Shock Management

Question 1

S&S: Hypovolemic Shock

Answer 1

Breathing rapid and shallow
Rapid heart rate
Skin cool/clammy
Uncontrolled hemorrhage
Low MAP/BP

Question 2

S&S: Cardiogenic Shock

Answer 2

Rapid breathing
Severe shortness of breath
Sudden, rapid heartbeat (tachycardia)
Loss of consciousness
Weak pulse
Low MAP/BP
Sweating
Pale skin
MI or Contusion Presentation on ECG

Question 3

S&S: Neurogenic Shock

Answer 3

Rapid onset of hypotension from massive vasodilation.
Possible bradycardia
Hypotension with a wide pulse pressure
Warm, flushed skin
Priapism due to vasodialation
Absent motor/sensory functions
Low MAP/BP

Question 4

S&S: Anaphylactic Shock

Answer 4

Skin reactions such as hives, flushed skin, or paleness
Suddenly feeling too warm
Difficulty Swallowing
Nausea, vomiting, or diarrhea
Abdominal pain
Weak and rapid pulse
Runny nose and sneezing
Swollen tongue or lips
Low MAP/BP

Question 5

S&S: Septic Shock

Answer 5

Shortness of breath
Fever, shivering, or feeling very cold
Extreme pain or discomfort
High heart rate
Unexplained confusion or disorientation
Sweaty or clammy skin
Low MAP/BP

Question 6

Physiology of shock in the body

Answer 6

Vasoconstriction in peripheries as blood is shunted to the heart brain and skeletal muscles.
Capillary flow to kidneys and abdominal organs decrease.
Lack of perfusion leads to anaerobic metabolism eventually leading to multiple organ failure

Question 7

Compensated Shock S&S

Answer 7

Heart rate: Mild Tachycardia
LOC: Lethargy, confusion, combativeness
Skin: Delayed capillary refill, cool skin
BP: Normal or slightly elevated

Question 8

Uncompensated Shock S&S

Answer 8

Heart Rate: Moderate Tachycardia
LOC: Confusion, unconsciousness
Skin: Delayed capillary refill, cold extremities, cyanosis
BP: decreased systolic and diastolic pressure

Question 9

Irreversible Shock S&S

Answer 9

Heart Rate: Bradycardia, severe dysrhythmias
LOC: Coma
Skin: Pale, cool clammy skin
BP: Frank hypotension

Question 10

Minimum treatment for PT in shock

Answer 10

All patients being treated for shock shall be given a blanket or hypothermia prevention kit.
(250 ml fluid Bolus, up to 1000ml)
Maintain SBP 90mmHg

Question 11

Fluid resusitation and minimum goal for blood pressure

Answer 11

Aollow permissive hypotensive resuscitation guidelines (PHRG) maintaining MAP 60, but not raising the BP into the “normal” range, which may increase bleeding. Only give minimal “bolus” appropriate resultative fluid per JTS CPG to maintain MAP >60, NIBP Systolic BP >90 , palpable Radial pulse
(250ml bolus, up to 1000ml)

Question 12

Use of hextend

Answer 12

Route: IV/IO
Dose: 250ml (available in 500ml bag)
Contraindications: Fluid in the lungs, acidosis (as Hextend includes lactate)