Shock

Question 1

Define Shock

Answer 1

Shock is a condition characterised by impaired cellular function as a result of a reduction in the effective circulating blood volume.

This causes inadequate tissue perfusion.

Question 2

Patient Risk Groups

Answer 2

Haemorrhages, injuries or fractures.
Heart conditions.
Burns & Scalds.
Elderly patients.
Pregnant Patients.

Question 3

Types of Shock

Answer 3

Hypovolaemic
Cardiogenic
Neurogenic
Septic
Anaphylactic

Question 4

Hypovolaemic shock

Answer 4

inadequate volume of blood.

whole blood loss, plasma loss, electrolyte loss, water loss

Question 5

Cardiogenic shock

Answer 5

Failure of pump.

heart failure, myocardial infarction, myocardium, tension pneumonia, cardiac tamponade

Question 6

Neurogenic shock

Answer 6

Loss of vasomotor tone.

high spinal cord injury, poisons, fainting

Question 7

Septic/toxic Shock

Answer 7

Bacteriological Septicaemia.

meningococcal meningitis, peritonitis

Question 8

Anaphylactic shock

Answer 8

A reaction which reduces peripheral resistance and venous return.

Question 9

Shock recognition

Answer 9

Shock develops in four stages which relate to the body’s compensatory mechanisms.

Question 10

normal blood volume (relating to patient =>12yr)

Answer 10

75mls / kg

Question 11

Shock stage one (relating to patient =>12yr)

Answer 11

up to 15% volume loss.
pallor of skin
normal capillary refill: ,2seconds
pulse rate in excess of 100bpm
no change in systolic or diastolic blood pressure.

Question 12

Shock stage two (relating to patient =>12yr)

Answer 12

15-30% volume loss.
pallor & cool, clammy skin
extended time for capillary refill
pulse rate in excess of 100bpm
increased respiratory rate
narrowing pulse pressure
normal systolic but elevated diastolic blood pressure.

Question 13

Shock stage three (relating to patient =>12yr)

Answer 13

30-40% volume loss.
Anxiety, restlessness and agitation
pulse rate in excess of 120bpm
falling systolic BP to 100mmHg or less

Question 14

Shock stage four (relating to patient =>12yr)

Answer 14

over 40% volume loss.
moribund appearance
central cyanosis
altered level of consciousness
marked tachycardia, weak pulse
signs of respiratory distress - air hunger
systolic blood pressure of 70mmHG or less

Question 15

Shock management

Answer 15

Safety.
Open airway.
Administer high % O2.
If conscious position patient flat with head and shoulders slightly raised.
If unconscious position patient in stable side position.
Where possible raise lower limbs.
Treat other injuries and bleeding.
Do not overheat or allow to get cold.
Avoid rough handling.
Constant reassurance.
Constant observations.
Nil by mouth.
Transport quickly but smoothly.
paramedic intervention.

Question 16

Shock - paramedic/medical help

Answer 16

All types of shock can be life-threatening so you must be able to quickly assess the situation and the need to request backup.

Remember to take into account the condition of the patient, time for assistance to arrive and the distance to hospital.