Shock

Question 1

Definition of shock

Answer 1

Hypoxia at cellular level

Question 2

Most common type of shock is

Answer 2

Hypovolemic shock

Question 3

What kind of injury can never give rise to hypovolemic shock?

Answer 3

Isolated head injury/isolated head bleed 

Question 4

Bleeding nature, when there is transaction of the artery

Answer 4

Vasospasm ; less bleeding

Question 5

Bleeding nature, when there is laceration of the artery

Answer 5

Vasospasm opening increases therefore more bleeding

Question 6

How does patient present when the bleeding source is venous in nature,

Answer 6

Gradual ooze - more time for body to compensate- late presentation

Question 7

How does reactionary hemorrhage a occurs?

Answer 7

It occurs 4 to 24 hours after surgery due to increase in BP or slippage of knot (grannies knot🪢 )

Question 8

What is the earliest indicator of hypovolemia?

Answer 8

tachycardia(release of adrenaline and noradrenaline)

Question 9

Best indicator to determine the amount of fluid required in shock

Answer 9

PCWP > CVP
Because PCWP will give us a idea about left sided heart pressure and CVP gives idea about right sided heart pressure.

Question 10

Best indicator of fluid resuscitation in shock

Answer 10

Urine output ; in adults >0.5 ML/KG/HR. children >1 ML/KG/HR.

Question 11

What is the most sensitive in GIT to hypovolemic insult

Answer 11

Gastric mucosa (stress, ulcers)

Question 12

Best end point of fluid resuscitation

Answer 12

MVOS

Question 13

Best clinical endpoint

Answer 13

Urine output

Question 14

Accurate measurement of MVOS can be done by drawing blood from a catheter in the

Answer 14

Right atrium

Question 15

What is a normal value of MVOS?

Answer 15

50-70 %

Question 16

High MVOS seen in

Answer 16

Septic shock

Question 17

Modified shock index is equal to

Answer 17

HR/MAP ( MOST SENSITIVE INDICATOR )

Question 18

RAPE rate overpressure difference=

Answer 18

= PR/ PP .
< 3 stable Patient.
>3 decompensated hemorrhagic shock.

Question 19

Complications of massive blood transfusion

Answer 19

• Hypothermia.
• Citrate is the anticoagulant used
Chelates Ca & Mg
-> Hypocalcaemia, hypomagnesemia
- citrate toxicity.
• Hyperkalaemia/ HypoKalaemia:
* Hyperkalaemia: Stored RBCs can lyse -> K* release.
Acidosis increases K*.
* Hypokalaemia: RBCs, after transfusion, can actively take in K+
• metabolic alkalosis : Due to citrate toxicity
Later on metabolic acidosis is seen.
• Blood transfusion reactions : Febrile (mc) anaphylactic reaction
•TACO & TRAIL

Question 20

MCC of death in massive blood transfusion is

Answer 20

Coagulopathy

Question 21

How to overcome coagulopathy

Answer 21

Ratio of PRBC : FFP : Platelets should be 1:1:1 should be maintained

Question 22

Scores that help in deciding massive blood transfusion

Answer 22

ABC score
TASH score

Question 23

Blood substitutes

Answer 23

1st generation: Perfluorocarbon.
2nd generation: stroma-free Haemoglobin.
• Next-generation:
Polyethylene glycol (PEG) hemoglobin.
• Hemospan A/K/A MP4OX - PEG conjugated human hemoglobin.
Pyridoxylated hemoglobin polyoxyethylene conjugate (PHP)

Question 24

In head injury there is

Answer 24

Bradycardia + Hypertension (cushing reflexes)

Question 25

In neurogenic shock there is

Answer 25

Bradycardia + Hypotension

Question 26

Inflammation markers are

Answer 26

IL-1 , IL-6 , TNF-α

Question 27

Parameters of SIRS

Answer 27

•Temprature <36 c or > 38°C • WBC (< 4000 or >12000 or >10% band forms in Peripheral smear.) •RR > 20/min (or) pCO2 <32mmHg • PR > 90 /min Any 2 Parameters are present: SIRS.

Question 28

Sepsis =

Answer 28

SIRS + known foci of infection

Question 29

Sepsis =

Answer 29

SIRS + known foci of infection

Question 30

Septic shock=

Answer 30

Sepsis + hypotension (which fails to respond to fluid)

Question 31

SOFA SCORE

Answer 31

Sequential (sepsis related ) organ failure assessment score SOFA >= 2 + known foci of infection : sepsis

Question 32

qSOFA SCORE

Answer 32

• SBP < 100 mmHg. • Altered mental status. • RR > 22/ min (tachypnea). A score of >=2 : poor outcome.

Question 33

During the first 6 hours of resuscitation, the goals of initial resuscitation of sepsis induced hypoperfusion should include all the following as a part of a treatment protocol:

Answer 33

1. CVP :8 - 12 mmig. 2. MAP: > = 65 mmHg. 3. urinary output : >=0.5ml/kg/hr. 4. MVOS: >=65% 5. Normalize lactate.

Question 34

Which metabolic abnormality is seen in massive blood transfusion

Answer 34

Metabolic acidosis

Question 35

The capillary refill time is prolonged in all type of shock except

Answer 35

Septic shock

Question 36

Definition of massive transition

Answer 36

Massive transfusion (MT) is defined as the replacement by transfusion of 10 units of pRBCs in 24 hours or more than 4 units of pRBCs in one hour.

Question 37

In patient with head injury with solution is contraindicated

Answer 37

5% dextrose

Question 38

Which fluid is given in severe head injury

Answer 38

Hypertonic saline

Question 39

Fogarty catheter is used in

Answer 39

Acute limb ischemia