Shock

Question 1

Shock

Answer 1

the inability of the heart and lungs to satisfy the metabolic and oxygen needs of the peripheral tissues

Question 2

What do all types of shock lead to

Answer 2

cellular hypoxia, anaerobic metabolism, lactic acidosis

Question 3

Initial stage of shock

Answer 3

Sudden drop in bp and tissue perfusion that triggers the SNS and RAAS

Question 3

Stages of shock

Answer 3

Initial, progressive, irreversible

Question 4

S/S of the initial stage of shock

Answer 4

anxious, pale, cold and clammy extremities

Question 5

When is medical intervention for shock decided

Answer 5

during the initial stage when compensatory mechanisms are not enough to stabilize bp

Question 6

Progressive stage of shock

Answer 6

the lungs, kidney, gut, pancreas, and liver experience decreased perfusion, there is waste/toxin accumulation, no peristalsis

Question 7

S/S of progressive stage of shock

Answer 7

multiple organ dysfunction

Question 8

Where is the small amount of available blood conserved for during the progressive stage of shock

Answer 8

heart and brain

Question 9

Irreversible stage of shock

Answer 9

myocardial and cerebral ischemia with widespread cellular hypoxia

Question 10

What happens on the cellular level of the irreversible stage of shock (6)

Answer 10

anaerobic metabolism uses glucose to produce energy and lactic acid, energy stores are depleted, mitochondria cannot make ATP, lactic acid builds up in the bloodstream, organelles fail, digestive enzymes are released to breakdown cellular debris

Question 11

Universal signs of shock

Answer 11

tachypnea, tachycardia, cyanosis, metabolic acidosis, metal status change, low urine output, ECG changes, changes in CO/CVP/TPR

Question 12

Signs of generalized inflammation in shock

Answer 12

fever, increased HR, rapid RR, low BP

Question 13

Types of shock

Answer 13

cardiogenic, hypovolemic, anaphylactic, neurogenic, septic

Question 14

Cardiogenic shock

Answer 14

severe hypotension, significant decrease in aortic perfusion, loss of circulation in systemic arteries –> low urinary output, peripheral cyanosis, altered mental status

Question 15

Cardiogenic shock causes

Answer 15

acute MI, cardiac tamponade, severe tachycardia, bradyarrhythmias

Question 16

What is treated in cardiogenic shock

Answer 16

reduce heart’s oxygen needs, support CO, perfusion to myocardium

Question 17

Treatment options for cardiogenic shock

Answer 17

meds, angioplasty, stent, CABG, Intra-aortic balloon pump

Question 18

Cardiac tamponade

Answer 18

occurs when there is an increased amount of fluid in the pericardial effusion

Question 19

Hypovolemic shock

Answer 19

the amount of blood in the body’s vascular system is reduced, reducing coronary artery blood flow, BP, and aortic volume

Question 20

What is hypovolemic shock usually caused by

Answer 20

extensive loss of blood in hemorrhage, loss of ECF through diarrhea/vomiting/ascites/severe burns, insufficient venous return

Question 21

Treatment of cardiogenic shock

Answer 21

rapid fluid replacement, stop fluid loss

Question 22

Anaphylactic shock

Answer 22

extreme manifestation of an allergic reaction, histamine is released causes vasodilation, increases capillary permeability –> hyperperfusion and hypotension

Question 23

Treatment of anaphylactic shock

Answer 23

epinephrine, antihistamines, glucocorticoids, IV saline due to large fluid shift from bloodstream to tissues, intubation if bronchoconstriction is severe, identify antigen and carry epipen

Question 24

Neurogenic shock

Answer 24

the SNS is disrupted by a spinal cord/brain injury that causes widespread vasodilation and reduced venous return –> reduces CO and hypotension

Question 25

When does a lack of sympathetic tone and the parasympathetic nervous system action occur

Answer 25

during spinal cord injury to upper thoracic region or higher

Question 26

Treatment of neurogenic shock

Answer 26

IV vasoconstrictors, fluid administration, atropine to counteract parasympathetic bradycardia, treat CNS injury

Question 27

Septic shock

Answer 27

a severe state of sepsis, body-wide infection, with persistent hypotension

Question 28

What accumulates during septic shock and what does it cause

Answer 28

toxins and inflammation creating capillary permeability, coagulation pathways, and hyperglycemia

Question 29

Treatment of septic shock

Answer 29

appropriate antibiotics, CO support, vasoconstrictors, respiratory support, possible surgery to remove infection, dialysis

Question 30

What type of shock is the most complex to treat and involves multiple specialists

Answer 30

septic shock

Question 31

What type of shock is most likely in immunocompromised patients

Answer 31

septic shock