Shock

Question 1

What is shock? What is the cause?

Answer 1

1. Shock: widespread inadequate tissue perfusion
2. Caused: by state of collapse and failure **of the cardiovascular system.

Question 2

What mechanisms does the body undergo to compensate during shock?

Answer 2

• Tachycardia
• Vasoconstriction
• Increased respiratory rate and depth
• Decreased urine production

Question 3

What are the four major categories of shock?

Answer 3

1. Hypovolemic
2. Cardiogenic
3. Obstructive
4. Distributive
   5.

Question 4

What is hypovolemic shock? What can cause hypovolemic shock?

Answer 4

1. Inadequate blood or fluid volume
2. a. trauma
   b. hemorrhage
   c. burns
   d. dehydration

Question 5

What is cardiogenic shock? What may onset it? What is another cause?

Answer 5

1. Cardiogenic shock: **heart lacks power to force through circulatory system. **
   - Congestive heart failure (CHF) is out of control
   - inadequat function of the heart or pump failure
   - leads to pulmonary edema
2. Onset: may be immediate or not apparent hours after Acute myiocardial infarction (AMI)
3. Dysrhythmias: can also cause cardiogenic shock

Question 6

What is an obstructive shock? What are some causes?

Answer 6

1. Physical obstruction of blood
   flow
2. a. tension pneumothorax
   b. cardia tamponade
   c. pulmonary embolus
   d. dissecting aortic aneurysm

Question 7

What is distributive shock? What are some causes?

Answer 7

1. Widespread reduction of blood vessel tone (vasodilation)
2. a. neurogenic (spinal chord trauma)
   b. sepsis (dehydration)
   c. anaphylaxis
   d. drugs/overdose
   e. psychogenic

Question 8

What are the early signs of shock?

Answer 8

*At this point the body begins to compensate*

1. Pale, cool, moist skin
2. Tachycardia
3. Delayed capillary refill
4. Tachypnea
5. Agitaation/anxiety/restlessness
6. Altered level of consciousness (ALOC)
7. Nausea/vomiting
8. Marked thirst

Question 9

What are the late signs of shock?

Answer 9

*Decompensation has occured*

1. Includes early signs
2. Hypotension
3. Labored irregular breathing
4. Ashen, mottled, cyanotic skin
5. Thready or absent peripheral pulses
6. Dilated pupils
7. Poor urinary output

Question 10

When would you expect shock?

Answer 10

1. Multiple severe fractures
2. Abdominal or chest injuries
3. Spinal injuries
4. Severe infection
5. Major heart attack
6. Anaphylaxis

Question 11

What is the treatment for shock?

Answer 11

Treatment does not vary with types of shock

Question 12

What are the actual_ _treatments for shock?

Answer 12

1. Maintaining airway
2. Control external bleeding
3. Shock position
4. High flow oxygen
5. Rapid transport
6. Keep warm
   _*Do not give the patient anything by mouth*_

Question 13

What are the ALS considerations?

Answer 13

• IV fluid“challenges” (hypovolemic)
• Medications (cardiogenic/distributive)
• MAST or medical anti shock trousers

Question 14

What may indicate dehydration?

Answer 14

History of:

• Nausea
• Vomiting
• Exertion
• Diarrhea

Question 15

What are some signs of Dehydration?

Answer 15

• Dry mucus membranes
• Sunken eyes
• Decreased urination
• Poor skin turgor
• The degree of elasticity of skin
• look at fontenelles for pediatrics

Question 16

What is eqaution for blood pressure?

Answer 16

BP = CO x PVR

Question 17

What is cardiac output? How do you calculate it?

Answer 17

1. Cardica output: the amount of blood pumped by the left ventricle over 1 minute
2. CO = stroke volume x BPM(beats per minute)

Question 18

What is stroke volume?

Answer 18

The amount of blood pumped by the left ventricle in one contraction

Question 19

What is peripheral vascular resistance? What is it determined by?

Answer 19

1. The force against which the heart has to beat
2. Partially determined by the size of the blood vessels

Question 20

WHat are the causes of shock?

Answer 20

1. Pump Failure:
   - cardiogenic
   - obstructive
2. Poor vessel function; Obstructive shock:
   - septic shock
   - neurogenic shock
   - anaphylactic
   - psychogenic
3. **Low fluid volume; Hypovolemic: **
   - hemorrhagic
   - nonhemorrhagic

Question 21

What is Cardiac tamponade?

Answer 21

• A collection of fluid between the pericardial sac and myocardium
• Casued by blunt or penetrating trauma