Chapter 13 PP Shock

Question 1

Perfusion

Answer 1

Passage of blood, a blood substitute or other fluid through the blood vessels or other natural channels in an organ tissue

Question 2

Shock (hypoperfusion)

Answer 2

Inadequate cellular perfusion

Circulatory failure that impairs delivery of oxygen and nutrients to peripheral tissues

Question 3

Perfusion triangle

Answer 3

Heart (pump function) - damage to the heart by disease or injury. It cannot move blood adequately to support perfusion

Blood vessels (container function) - if all the vessels dilate at once, the normal amount of blood volume is not enough to fill the system and provide adequate perfusion to the body

Blood (content function) - if blood or plasma is lost, the volume in the container is not enough to support the perfusion needs of the body

Heart is the pump. Pipes are the blood vessels. Fluid is the blood volume

Question 4

What does perfusion require?

Answer 4

Adequate:

Oxygen exchange in the lungs
Nutrients in the form of glucose in the blood
Waste removal, primarily through the lungs

Question 5

Causes of shock

Answer 5

Pump failure (Cardiogenic sock and obstructive shock)
Poor vessel function (distributive shock)
Low blood volume (hypovolemic shock)

Question 6

Compensated vs decompensated shock

Answer 6

Body will try to compensate by any means necessary (maintain BP)

Decompensated shock = no longer able to maintain adequate BP (BP falling)

Question 7

Cardiogenic shock

Answer 7

Caused by inadequate function of the heart (pump is too weak)

Usually results of a heart attack (myocardial infarction)

Blood can back up into pulmonary vessels (lungs) called pulmonary adema

Question 8

Obstructive shock

Answer 8

Secondary force effects hearts ability to move blood effectively

Physical obstruction of the great vessels or heart itself

Causes
-something squeezing the heart - tension pneumothorax / pericardial tamponade
-blood blocked from exiting heart - pulmonary embolism

Question 9

What causes cardiac tamponade?

Answer 9

Caused by compression of the heart by fluid collecting in the pericardial sac. Since the pericardial sac will not expand to accommodate the buildup of fluid, the pressure squeezes the heart. This compresses the jugular veins and the aorta causing JVD and hypotension. The fluid surrounding the heart also makes a heart tones sound more muffled

Question 10

Pulmonary embolism

Answer 10

Bloackage in one of the pulmonary arteries in your lungs

Pulmonary embolism is caused by blood clots that travel from the legs

These blood clots in the legs are called deep vein thrombosis or DVT

Question 11

What are some forms of obstructive shock?

Answer 11

Cardiac tamponade

Tension pneumothorax

Pulmonary embolism

Question 12

Cardiac tamponade

Answer 12

Caused by compression of the heart by fluid collecting in the pericardial sac

Since the pericardial sac will not expand to accommodate the buildup of fluid, the pressure squeezes the heart.

Compressing the jugular veins and the aorta causing JVD and hypotension

Question 13

Signs of a tension pneumothorax

Answer 13

Diminished or absent lung sounds on the affected side

Severe respiratory distress or failure

Patient may also present with JVD

Question 14

Obstructive shock (KEY SIGNS)

Answer 14

Fluid accumulates in pericardial sack
-squeezes heart
-heart cannot stretch to fill
-little blood in heart = little blood out the heart

Leads to lower systolic BP
-systolic/diastolic get closer together
-called narrow pulse pressure

Blood backs up in veins leading into heart
-can cause JVD

Heart surrounded by fluid = sounds muffled
-“lub dub” of valves closing sounds like its under water

Narrow pulse pressure + JVD + muffled heart tones = Becks Triad (key signs)

Question 15

Obstructive shock - tension pneumothorax

Answer 15

Pneumothorax = air in chest (pleural space)

Tension = pressure exerted on heart, vena cava, aorta

Squished heart cannot pump, compressed lung cannot inflate

Can be caused by any pneumothorax

Key sign = absent or severely diminished breath sounds

Trachea can shift toward unaffected side (very late sign)

Question 16

Obstructive shock - pulmonary embolism

Answer 16

Caused by blockage in pulmonary artery

Blood flow decreased from heart to lung

Affects blood flow through lungs, not airways directly (patient may be very SOB with clear lung sounds)

Typically caused by clots traveling from legs (called DVTs)

Usually causes severe chest pain and SOB (key signs)

Question 17

Distributive shock

Answer 17

Results from widespread vasodilation

Circulating blood volume pools in th dilated vascular beds

Tissue perfusion decreases leading to acidosis in blood

Question 18

What are four primary types of distributive shock?

