Shock basics Flashcards
Q: What is shock?
A: Shock is a life-threatening condition that occurs when inadequate tissue perfusion and oxygen delivery leads to end organ damage and potentially death.
Q: What are the four types of shock?
A: The four types of shock are distributive, hypovolemic, cardiogenic, and obstructive.
Q: What causes distributive shock?
A: Distributive shock occurs due to excessive systemic vasodilation, leading to impaired blood flow distribution.
Q: What causes hypovolemic shock?
A: Hypovolemic shock is caused by a critical loss of fluid volume.
Q: What causes cardiogenic shock?
A: Cardiogenic shock results from compromised myocardial performance, leading to a severely decreased cardiac output.
Q: What causes obstructive shock?
A: Obstructive shock results from an obstruction of blood flow from either filling the heart or ejecting into the great vessels, leading to decreased cardiac output.
Q: What is the initial management for a patient presenting with signs of shock?
A: Immediately perform an ABCDE assessment, stabilize the airway, breathing, and circulation, obtain IV access, and consider giving IV fluids and medications.
Q: What is the purpose of placing a central venous catheter in shock management?
A: A central venous catheter is placed for administration of medications and hemodynamic monitoring.
Q: What is the purpose of an arterial catheter in shock management?
A: An arterial catheter is used for continuous monitoring of the mean arterial pressure (MAP).
Q: What are common symptoms of shock?
A: Symptoms include generalized weakness, fatigue, lethargy, and postural dizziness.
Q: What physical exam findings are indicative of shock?
A: Physical exam findings include hypotension, weak peripheral pulses, tachycardia, and altered mental status.
Q: What is the significance of capillary refill time (CRT) in shock assessment?
A: CRT is an indicator of perfusion; a prolonged CRT suggests poor perfusion due to impaired cardiac output.
Q: What is distributive shock?
A: Distributive shock occurs due to excessive systemic vasodilation, leading to impaired blood flow distribution.
Q: What are the common causes of distributive shock?
A: The common causes include sepsis, anaphylaxis, and neurogenic injury.
Q: What are the clinical features of septic shock?
A: Features include fever, flank pain, costovertebral tenderness, leukocytosis, thrombocytopenia, elevated lactate, and elevated inflammatory markers.
Q: How is septic shock diagnosed?
A: Diagnosis involves blood cultures and imaging to identify the source of infection.
Q: What is the management of septic shock?
A: Management includes fluid resuscitation, broad-spectrum antibiotics, and vasopressors like norepinephrine or dopamine.
Q: What are the clinical features of anaphylactic shock?
A: Features include exposure to an allergen, urticaria, itchy skin, labored breathing, wheezing, and stridor.
Q: How is anaphylactic shock diagnosed?
A: Diagnosis can be supported by elevated tryptase levels.
Q: What is the management of anaphylactic shock?
A: Management includes removing the allergen and administering intramuscular epinephrine.
Q: What are the clinical features of neurogenic shock?
A: Features include a history of brain or spinal cord injury, paradoxical bradycardia, and neurologic deficits.
Q: How is neurogenic shock diagnosed?
A: Diagnosis is supported by CT imaging revealing skull or vertebral fractures or spinal cord injury.
Q: What is hypovolemic shock?
A: Hypovolemic shock is characterized by a decrease in intravascular blood volume to a point where tissue perfusion can’t be adequately maintained.
Q: What are the clinical features of hypovolemic shock?
A: Features include cold, clammy skin and delayed CRT.
Q: What are the causes of hypovolemic shock?
A: Causes include hemorrhagic (blood loss) and non-hemorrhagic (fluid loss due to vomiting, diarrhea, or burns).
Q: How is hemorrhagic shock diagnosed?
A: Diagnosis involves CBC (low hemoglobin) and imaging like ultrasound and CT to visualize the bleeding source.
Q: How is non-hemorrhagic shock diagnosed?
A: Diagnosis involves assessing for fluid loss, CBC (high hemoglobin), and identifying underlying causes like gastrointestinal issues or burns.
Q: What is the management of hypovolemic shock?
A: Management includes addressing the underlying cause, giving IV fluids, and blood transfusions if needed.
Q: What is cardiogenic shock?
A: Cardiogenic shock results from compromised myocardial performance, leading to severely decreased cardiac output.
Q: What are the clinical features of cardiogenic shock?
A: Features include cold, clammy skin, delayed CRT, and no evidence of blood or fluid loss.
Q: What are the common causes of cardiogenic shock?
A: Common causes include heart failure and myocardial infarction.
Q: How is myocardial infarction diagnosed?
A: Diagnosis involves ECG (ST elevations), elevated cardiac enzymes, and physical exam findings of chest pain and diaphoresis.
Q: How is heart failure diagnosed?
A: Diagnosis involves labs (elevated BNP), TTE (systolic or diastolic dysfunction), and physical exam signs of volume overload.
Q: What is obstructive shock?
A: Obstructive shock results from an obstruction of blood flow from either filling the heart or ejecting into the great vessels, leading to decreased cardiac output.
Q: What are the clinical features of obstructive shock?
A: Features include cold, clammy skin, delayed CRT, and no evidence of blood or fluid loss.
Q: What are the common causes of obstructive shock?
A: Common causes include pulmonary embolism, cardiac tamponade, and tension pneumothorax.
Q: How is pulmonary embolism diagnosed?
A: Diagnosis involves Wells criteria, CTPA, and clinical signs like pleuritic chest pain and hemoptysis.
Q: How is cardiac tamponade diagnosed?
A: Diagnosis involves echocardiogram (pericardial effusion) and physical exam (Beck triad).
Q: How is tension pneumothorax diagnosed and treated?
A: Diagnosis is clinical based on history and physical exam, and treatment involves emergent needle decompression.
Q: What are the main steps in the initial management of shock?
A: Perform an ABCDE assessment, stabilize the airway, breathing, and circulation, obtain IV access, consider IV fluids, and continuous vital sign monitoring.
Q: What are key diagnostic tools for shock?
A: Key diagnostic tools include labs (CBC, cardiac enzymes, BNP), imaging (CT, echocardiography), and hemodynamic monitoring (central venous catheter, arterial catheter).
Q: What physical exam finding indicates poor perfusion in shock?
A: A prolonged capillary refill time (CRT) indicates poor perfusion.
Q: What is the main management strategy for hypovolemic shock?
A: The main management strategy includes addressing the underlying cause and giving IV fluids or blood transfusions.
Q: How is distributive shock differentiated from other types of shock based on skin findings?
A: Distributive shock typically presents with warm, dry, flushed skin, while other types of shock present with cold, clammy skin.
