Shock

Question 1

What are the four phases of shock?

Answer 1

Class one initial stage where cells switch from aerobic to anaerobic metabolism. Class 2 Compensatory phase. Class 3 Progressive or de-compensatory phase. Class 4 Refractory or irreversible phase.

Question 2

Children can maintain blood pressure until they have lost what percentage of blood?

Answer 2

30-40% (Caroline, 2013)

Question 3

What occurs during the stage of irreversible shock?

Answer 3

Blood is shunted away from the liver, kidney and lungs to perfuse the brain and heart. (Caroline, 2013)

Question 4

How do paediatric patients compensate?

Answer 4

Can compensate up to 30-35% of blood loss then rapid decline follows. This compensation is achieved by increasing their pulse rate and systemic vascular resistance. However, this causes them to burn glucose rapidly and they have little glucose in storage. In addition, they can increase their pulmonary vascular resistance up to the point where not enough blood is perfumed to the brain, heart and lungs. (Caroline, 2013)

Question 5

What are the three basic causes of shock?

Answer 5

Pump failure Low fluid volume Poor vessel function (Caroline, 2013)

Question 6

What is the definition of shock?

Answer 6

A lack of tissue perfusion at the cellular level, leading to anaerobic metabolism and the loss of energy production needed to support life (PHTLS, 2011). If shock is not treated expeditiously, organ damage can occur and death can follow (Caroline, 2013).

Question 7

To avoid shock and function correctly, the body requires 3 intact mechanisms which are:

Answer 7

Efficient heart Adequate blood volume Intact blood vessels which are able to dilate and constrict in response to the demands of the body?

Question 8

What is the ischemic sensitivity of the organs?

Answer 8

Heart, brain, lungs = 4-6 mins Kidneys, liver, GI tract = 45-90 mins Muscle, bone, skin = 4-6 hours PHTLS, 2011

Question 9

What are the classifications of shock?

Answer 9

Shock occurs in three main phases or classes Compensated, decompensated and irreversible. However, haemorrhagic shock can be categorized into four classes. Class 1 - cells switch from aerobic to anaerobic metabolism. Class 2 - Compensatory stage Class 3 - Decompensatory stage(Progressive) - compensatory mechanisms begin to fail. Class 4 Irreversible stage.

Question 10

Describe stage 1 shock

Answer 10

Up to 15% of blood volume lost Few clinical signs. slightly anxious Minimal tachycardia

Question 11

Describe stage 2 shock

Answer 11

15-30% blood volume loss tachycardia, increased vr, narrowed pulse pressure Mildly anxious Pallid, cool, clammy skin CRT >2 secs PR 100-120 Increased RR (20-30) Systolic normal (pulse pressure narrows) At this stage the body is at limit of compensation. (PHTLS, 2011)

Question 12

Describe stage 3 shock

Answer 12

30-40% blood volume loss tachycardia, tachypnea, severe anxiety or confusion PR 120-140 Systolic

Question 13

Describe class 4 shock

Answer 13

>40% blood volume loss marked tachycardia and tachypnea, profound confusion, moribund appearance. Greatly reduced systolic - typically around 60 mm Hg. PR > 140 and weak RR > 35 Minutes to live. (PHTLS, 2011)

Question 14

What are the 4 ups of shock?

Answer 14

PR to compesate for blood loss RR Pupils (due to hypoxia) Diaphoresis

Question 15

What are the 4 downs of shock

Answer 15

Level of conciousness due to hypoxia Colour (lack of blood to peripherals) Temperature (as above) Blood pressure (late stage)

Question 16

what are the 8 across of shock

Answer 16

Nausea, fear, restlessness, anxiety, apathy, thirst, vomiting, lethargy.

Question 17

What are the distributive types of shock?

Answer 17

Septic/Anaphylactic/Neurogenic

Question 18

What are the obstructive types of shock?

Answer 18

Pulmonary embolism Aortic aneurysm Cardiac tamponade

Question 19

What are the hypovolaemic types of shock?

Answer 19

Haemorrhage Dehydration Diarrhoea

Question 20

What are the types of cardiogenic shock?

Answer 20

AMI Valvular disease Arrhythmias

Question 21

What is neurogenic “shock”?

Answer 21

Spinal cord injury ( usually in the thoracolumbar region) results in interrupts the sympathetic nervous system pathway leading to massive vasodilation and pooling of blood in the peripheral vessels to the point where adequate perfusion is lost. (PHTLS, 2011)

Question 22

What are the signs of neurogenic shock?

Answer 22

Skin warm and dry (peripheral vessels unable to constrict and no sweating as controlled by sympathetic nervous system) pulse 72 resps 20 and regular BP systolic 80 = neurogenic shock BP falls without signs of shock

Question 23

What is sepsis?

Answer 23

It arises when the body’s attempt to fight an infection results in damage to its own tissues and organs. can lead to shock, MOF and death. Esp if not recognized early and treated promptly. Results of toxins produced in severe infection(usually bacterial) leading to reaction which causes a reaction which dilates the blood cells and allows blood to pool in the extremities and fluid to leak into surrounding tissue.

Question 24

Who can get toxic shock syndrome?

Answer 24

Previously healthy women who use tampons - but any one can get it.

Question 25

Treat all shock as…

Answer 25

Hypovolaemic shock until proven otherwise. Hodgetts and Turner, 2007)

Question 26

Technician treatment of shock is…

Answer 26

Treatment is based on the three parts of the Fick Principle being maintained. Those parts are Transfer of oxygen to the blood cells in the lung Transport of oxygenated blood cells to the tissues Transfer of the oxygen from the blood cells to the tissue. To that end the following actions would be taken Dealing with any catastrophic haemorrhage. Maintaining an adequate airway and ventilation by inspecting the airway and using airway adjuncts and providing ventilation if required. Using high levels of supplemental oxygen to increase the partial pressure of oxygen and increase oxygen uptake by the red blood cells. Maintaining adequate circulation by use of IV administered fluids (if paramedic available). (PHTLS, 2011) Other treatments would include positioning e.g. elevation of limbs if injury permits, reducing pain, immobilisation of injuries, controlling bleeding, reassurance, keeping them at right temperature. Rapid transport with constant, systematic, reassessment using ABCDE with particular attention given to PR, RR, BP and LOC. Consider the MOI to help detect hidden injuries, particularly when signs of shock exist without obvious cause (Caroline, 2013).

Question 27

Which groups are at particular risk of shock?

Answer 27

Those with haemorrhages, injuries or fractures. Heart conditions Burns or scalds Elderly Pregnant patients

Question 28

What is the lethal triad?

Answer 28

Haemorrhagic shock and the associated reduction in tissue perfusion, results in acidosis, hypothermia and coagulopathy (Sharpe DB et al, 2011).