Shock

Question 1

What is shock?

Answer 1

Widespread impaired tissue perfusion

Question 2

What are the different types of shock?

Answer 2

Hypovolaemic, Cardiogenic, Distributive, Obstructive

Question 3

What is hypovolaemic shock?

Answer 3

Inadequate tissue perfusion due to inadequate circulating volume
- Apparent blood loss (e.g. external haemorrhage)
- Internal bleeding (e.g. penetrating trauma)
- Body fluid loss (e.g. diarrhoea, vomiting, diuresis)
- Plasma loss (e.g. burns)

Question 4

What is the progression of hypovolaemic shock?

Answer 4

1. Decreased intravascular volume
2. Decreased venous return
3. Decreased preload
4. Decreased cardiac output
5. Decreased tissue perfusion

Question 5

What is cardiogenic shock?

Answer 5

Inadequate tissue perfusion due to cardiac dysfunction
- Myocardial infarction
- End-stage cardiomyopathy
- Arrhythmias

Question 6

What is distributive shock?

Answer 6

Inadequate tissue perfusion due to maldistribution of blood
- Sepsis
- Anaphylaxis
- Neurogenic

Question 7

What is septic shock?

How is it identified?

Answer 7

Shock in response to severe infection.

Diagnostic conditions:
- Known or suspected infection
- Two or more clinical indicators of systemic inflammatory response
- Evidence of at least one organ dysfunction

Question 8

What is anaphylactic shock?

How fast does anaphylactic shock develop and what are some symptoms?

Answer 8

IgE-dependent widespread peripheral vasodilation, increasing capillary permeability and causing bronchoconstriction

Developing over seconds-minutes:
- Hypotension
- Hives (Urticaria)
- Itchy skin (Pruritus)
- Angioedema
- Vomiting/Diarrhoea

Question 9

What is the management of anaphylactic shock?

Answer 9

Remove allergen
Call for help
Intramuscular adrenaline (Epipen)
Reassurance

Question 10

What is neurogenic shock?

Answer 10

Sympathetic disruption leaving unopposed vagal tone leading to widespread peripheral vasodilation
- Spinal anaesthesia
- Injury or disease above T6

Question 11

What is obstructive shock?

Answer 11

Inadequate tissue perfusion due to physical obstruction of blood circulation
- Pulmonary embolism
- Cardiac tamponade

Question 12

What are the stages of shock?

Answer 12

Initial stage
Compensatory stage
Progressive stage
Refractory/Irreversible stage

Question 13

What are the symptoms of the initial stages of shock?

Answer 13

Sweaty, cool hands and feet
Feeling restless, anxious or just exhausted
Feeling dizzy or light headed
Feeling thirsty
Increased respiratory rate

Question 14

What are the symptoms of the compensatory stage of shock

Answer 14

Alert but restless and agitated
- Panicked “I’m dying” feeling
Increased heart rate
Increased respiratory rate
Cool, moist skin (unless distributive shock)
Nausea/Vomiting/Diarrhoea

Question 15

What are the symptoms of the progressive stage of shock?

Answer 15

Agitated or drowsy/minimally responsive
Hypotension due to decreased circulating volume and failure of compensatory mechanisms
Hypothermia

Question 16

What are the signs of the refractory/irreversible stage of shock?

Answer 16

Respiratory failure
Hypothermia
Anuria
Mottled, cyanotic skin
Loss of consciousness
Death

Question 17

What is the treatment for shock?

Answer 17

Identify the cause and prevent further deterioration
Normalise systemic perfusion
Preserve organ function

Airyway & breathing
- Airway adjuncts
- Patient positioning
- Oxygen therapy

Circulation
- Resolve underlying cause (fix leaks/pump)
- Decrease oxygen demands (Analgesia, Antiemetics, reassurance)

Question 18

What are some variables to monitor for shock?

Answer 18

Heart rate/rhythm
Level of consciousness
Non-invasive or arterial blood pressure
Respiratory rate, depth and effort
Oxygen saturation
pH, lactate and electrolytes
Urine output (ideally >0.5ml/kg/hr)