Shock

Question 1

Hypovolemic shock- Eti

Answer 1

• Derangement in end diastolic volume
• Insufficient intravascular volume
• Blood loss (hemorrhage), volume loss (decreased intake, ascites, heat stroke, GI loss)

Question 2

Hypovolemic shock- Sx

Answer 2

• Pale, cool, moist skin
• High HR, low BP
• High RR
• Elevated SVR, vascular tone
• Narrowed pulse pressure
• Tachycardia
• Decreased urine
• Agitation

Question 3

Hypovolemic shock- Dx

Answer 3

• CBC, coag studies

- Determine underlying condition

Question 4

Hypovolemic shock- Tx

Answer 4

• Stop bleeding/ fluid loss
• Replace volume: Crystalloid Infusion of saline or ringers lactate
• Warm fluids
• Correct lytes imbalances
• Blood if hemorrhagic

Question 5

Distributive shock- Eti

Answer 5

• Sepsis, anaphylaxis
• Adrenal insufficiency
• Neurogenic- loss of sympathetic fibers, decreased autonomic tone
• Drug induced vasodilation
• Blood volume inappropriately distributed
• Relative hypovolemia and decreased perfusion

Question 6

Distributive shock- Sx

Answer 6

• Warm patient in shock
• Erythematous warm skin despite hypotension
• Loss of vascular tone
• Increased CO, low vascular resistance
• High pulse pressure
• Neurogenic- normal to slow HR

Question 7

Distributive shock- Dx

Answer 7

• Cultures
• Assess airways
• Issue with SVR-

Question 8

Distributive shock- Tx

Answer 8

• Anaphylaxis- Epi, removal of allergen, IVFs, H1 and H2 blockers, steroids, magnesium,
• Sepsis- Target abx, oxygen
• Adrenal crisis- additional steroids, quickly
• Beta blockers- glucagon
• Neurogenic- vassopressors, atropine for bradycardia

Question 9

Obstructive shock- Eti

Answer 9

• Impairment of ventricular filling and CO
• Impaired cardiac output from physical obstruction of blood flow
• Tension pneumo, tamponade, PE
• Structural heart disease in infants

Question 10

Obstructive shock- Sx

Answer 10

• Hypotension
• Elevated JVD
• pulsus paradoxus
• Kussmal signs
• Chest pain, syncope, tachypenia
• Decreased CO, increased SVR

Question 11

Obstructive shock- Dx

Answer 11

• Tracheal deviation, hyper-resonance
• JVD, muffled heart sounds
• Hypoxemia

Question 12

Obstructive shock- Tx

Answer 12

• Norepi

- Tx underlying cause

Question 13

Cardiogenic shock- Eti

Answer 13

• Dysrhthmia
• Cardiomyopathy
• Mechanical- leaky valves
• Myocarditis- post viral

Question 14

Cardiogenic shock- Sx

Answer 14

• Left sided heart failure- pulmonary edema
• Increased HR, systemic vast resistance
• Peripheral edema
• Elevated JVD

Question 15

Cardiogenic shock- Dx

Answer 15

• No fluid challenge
• Obtain cardiac enzymes
• EKG

Question 16

Cardiogenic shock- Tx

Answer 16

Tachy- Cardioversion
Brady- transcutaneous pacing
- O2, Asa, heparin, gentle fluid challenge
- Atropine