Shock

Question 1

Shock-Pathophysiology (4)

Answer 1

Definition:
Low perfusion to peripheral cells.

Time:
4-6 minutes: brain, heart, lungs.
45-90 minutes: other organs.
4-6 hours: external muscles.

1) Decline in perfusion>
2) Anaerobic breathing>
3) Toxins are released>
4) Adrenal glands secrete adrenaline>
1. Blood vessels to peripheral cells narrow, to heart, lungs and head widen.
2. Tachycardia,Tachypnea.
3. Relaxed Anti Duretic Hormone (ADH)

Question 2

Causes of shock (3), Types of shock (5),

Stages of shock (3)

Answer 2

Causes:

1) Decline in blood volume
2) Dysfunctional heart activity
3) Blood vessels expand > Decreases venous return > Decreased cardiac output (complex shock)

Types:

1) Hypovolemic (most common in trauma)
2) Septic (common in hospitals and old age homes)
3) Anayphelactic
4) Cardiogenic
5) Neurogenic (unique symptoms)

Stages:

1) Compensatory
2) Progressive
3) Refractory

Question 3

Hypovolemic Shock

Definition and causes (5)
Treatment (1)

Answer 3

Definition:
Loss of fluids 
-Bleeding
-Burns
-Urination
-Diarrhoea
-Vomiting

Treatment-Specifics:
1)Stop bleeding.

Question 4

Septic Shock

Definition

Answer 4

Definition:

Lack of perfusion due to wide spread infection.

Question 5

Neurogenic Shock

Definition and Difference

Answer 5

Definition:
Loss of perfusion due to loss of tone in the tunica media.

-Neurogenic Shock has unique symptoms due to stimulation of parasympathetic nervous system and partial complex shock.

Question 6

Anaphylactic Shock

Definition and Difference

Answer 6

Definition:
Lack of perfusion due to elevated histamine levels.

-Additional risk of blocked airway.

Question 7

Cardiogenic Shock

Definition
Causes (5)

Answer 7

Definition:
Lack of perfusion due to dysfunctional heart activity. (Cardiac output)

Causes:

• Direct
  
  1. Heart damage (heart attack, chronic heart disease, dull trauma)
  2. Cardiac arrhythmia
  3. Valvular heart disease (regurgitation and Pulmonary Edema)
• Indirect
  
  1. Cardiac tamponnade
  2. Pressure Pneumothorax

Question 8

Shock-Signs (9)

• Most symptoms will not show immediately.
• The best sign to rely on is pulse.

Answer 8

1) Tachycardia-Compensate for low BP/Bradycardia-Vagus nerve stimulation. (Neurogenic Shock)
2) Low BP
3) Tachypnea-Compensate for metabolic acidosis.
4) Pale skin, cold sweat-Narrow blood vessels, active sympathetic system (adrenalin)/Hot, sweaty or itchy skin. (Neurogenic/Anaphylactic Shock)
5) Shivery-Loss of blood/temperature regulation
6) Nausea and thirst-Decrease in functionality of digestive system.
7) Unfrequent urination-Decrease in functionality of urinary system.
8) Decline in consciousness-Lack of oxygen to brain/ Full consciousness. (Neurogenic Shock)
9) Capillary filling time (CFT): slow/normal (Neurogenic Shock)

Question 9

Shock-Treatment (5)

Answer 9

1) ABC according to PHTLS scheme.
2) Oxygen/Artificial respiration
3) Diagnose and treat source of shock.
4) Emergency evacuation/ICU
5) Monitor vitals and I.V. during evacuation.