SHOCK

Question 1

What is the most common type of shock? What is the most common cause?

Answer 1

Hypovolemic; trauma

Question 2

What is the 3;1 fluid resuscitation rule?

Answer 2

3mL of fluid for every 1mL lost

Question 3

What is the most commonly used IO site, this site is preferred on peds

Answer 3

Proximal tibia

Question 4

What are the landmarks of the proximal tibia IO site?

Answer 4

1-3cm below tibial tuberosity and medially on the tibial plateau

Question 5

How do we treat hypovolemic shock? (4)

Answer 5

-1-2L of warmed NS or LR initially (20mL/kg in peds)
-O NEGATIVE blood
-Pressors after addressing bleeding
-Assess peripheral perfusion/urinary output (30mL/hr adults, 1-2mL/kg/hr peds)

Question 6

What are 3 ways to treat cardiogenic shock?

Answer 6

-Decrease preload (lasix, morpine, nitrates)

-Decrease afterload (nipride, nitrates, ACEI)

-Decrease contractility (dobutamine, inotropes)

Question 7

With this type of shock we should NOT increase BP! Avoid norepi/epi and caution with IVF!

Answer 7

Cardiogenic Shock

Question 8

This shock is due to a vascular/vasodilation problem. Includes septic, anaphylactic, neurogenic.

Answer 8

Distributive Shock

Question 9

What are the 3 types of distributive shock?

Answer 9

-septic
-anaphylactic
-neurogenic

Question 10

Type of distributive shock that causes a perfusion problem due to injury at T6 and higher. Loss of sympathetic function below injury, unopposed vagal (parasympathetic) influence leads to vasodilation, pooling of blood in extremities, decreased BP, decreased HR, warm/dry skin below level of injury

Answer 10

Neurogenic Shock

Question 11

Neurogenic shock occurs from injury at what level?

Answer 11

T6 and higher

Question 12

What cause of shock does cardiac tamponade cause?
(S&S = distant/dampened/muffled heart sounds)

Answer 12

Obstructive shock

Question 13

Name 4 types of shock

Answer 13

-Hypovolemic (fluid problem)

-Distributive (blood vessel problem)

-Cardiogenic (pump problem)

-Obstructive (blockage)

Question 14

What 5 things may cause obstructive shock?

Answer 14

-tension PTX
-PE
-Air embolism
-Dissection
-cardiac tamponade

Question 15

How do we decrease afterload?

Answer 15

Vasodilator

Question 16

What 3 meds decrease preload?

Answer 16

Lasix, morphine, nitro

Question 17

What BP/HR differences do we see b/t neurogenic and spinal shock?

Answer 17

Neurogenic = low BP, low HR

Spinal = normal BP, normal HR

Question 18

How do we do a needle decompression?

Answer 18

Affected side, MCL 2nd-3rd ICS, up and over rib, aspirate as you advance, listen for “whoosh” of air or return of syringe plunger, secure

Question 19

What type of shock would a tension pneumothorax cause?

Answer 19

Obstructive

Question 20

What is the SQ EPI concentration?

What is the IV EPI concentration?

Answer 20

SQ = 1:1000 (1mg/mL) - apaphylaxis dose is 0.3mg

IV = 1:10,000 (0.1mg/mL) - code dose is 1mg