Shock

Question 1

Stages of Shock

Answer 1

1. Initial
2. Compensatory
3. Progressive
4. Refractory

Question 2

Initial

Answer 2

a. Cells deprived of oxygen; inhibits ability to produce energy
b. Cells not functioning appropriately
c. Major impact on body systems

Question 3

Compensatory

Answer 3

a. Body performs physiological adaptations in an attempt to overcome shock
b. Examples of physiological adaptation

Question 4

Progressive

Answer 4

a. Failed compensatory mechanisms

b. Vital organs are compromised; will not function appropriately

Question 5

Refractory

Answer 5

a. Failure of the vital organs

b. Shock condition is irreversible

Question 6

Hypovolemic Shock

Answer 6

1. MOST COMMON
2. Caused by inadequate venous return to the heart
3. Most common etiologies: hemorrhage or dehydration
4. Treatment:
   a. Arrest the bleeding, diarrhea, or vomiting
   b. Contact EMS
   c. CABs
   d. Provide intravenous fluids to restore circulating blood volume

Question 7

Cardiogenic Shock

Answer 7

1. Reduction in tissue perfusion due to decrease in cardiac output
2. common causes:
   a. Myocardial infarction
   b. Cardiac arrhythmias
   c. Cardiac dysfunction
3. Signs and Symptoms:
   a. reduction in blood pressure; systolic below 90mmhg
   b. Fast, weak pulse
   c. Cold, clammy, and cyanotic skin
   d. Nonspecific chest pain and shortness of breath
   e. Reduced urine output
   f. Mental confusion due to poor cerebral perfusion
4. Treatment:
   a. Adequate oxygenation using a non-rebreather mask
   b. IV fluids
   c. Beta-blockers, vasodilators, and positive inotropes used to improve cardiac output.

Question 8

Distributive Shock

Answer 8

Def: shock occurs as a result of vasodilation and abnormal distribution of fluids within the circulatory system.

• 3 types of distributive shock
  1. Anaphylactic shock
  2. Septic shock
  3. Neurogenic shock
  4. Obstructive shock

Question 9

Anaphylactic Shock

Answer 9

a. Sudden massive vasodilation and circulatory collapse due to individual’s exposure to an allergen
b. Treatment includes use of epinephrine, histamine blockers, and corticosteroids

Question 10

Septic Shock

Answer 10

a. Certain bacteria, particularly gram negative bacilli, invade the bloodstream
b. Causes body to begin an inflammatory response to try to rid itself of the invader via a cascade of chemical mediators.
c. Signs and symptoms include fever, vasodilation, increased cardiac output, and tissue edema
d. Treatment includes aggressive fluid resuscitation and antimicrobial therapy, and possibly surgery to eliminate/ reduce infection.

Question 11

Neurogenic Shock

Answer 11

a. Loss of sympathetic nerve activity from the brain’s vasomotor center due to an emotional trauma, disease, drug, or traumatic injury
b. Causes major peripheral vascular dilation; leads to reduction in venous return to heart.
c. Decrease in cardiac output occurs, with hypotension soon to follow
d. Signs and symptoms include hypotension, bradycardia, and peripheral vasodilation.
e. Treatment includes drug therapy and epinephrine

Question 12

Obstructive Shock

Answer 12

1. Results from indirect heart pump failure leading to decreased cardiac function and reduced circulation
2. Etiologies include arterial stenosis, pulmonary embolism, and cardiac tamponade.
3. Signs and symptoms include hypotension and dyspnea
4. Treatment includes relieving the source of the obstruction, surgical intervention IV fluids should be administered.