Shock (A0705)

Question 1

What is the definition of Shock?

Answer 1

Shock is a state of cellular and tissue hypoxia due to reduced oxygen delivery, increased oxygen consumption, inadequate oxygen utilization, or a combination of these processes.

Question 2

What is the strongest indicator of shock?

Answer 2

The strongest indicator of shock is profound hypotension, potentially offset transiently by compensatory tachycardia.

Question 3

Max normal saline dose for risk of fluid overload?

Answer 3

Max. 1000 mL for patients with a history of cardiac failure, chronic renal failure, or for elderly patients.

Question 4

Actions to take for IV extravasation?

Answer 4

Stop infusion, disconnect leaving cannula, get alternative access, attempt to aspirate drug, remove cannula, elevate limb, mark site, hand over, document details.

Question 5

Treatment modification for sepsis?

Answer 5

Reduced max fluid dose, for elderly or those with chronic renal/cardiac failure: 500 mL, others: 1000 mL. Consider Ceftriaxone 2g IV if transport time > 30 minutes.

Question 6

Preferred IV access for fluid administration?

Answer 6

18G or larger, ideally in a large proximal vein like the antecubital fossa.

Question 7

What are the SIRS criteria?

Answer 7

Temperature < 36°C or > 38°C, Heart Rate > 90, Respiratory Rate > 20.

Question 8

What to do if a patient has signs of sepsis?

Answer 8

Manage per guidelines with modifications for systolic BP < 100 mmHg, suspect infection with risk factors for sepsis or SIRS criteria.

Question 9

Fluid administration strategy in shock?

Answer 9

Titrate to response; max 2000 mL for general patients, max 1000 mL for at-risk groups.

Question 10

Ambulation risk assessment in shock patients?

Answer 10

Do not stand or walk the patient; extricate supine or sitting as appropriate.

Question 11

Considerations for shock patient management?

Answer 11

Achieve a perfusion target appropriate to the patient and their presenting illness, considering underlying conditions.

Question 12

Signs and symptoms suggestive of infection?

Answer 12

Fevers, chills, rigors, malaise, altered mental status, cough, dyspnea, abdominal pain, rigidity, tenderness, guarding, swelling, dysuria, urinary frequency or urgency, haematuria.

Question 13

Risk factors for sepsis?

Answer 13

Neutropenia, recent chemotherapy, recent pneumonia, COPD, recent trauma/surgery/procedure, hospital stay in last 6 weeks, indwelling medical devices like catheters.

Question 14

Management of shock with unknown cause?

Answer 14

Apply this guideline if the patient is ≥16 years old with inadequate perfusion not addressed by another guideline or if the cause is not immediately clear.

Question 15

Care objectives for shock management?

Answer 15

To achieve perfusion target appropriate to the patient and their presenting illness.

Question 16

What should you assess regarding ambulation risk in shock patients?

Answer 16

Assess the safety of allowing the patient to stand or walk. Typically, do not allow shock patients to stand or walk and extricate them supine or sitting, as appropriate.

Question 17

How should fluid management be approached in septic patients?

Answer 17

Use a conservative approach due to potential complications from aggressive fluid resuscitation. Consider the patient’s fluid intake, loss, and current research guidelines.