Shock

Question 1

What is shock?

Answer 1

Shock is inadequate organ perfusion leading to inadequate oxygen delivery to tissues and eventually organ failure

Question 2

What are the main types of shock?

Answer 2

Hypovolaemic
Cardiogenic
Neurogenic
Septic
Anaphylactic

Question 3

What term is used as an umbrella term for septic, anaphylactic and neurogenic shock?

Answer 3

Distributive shock (i.e. there is fluid but not in the right place)

Question 4

What is the main cause of hypoovolaemic shock?

Answer 4

Blood loss

Question 5

Give some causes of cardiogenic shock

Answer 5

Acute MI
Pulmonary embolism
Cardiac tamponade
Valvular heart problems
Heart failure

Question 6

What is the main cause of septic shock?

Answer 6

Gram +ve bacterial infection

Question 7

What causes an anaphylactic shock?

Answer 7

Body reacts to allergen

Question 8

Give the two main causes of neurogenic shock

Answer 8

Spinal cord injury

Spinal anaesthesia

Question 9

What happens to cardiac output, blood pressure, heart rate and temperature in hypovolaemic shock?

Answer 9

CO = decreased
BP = maintained initially then falls in late stage
HR = increased
Temperature = normal

Question 10

What happens to cardiac output, blood pressure, heart rate and temperature in cardiogenic shock?

Answer 10

CO = decreased
BP = increased
HR = increased
Temperature = normal

Question 11

What happens to cardiac output, blood pressure, heart rate and temperature in septic shock?

Answer 11

CO = increased (initially)
BP = decreased
HR = increased
Temperature = increased

Question 12

What happens to cardiac output, blood pressure, heart rate and temperature in anaphylactic shock?

Answer 12

CO = decreased
BP = decreased (profoundly)
HR = increased
Temperature = normal

Question 13

What happens to cardiac output, blood pressure, heart rate and temperature in neurogenic shock?

Answer 13

CO = decreased
BP = decreased
HR = decreased
Temperature = dysregulated

Question 14

What skin change occurs in hypovolaemic shock?

Answer 14

Skin becomes cool and pale

Question 15

What skin change occurs in cardiogenic shock?

Answer 15

Swollen and oedematous

Question 16

What skin change occurs in septic shock?

Answer 16

Skin becomes flushed and warm then cool and pale

Question 17

What is the main skin change in anaphylactic shock?

Answer 17

Urticaria

Question 18

What happens to the skin in neurogenic shock?

Answer 18

Becomes vasodilated below the lesion

Question 19

Anaphylactic shock results from what?

Answer 19

Mast cell degranulation releasing vasoactive mediators such as histamine

Question 20

What occurs in neurogenic shock?

Answer 20

There is loss of sympathetic outflow in the thoracic spine causing a lack of feedback

Question 21

How should hypovolaemic shock be treated?

Answer 21

Fluid and blood replacement

Question 22

How should cardiogenic shock be treated?

Answer 22

Fluid management
Inotropes (dobutamine etc.)
Vasopressors (noradrenaline)

Question 23

How should septic shock be treated?

Answer 23

Start sepsis 6 bundle

Vasopressors if fluid unresponsive

Question 24

What is the first line treatment for anaphylactic shock?

Answer 24

Adrenaline

Question 25

What is the first line treatment for neurogenic shock?

Answer 25

Vasopressors

Question 26

What are the two main theories for CPR?

Answer 26

Physically pumps the heart

Increases intrathoracic pressure causing a pressure gradient that causes blood flow

Question 27

What are the reversible causes of cardiac arrest?

Answer 27

4Hs - hypothermia; hyperkalaemia (also hypokalaemia/natraemia/calcaemia); hypoxia and hypovolaemia
4Ts - trauma; tamponade; tension pneumothorax; thromboembolism

Question 28

What are the main rhythms appropriate for immediate defibrillation?

Answer 28

Pulseless ventricular tachycardia

Ventricular fibrillation