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CEN Review > Shock Emergencies > Flashcards

Shock Emergencies Flashcards

1
Q

A trauma patient with a massive hemothorax will exhibit

A. Tracheal deviation
B. Distended neck veins
C. Hyperresonance on affected area
D. Hypotension

A

D. Hypotension

(A, B & C = tension pneumo)

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2
Q

Which of the following medications used for RSI intubation should be avoided if possible when managing a patient in shock?

A. Lidocaine
B. Succinylcholine
C. Etomidate
D. Ketamine

A

C. Etomidate (this may cause adrenal suppression)

(Ketamine preferred)

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3
Q

A syndrome characterized by generalized inadequate perfusion of tissues resulting in widespread impairment of cellular metabolism and
dysfunction of critical organs

A

Shock

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4
Q

What are 3 categories of shock?

A

-Alterations in circulating volume (Preload)

-Alterations in cardiac function (Pump)

-Alterations in vascular tone (Pipes)

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5
Q

The patient really looks relatively normal in this kind of shock.
May have anxiety, hyperventilation, narrowing pulse pressure (normotensive), cool clammy skin, increasing serum glucose

A

Compensated Shock

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6
Q

Type of shock that may cause alterations in level of consciousness, hypotension, significant tachycardia, peripheral cyanosis, decreasing urine output, ↓ pulmonary capillary blood flow and gas exchange (endothelial damage to lungs leads to metabolic and
respiratory acidosis), microcapillary clotting from sluggish blood flow (consumption of clotting factors)

A

Uncompensated Shock

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7
Q

Type of shock that causes progressive organ dysfunction leading to death of the individual. Causes cardiac failure, acidosis, clotting derangements, cerebral ischemia.
S&S: cold/pale/mottled skin, weak & thready pulses, significant tachycardia and dysrhythmias deteriorating to bradycardia, severe hypotension, hypothermia

A

Irreversible Shock

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8
Q

Type of shock from inadequate vascular volume (preload). Primary causes are massive blood loss (external or internal), vomiting/diarrhea, Diabetes Insipidus, burns, DKA, excessive diaphoresis

A

Hypovolemic Shock

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9
Q

Hypovolemic shock treatment (9)

A

-Control hemorrhage
-REBOA (occludes aorta to stop hemorrhage, stops all blood supply distally)
-2 large bore IV’s/IO/central access
-3:1 crystalloid to blood replacement
-Hypertonic saline
-Warm all IV fluids and Blood Products
-Monitor urine output
-Keep patient warm
-20 ml/kg bolus (x 2-3) crystalloid & 10 ml/kg PRBC’s for peds

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10
Q

Class of shock:

Volume loss: up to 15%, 750ml
VS: HR <100, BP normal
PE: essentially normal

A

Class I

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11
Q

Class of shock:

Volume loss: 15-30%, 750ml-1500ml
VS: HR >100, BP normal, decreased pulse pressure
PE: pale, anxious, diaphoretic, cool/clammy skin

A

Class II

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12
Q

Class of shock:

Volume loss: up to 30-40%, 1500ml-2000ml
VS: HR >120, BP low, decreased pulse pressure
PE: very anxious, confused, oliguria

A

Class III

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13
Q

Class of shock:

Volume loss: >40%, >2000ml
VS: HR >140, BP low, low pulse pressure
PE: lethargic, unresponsive, anuria, cols/pale extremities

A

Class IV

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14
Q

A 42-yr-old male patient presents to the ED via ambulance with a chief complaint of vomiting blood. Vital signs are BP 70/palp, HR 128/min and RR 38/min. The patient is confused. You conclude that your patient has which category of volume loss/hemorrhagic shock?

A. Class I
B. Class II
C. Class III
D. Class IV

A

C. Class III

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15
Q

Typical vital sign changes that occur in uncompensated (progressive) shock include:

A. A widening pulse pressure
B. Bradycardia
C. Decreased capillary refill
D. Narrowed pulse pressure

A

D. Narrowed pulse pressure

(widening PP not assoc with shock, bradycardia is in irreversible shock, decreased cap refill is good sign)

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16
Q

Which electrolyte imbalance is the patient who receives multiple blood transfusions at an increased risk for developing?

