35

1) Diffuse urticarial angioedema
2) Bronchospasm
3) SOB
4) Fullness of throat
5) Hoarsness

Answer 35

Anaphylactic Shock

Question 36

1) Hypotension WITHOUT Tachycardia
2) Bradycardia
3) Warm, dry skin
4) Unresponsive to fluid resuscitation

Answer 36

Neurogenic Shock

Question 37

Treatment for septic shock

Answer 37

1) ABCs
2) 02 if SPO2 <92
3) Treat infection: Ertapenem 1 gram
4) IV LR
5) If unresponsive to 2L of LR = Vasosupressors

Question 38

When should Vaso-suppressors be initiated for Septic Shock?

Answer 38

1) IF does not respond to 2 Liters

2) Mean Arterial Pressure is below 60

Question 39

Treatment for Anaphylactic Shock

Answer 39

1) ABC
2) O2 if SPO2 below 92%
3) Secure airway
4) Epipen every 10-15 minutes
5) IV LR or NS
6) Benadryl, Zantac, Solumedral

Question 40

Treatment for Neurogenic Shock

Answer 40

1) ABCDE
2) C-Spine
3) IV LR or NS BOLUS
4) Secondary Survey