Shock

Question 1

Shock definition

Answer 1

inadequate tissue perfusion

Question 2

Shock is divided into four mechanistic classifications:

Answer 2

hypovolemic (inadequate circulatory volume)

cardiogenic (inadequate cardiac pump function)

distributive (maldistribution of blood flow)

obstructive (extracardiac obstruction to blood flow).

Question 3

______ is a late vitals finding in shock

Answer 3

Hypotension

narrowing of pulse pressure tends to occur earlier (and is due to increased sympathetic tone).

Question 4

Early signs of shock include

Answer 4

tachycardia
increased respiratory rate
Occur as the body attempts to maintain high perfusion.

Question 5

All patients with shock should receive as the first priority

Answer 5

Supplemental O2

Question 6

Children shock tends to be caused by ______

Answer 6

trauma and infections

Children’s signs and symptoms may be more subtle than those of adults in shock, rendering the physical examination less reliable in pediatrics.

Question 7

One of the key differences in peds vs adults in shock is a child’s ability to ___________

Answer 7

maintain blood pressure despite presence of shock.

Question 8

4 classes of hypovolemic shock based on the percent of volume loss;

Answer 8

Class I is loss of up to 15% blood volume
Class II is 15-30% loss
Class III, 30-40%
Class 4, over 40%.

Question 9

In general, blood pressure does not drop until approximately _____ of blood volume is lost.

Answer 9

30%

Question 10

-Acute hemorrhage or volume loss is characterized by _____
AND
-Skin tends to be __________.

Answer 10

Tachycardia, narrow pulse pressure, poor capillary refill and decreased urine output.

Skin tends to be cold and clammy.

Late findings include hypotension and altered mental status.

Question 11

the goal of IV resuscitation is to restore intravascular volume. Fluids that are ____ are preferred.

Answer 11

isotonic- blood, albumin, LR, NS

D5W is hyptonic, and therefore a poor choice for volume resuscitation.

Question 12

Goals of RX in cardiogenic shock

Answer 12

The goal of therapy is to improve oxygenation, minimize ischemia, improve pump function, and decrease afterload.

Dobutamine is the agent of choice in the setting of heart failure. An intra-aortic balloon pump may be a temporizing measure.

Question 13

neurogenic shock features

Answer 13

disruption of the autonomic nervous system leading to vasodilation and hypotension (without the expected tachycardic response).

Question 14

Treatment of a spinal cord injury with neurogenic shock includes

Answer 14

high dose steroids
IV fluids
immobilization
potentially pressors