Shock

Question 1

What are the main types of shock? (4)

Answer 1

Hypovolemic
Cardiogenic
Distributive
Obstructive

Question 2

What are the three general signs of all types of shock?

Answer 2

What are the three general signs of all types of shock?
Low BP
Decreased urine output
Altered mental status

Question 3

What happens during pre-shock?

Answer 3

The body compensates for diminished tissue perfusion. May be asymptomatic up to 10% reduction in total effective arterial blood volume.

Question 4

What are SSX for early shock?

Answer 4

Hypotension
Tachycardia
Dyspnea
Mental confusion
Restlessness
Diaphoresis
Cool, clammy skin

Question 5

Which type of shock can result from burns, excessive vomiting, diarrhea, severe exfoliation, or internal or external loss of blood?

Answer 5

Hypovolemic

Question 6

What are some risk factors for hemostasis in hypovolemic shock?

Answer 6

Disorders involving vascular integrity, platelet number or function, coagulation factors, or medications (NSAIDS, coumadin)

Question 7

What is the mechanisms of most NSAIDS?

Answer 7

Inhibitions of the COX 1 and 2 enzymes (Ibuprofen, which is reversible. Aspirin is irreversible)

Question 8

What tests are run for Coumadin? for Heparin?

Answer 8

Coumarin - PT (prothrombin time)

Heparin - PTT (partial thromboplastin time)

Question 9

How is the shock index calculated?

Answer 9

HR/systolic BP

Question 10

What is the normal range of shock index?

What predicts nine times the risk of massive transfusion?

Answer 10

Normal = 0.5 - 0.7

> 1.3

Question 11

Up to what percentage of blood loss is a Class I hemorrhage?

Answer 11

15%; vital signs are usually normal, fluid resuscitation is not usually necessary.

Question 12

What is a common skin finding consisting of reticulated vascular pattern that may occur during shock?

Answer 12

Livedo reticularis

Question 13

What percentage of blood volume loss is a Class III and IV hemorrhage?

Answer 13

III - 30-40%

IV - >40%

Question 14

If a BP cuff is unavailable which palpable peripheral pulses indicate an approximate systolic BP?

Answer 14

Radial = 80
Brachial = 70
Femoral = 60
Carotid = 50

Question 15

Should you consider food or drink for someone in shock?

Answer 15

No, they may need emergency surgery.

Question 16

What results in cardiogenic shock?

Answer 16

Inadequate circulation of blood due to primary failure of the ventricles of the heart.

Question 17

What type of shock occurs even though the output of the heart is at or above a normal level? What causes are included in this type?

Answer 17

Distributive shock:
Septic
Anaphylactic
Neurogenic
Vasodilator drugs
Endocrine related

Question 18

What is the most common cause of distributive shock?

Answer 18

Sepsis

Question 19

What defines obstructive shock?

Answer 19

Physical obstruction of the great vessels or the heart itself.