Shock basics

Question 1

Q: What is shock?

Answer 1

A: Shock is a life-threatening condition that occurs when inadequate tissue perfusion and oxygen delivery leads to end organ damage and potentially death.

Question 2

Q: What are the four types of shock?

Answer 2

A: The four types of shock are distributive, hypovolemic, cardiogenic, and obstructive.

Question 3

Q: What causes distributive shock?

Answer 3

A: Distributive shock occurs due to excessive systemic vasodilation, leading to impaired blood flow distribution.

Question 4

Q: What causes hypovolemic shock?

Answer 4

A: Hypovolemic shock is caused by a critical loss of fluid volume.

Question 5

Q: What causes cardiogenic shock?

Answer 5

A: Cardiogenic shock results from compromised myocardial performance, leading to a severely decreased cardiac output.

Question 6

Q: What causes obstructive shock?

Answer 6

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.

Question 7

Q: What is the initial management for a patient presenting with signs of shock?

Answer 7

A: Immediately perform an ABCDE assessment, stabilize the airway, breathing, and circulation, obtain IV access, and consider giving IV fluids and medications.

Question 8

Q: What is the purpose of placing a central venous catheter in shock management?

Answer 8

A: A central venous catheter is placed for administration of medications and hemodynamic monitoring.

Question 9

Q: What is the purpose of an arterial catheter in shock management?

Answer 9

A: An arterial catheter is used for continuous monitoring of the mean arterial pressure (MAP).

Question 10

Q: What are common symptoms of shock?

Answer 10

A: Symptoms include generalized weakness, fatigue, lethargy, and postural dizziness.

Question 11

Q: What physical exam findings are indicative of shock?

Answer 11

A: Physical exam findings include hypotension, weak peripheral pulses, tachycardia, and altered mental status.

Question 12

Q: What is the significance of capillary refill time (CRT) in shock assessment?

Answer 12

A: CRT is an indicator of perfusion; a prolonged CRT suggests poor perfusion due to impaired cardiac output.

Question 13

Q: What is distributive shock?

Answer 13

A: Distributive shock occurs due to excessive systemic vasodilation, leading to impaired blood flow distribution.

Question 14

Q: What are the common causes of distributive shock?

Answer 14

A: The common causes include sepsis, anaphylaxis, and neurogenic injury.

Question 15

Q: What are the clinical features of septic shock?

Answer 15

A: Features include fever, flank pain, costovertebral tenderness, leukocytosis, thrombocytopenia, elevated lactate, and elevated inflammatory markers.

Question 16

Q: How is septic shock diagnosed?

Answer 16

A: Diagnosis involves blood cultures and imaging to identify the source of infection.

Question 17

Q: What is the management of septic shock?

Answer 17

A: Management includes fluid resuscitation, broad-spectrum antibiotics, and vasopressors like norepinephrine or dopamine.

Question 18

Q: What are the clinical features of anaphylactic shock?

Answer 18

A: Features include exposure to an allergen, urticaria, itchy skin, labored breathing, wheezing, and stridor.

Question 19

Q: How is anaphylactic shock diagnosed?

Answer 19

A: Diagnosis can be supported by elevated tryptase levels.

Question 20

Q: What is the management of anaphylactic shock?

Answer 20

A: Management includes removing the allergen and administering intramuscular epinephrine.

Question 21

Q: What are the clinical features of neurogenic shock?

Answer 21

A: Features include a history of brain or spinal cord injury, paradoxical bradycardia, and neurologic deficits.

Question 22

Q: How is neurogenic shock diagnosed?

Answer 22

A: Diagnosis is supported by CT imaging revealing skull or vertebral fractures or spinal cord injury.

Question 23

Q: What is hypovolemic shock?

Answer 23

A: Hypovolemic shock is characterized by a decrease in intravascular blood volume to a point where tissue perfusion can’t be adequately maintained.

Question 24

Q: What are the clinical features of hypovolemic shock?

Answer 24

A: Features include cold, clammy skin and delayed CRT.

Question 25

Q: What are the causes of hypovolemic shock?

Answer 25

A: Causes include hemorrhagic (blood loss) and non-hemorrhagic (fluid loss due to vomiting, diarrhea, or burns).

Question 26

Q: How is hemorrhagic shock diagnosed?

Answer 26

A: Diagnosis involves CBC (low hemoglobin) and imaging like ultrasound and CT to visualize the bleeding source.

Question 27

Q: How is non-hemorrhagic shock diagnosed?

Answer 27

A: Diagnosis involves assessing for fluid loss, CBC (high hemoglobin), and identifying underlying causes like gastrointestinal issues or burns.

Question 28

Q: What is the management of hypovolemic shock?

Answer 28

A: Management includes addressing the underlying cause, giving IV fluids, and blood transfusions if needed.

Question 29

Q: What is cardiogenic shock?

Answer 29

A: Cardiogenic shock results from compromised myocardial performance, leading to severely decreased cardiac output.

Question 30

Q: What are the clinical features of cardiogenic shock?

Answer 30

A: Features include cold, clammy skin, delayed CRT, and no evidence of blood or fluid loss.

Question 31

Q: What are the common causes of cardiogenic shock?

Answer 31

A: Common causes include heart failure and myocardial infarction.

Question 32

Q: How is myocardial infarction diagnosed?

Answer 32

A: Diagnosis involves ECG (ST elevations), elevated cardiac enzymes, and physical exam findings of chest pain and diaphoresis.

Question 33

Q: How is heart failure diagnosed?

Answer 33

A: Diagnosis involves labs (elevated BNP), TTE (systolic or diastolic dysfunction), and physical exam signs of volume overload.

Question 34

Q: What is obstructive shock?

Answer 34

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.

Question 35

Q: What are the clinical features of obstructive shock?

Answer 35

A: Features include cold, clammy skin, delayed CRT, and no evidence of blood or fluid loss.

Question 36

Q: What are the common causes of obstructive shock?

Answer 36

A: Common causes include pulmonary embolism, cardiac tamponade, and tension pneumothorax.

Question 37

Q: How is pulmonary embolism diagnosed?

Answer 37

A: Diagnosis involves Wells criteria, CTPA, and clinical signs like pleuritic chest pain and hemoptysis.

Question 38

Q: How is cardiac tamponade diagnosed?

Answer 38

A: Diagnosis involves echocardiogram (pericardial effusion) and physical exam (Beck triad).

Question 39

Q: How is tension pneumothorax diagnosed and treated?

Answer 39

A: Diagnosis is clinical based on history and physical exam, and treatment involves emergent needle decompression.

Question 40

Q: What are the main steps in the initial management of shock?

Answer 40

A: Perform an ABCDE assessment, stabilize the airway, breathing, and circulation, obtain IV access, consider IV fluids, and continuous vital sign monitoring.

Question 41

Q: What are key diagnostic tools for shock?

Answer 41

A: Key diagnostic tools include labs (CBC, cardiac enzymes, BNP), imaging (CT, echocardiography), and hemodynamic monitoring (central venous catheter, arterial catheter).

Question 42

Q: What physical exam finding indicates poor perfusion in shock?

Answer 42

A: A prolonged capillary refill time (CRT) indicates poor perfusion.

Question 43

Q: What is the main management strategy for hypovolemic shock?

Answer 43

A: The main management strategy includes addressing the underlying cause and giving IV fluids or blood transfusions.

Question 44

Q: How is distributive shock differentiated from other types of shock based on skin findings?

Answer 44

A: Distributive shock typically presents with warm, dry, flushed skin, while other types of shock present with cold, clammy skin.