Shock

Question 1

What is shock?

Answer 1

Decreased tissue perfusion and impaired cellular metabolism

Imbalance in supply/demand for O2 and nutrients

Question 2

What are the two categories shock?

Answer 2

Low blood flow

Maldistribution

Question 3

What are examples of “low blood flow” (LBF) shock?

Answer 3

• Hypovolemic
• Cardiogenic
• • Dysfunction in cardiac output

Question 4

What are examples of “maldistribution” shock?

Answer 4

• Septic shock
• Anaphylactic shock
• Neurogenic shock
• ** Same amount of blood in the vessel, but the vessel is extremely dilated

Question 5

What are early manifestations of LBF shocks?

Answer 5

Tachycardia
Tachypnea 
Hypotension
Narrowed pulse pressure
Increased myocardial O2 consumption
- Heart is working harder to fuel itself and the brain

Question 6

Treatment for LBF shock

Answer 6

Priority - Restore blow flow to the myocardium

Thrombolytic therapy
Angioplasty with stenting
Emergency revascularization
Valve replacement
*** Treat underlying problem

Question 7

Hypovolemic shock is known and the….

Answer 7

“Classic” shock

• Most commonly seen

Question 8

S/S of Hypovolemic shock

Answer 8

Anxiety
Tachypnea 
Increase in CO
Increased HR
Decrease in stroke volume, PAWP, and urinary output

Question 9

If loss is greater than ______% blood volume needs to be replaced

Answer 9

30%

• Pt needs to be replaced with blood products, NOT fluids. Fluids do NOT have the ability to transport O2 to the tissues and that is what the body needs

Question 10

Priorities in treating hypovolemic shock

Answer 10

Stop fluid loss and restore circulating volume

Fluid replacement

Vasopressors

Question 11

Neurogenic shock happens within _____ minutes of a spinal cord injury at the T6 or aboved

Answer 11

30 minutes

Question 12

What are the results of neurogenic shock?

Answer 12

Massive vasodilation, leading to the pooling of blood in vessels

Question 13

S/S of Neurogenic shock

Answer 13

Hypotension
Bradycardia
Temp dysregulation 
- Resulting in heat loss
Dry skin
Poikilothermia
- Taking on the temp of the environment

Question 14

Treatment for Neurogenic shock

Answer 14

Stabilize spinal cord
Treat hypotension with vasopressors 
Treat bradycardia with atropine
Use fluids cautiously, as hypotension is generally not related to fluid loss
Monitor for hypothermia

Question 15

Anaphylactic shock is an _______, life-threatening, ___________ reaction

Answer 15

Anaphylactic shock is an ACUTE, life-threatening, HYPERSENSITIVITY reaction.

Question 16

What happens in anaphylactic shock?

Answer 16

Massive vasodilation
Release of mediators (they cause inflammation)
Increase in capillary permeability

Question 17

S/S of anaphylactic shock

Answer 17

Anxiety, confusion, dizziness
Sense of impending doom
Chest pain
Incontinence
Swelling of lips, tongue, and angioedema
Wheezing, stridor
Flushing, pruritus, urticaria
Respiratory distress and circulatory failure

Question 18

Treatment of anaphylactic shock

Answer 18

Epi and/or Benadryl
Maintaining patient’s airway
Aggressive fluid replacement
IV corticosteroids

Question 19

What is septic shock?

Answer 19

Presence of sepsis (infection) with hypotension despite fluid resuscitation and tissue perfusion abnormalities

Question 20

What happens to the blood in septic shock?

Answer 20

Increased coagulation and inflammation
Decreased fibrinolysis
- Causing the formation of microclots

Basically DIC

Question 21

S/S of septic shock

Answer 21

Tachypnea/Hyperventilation
Temp dysregulation
Decreased urine output
Altered LOC
GI dysfunction
Respiratory failure is common

Question 22

Treatment of septic shock

Answer 22

IV corticosteroids

Antibiotics after cultures are obtained

Question 23

What is obstructive shock?

Answer 23

When a physical obstruction to blood flow occurs with decreased cardiac output