A. Hyponatremia
B. Hypokalemia
C. Hypocalcemia
D. Hypomagnesemia

A

C. Hypocalcemia

(+hyperkalemia)

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17
Q

Clinical manifestations of cardiogenic shock include all of the following except:

A. Distended neck veins
B. Pulmonary congestion
C. S3 heart sound
D. Low CVP

A

D. Low CVP (see this with hypovolemic shock)

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18
Q

Type of shock in which something causes decreased circulating
volume by preventing the myocardium from mechanically emptying or filling during diastole. Causes may include a tension pneumothorax, pericardial tamponade, pulmonary embolism, aortic aneurysm

A

Obstructive Shock

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19
Q

Type of shock from impairment of pumping ability/contractility of the heart. Causes may include MI, myocardial contusion, cardiomyopathies, valve dysfunction, ruptured septum

A

Cardiogenic Shock

20
Q

12 S&S of cardiogenic shock

A
  • Restless, apprehensive, confused, or obtunded
  • Chest pain
  • Pale, cool, clammy skin
  • Thready peripheral pulses
  • Delayed capillary refill
  • EKG changes/ dysrhythmias
  • Shallow rapid breathing
  • Decreased urine output
  • Metabolic acidosis
  • Hypoxemia/Hypocapnia
  • Weak or muffled heart sounds; S3 gallop
  • Distended neck veins (right ventricular failure)
21
Q

How do we manage cardiogenic shock? (8)

A

*ABC’s (anticipate ETT/ventilation, initiate CPR)
-12-lead EKG
*Anticipate need for thrombolytics
*increase/decrease preload (volume increases preload, nitro decreases)
*Improve contractility (with inotropes)
*Decrease afterload (with nitroprusside (Nipride)/ACE inhibitors)
*Anticipate need for mechanical support
*Correct the “obstruction” (needle thoracostomy, pericardiocentesis)

22
Q

Shock from abnormal placement of the intravascular volume. Causes vasodilation. Includes septic shock, anaphylactic shock & neurogenic shock.

A

Distributive Shock

23
Q

3 types of distributive shock

A

-septic shock
-anaphylactic shock
-neurogenic shock.

24
Q

Type of distributive shock: toxins released by invading organisms cause vasodilation and activate cellular, humoral and immunologic systems. Gram positive bacteria = exotoxins, gram negative bacteria = endotoxins. Bacteria cause release of cytokines and other inflammatory mediators, leading to massive vasodilation and increased capillary permeability. This causes inadequate cellular perfusion and leads to cell death.

A

Septic Shock

25
Q

Sepsis Definition: fever, HR >90, RR >20, WBC elevated

A

SIRS

26
Q

Sepsis Definition: SIRS + infection or presumed infection; life threatening organ dysfunction R/T infection (SOFA score ≥ 2)

A

Sepsis

27
Q

Sepsis Definition: Sepsis with ≥ 1 organ dysfunction

A

Severe Sepsis

28
Q

Sepsis Definition: Sepsis + hypotension that requires vasopressors (refractory to crystalloids)

A

Septic Shock

29
Q

What are 7 early S&S of septic shock?

7 late signs?

A

Early: tachycardia, increased cardiac output/index, decreased vascular resistance, widened pulse pressure, normal BP or mild hypotension, flushed skin, decreased LOC

Late: progressive decline in LOC, profound hypotension, pale/cool/clammy/mottled skin, weak/thready peripheral pulses, severe acidosis, hypoxemia & progressive increase in WOB, systemic and pulmonary edema

30
Q

Type of distributive shock: has a sudden onset from a severe allergic reaction (systemic antigen-antibody reaction or hypersensitivity). This causes massive vasodilation and increased capillary permeability which releases histamine, leukotrienes, and other vasoactive mediators

A

Anaphylactic Shock

31
Q

Anaphylactic shock common triggers (5)

A

-Antibiotics
*Shellfish
*Peanuts
*Eggs
*Insects (hymenoptera)

32
Q

Anaphylactic shock S&S (15)

A

*Relationship of time of exposure to symptoms
*Anxiety, feeling of impending doom
*Pruritus
*Urticaria, rash
*Sudden headache
*Abdominal pain
*Dyspnea & Tachypnea
*Syncope
*Angioedema
*Skin warm & flushed (early)
*Cool & clammy (late)
*Stridor or wheezing
*Nasal flaring
*Use of accessory muscles
*Profound respiratory distress

33
Q

What meds do we use in anaphylactic shock? (5)

A

-Epi 1:1000 0/1-0.5mg IM/SQ
-H1 antihistamine: benadryl
-H2 antihistamine: famotidine
-bronchodilators: albuterol
-steroids

34
Q

Type of shock: Loss of sympathetic vasomotor function, uncontested parasympathetic response, seen most frequently in brain stem injuries
and SCI at or above T6; causes hypotension & BRADYCARDIA, warm/dry/flushed skin, poikilothermia, spinal shock; Tx: ABC’s, volume administration with crystalloids, keep pt normothermic, vasopressors, phenylephrine, norepinephrine, stabilize spine. Typically resolves 24-48 hours after initial injury.

A

Neurogenic Shock

35
Q

Neurogenic shock is seen most frequently in brain stem injuries
and SCI at or above what?

A

T6

36
Q

Not true shock; causes loss of all neurological function below the level
of the lesion

A

Spinal shock

37
Q

What kind of IV fluids are NS and LR?

3% NS?

A

NS & LR = isotonic crystalloids

3% NS = hypertonic saline

38
Q

Who do we give O+ blood to?

A

Men and females > childbearing age; worry about Rh +

39
Q

Blood types can donate to:

O?
A?
B?
AB?

A

O = universal donor

A = donate to A & AB

B = donate to B & AB

AB = donate to AB (universal recipient)

40
Q

Blood products that are about to be administered to a patient with hemorrhagic shock should be warmed to prevent:

A. A transfusion reaction
B. Metabolic alkalosis
C. Hypokalemia
D. Hypothermia

A

D. Hypothermia

41
Q

How much crystalloid should be given per bolus for the pediatric patient presenting in shock?

A. 10ml/kg
B. 20ml/kg
C. 25ml/kg
D. 40ml/kg

A

B. 20ml/kg

(blood = 10ml/kg)

42
Q

A patient who is admitted to the ED in the early stages of septic shock most likely presents with:

A. Rapid, thready pulses and hypotension
B. Decreased urine output
C. Warm flushed skin
D. Hyperventilation and bradycardia

A

C. Warm flushed skin

43
Q

After exposure to a known allergen, a patient typically develops signs/symptoms of an allergic reaction and/or anaphylaxis within:

A. 10 minutes
B. 30 to 60 minutes
C. 24 hours
D. 2 days

A

A. 10 minutes

44
Q

The initial body’s response that occurs in sepsis is caused by:

A. The immune system’s response to the invading organism and the release of histamine
B. The loss of volume that occurs in sepsis due to pyrexia
C. The toxins of the infecting microorganism
D. The vascular system’s response to nitric oxide release

A

C. The toxins of the infecting microorganism

45
Q

A 10-yr-old female presents to the ED with severe shortness of breath, wheezing, and facial edema. Her mother says she was just stung by a yellow jacket. The initial dose of epinephrine for this child who weighs 30kg is

A. 0.3mg epinephrine 1:1,000 SQ
B. 0.3mg epinephrine 1:10,000 SQ
C. 0.3mg epinephrine 1:10,000 IM
D. 0.3mg epinephrine 1:1,000 IV

A

A. 0.3mg epinephrine 1:1,000 SQ

CEN Review (6 decks)

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