Answer 18

Neurogenic shock

Anaphylaxis shock

Septic shock

Psychogenic shock

Question 19

Distributive shock - neurogenic shock

Answer 19

Usually the result of high spinal cord injury
-at or above mid thoracic

Nerve impulses to blood vessels below the level of the injury are blocked

Vessels cut off from nerve impulses dilated, causes blood to pool

Heart does not receive sympathetic signals so HR does not increase = cannot compensate to maintain BP

Trauma + decreased CSM (key signs)

Question 20

Distributive shock - anaphylaxis shock

Answer 20

Immune system overreacts to perceived threat, causing severe allergic reaction and violent response
-excessive histamine response causes vasodilation and inflammation

Each subsequent exposure tends to produce a more severe reaction

PT usually exhibits outward signs of allergic reaction (key signs)
-rash, hives, swelling of skin
-difficulty breathing with stridor and/or wheezing
-signs may be more subtle like cramping

Question 21

Distributive shock - septic shock

Answer 21

Infection in bloodstream

Infection in bloodstream causes vasodilation

Dilated vessels leak fluid

Decreased tissue perfusion

Patient usually febrile aka feverish (key signs)

Question 22

Distributive shock - psychogenic shock

Answer 22

Caused by sudden reaction of the nervous system (parasympathetic)

Produces temporary, generalized vascular dilation

Results in fainting (syncope)

Patients may feel fine by the time EMS arrives

Question 23

Hypovolemic shock

Answer 23

Results of inadequate amount of fluid volume in the circulatory system

Hemorrhagic causes and non hemorrhagic causes

If bleeding externally - stop the bleed

Occurs with severe thermal burns, diarrhea and vomiting

Question 24

Three stages of shock

Answer 24

Compensated shock

Decompensated shock

Irreversible shock

Question 25

Compensated shock

Answer 25

Pulse rate increases Respirations increase Weak pulse Cool, clammy skin Anxious, restless, combative Thirsty weak Stage I and II hemorrhages Stop bleeding. Oxygenation. Give fluids. Keep patient warm. Get them to definitive care

Question 26

Decompensated shock

Answer 26

Very weak or absent pulse Severe drop in blood pressure Altered mental status or unconscious Slow breathing to apnea Stages III and IV hemorrhages Get patient back, but you need to work fast

Question 27

Irreversible shock

Answer 27

Cell death Organ system failure Washout Hemorrhaging all over Patient dies Stage IV hemorrhage Death

Question 28

Five critical interventions for a patient in shock

Answer 28

Control bleeding (if present) Place supine High flow oxygen as needed Prevent heat loss Rapid transport

Question 29

The term “shock” is most accurately defined as: A. A decreased supply of oxygen to the brain B. Cardiovascular collapse leading to inadequate perfusion C, decreased circulation of blood within the venous circulation D. Decreased function of the respiratory system leading to hypoxia

Answer 29

B. Cardiovascular collapse leading to inadequate perfusion

Question 30

Anaphylactic shock is typically associated with: A. Urticaria B. Bradycardia C. Localized welts D. A severe headache

Answer 30

A. Urticaria (hives)

Question 31

Signs of compensated shock include all of the following except: A. Restlessness or anxiety B. Pale, cool, clammy skin C. A feeling of impending doom D. Hypotension

Answer 31

D. Hypotension

Question 32

When treating a trauma patient who is in shock, lowest priority should be given to: A. Spinal protection B. Thermal management C. Splinting fractures D. Notifying the hospital

Answer 32

C. Splinting fractures

Question 33

Potential causes of Cardiogenic shock include all of the following except: A. Inadequate heart function B. Disease of muscle tissue C. Severe bacterial infection D. Impaired electrical system

Answer 33

C. Severe bacterial infection

Question 34

A 60 year old woman presents with a BP of 80/60 mmHg, a pulse rate of 110bpm, mottled skin, and a temperature of 103.9 degrees. She is most likely experiencing: A. Septic shock B. Neurogenic shock C. Profound heart failure D. A severe viral infection

Answer 34

A. Septic shock

Question 35

A patient with neurogenic shock would be least likely to present with: A. Tachypnea B. Hypotension C. Tachycardia D. Altered mentation

Answer 35

C. Tachycardia

Question 36

A 20 year old man was kicked numerous times in the abdomen during an assault. His abdomen is rigid and tender, his heart rate is 120bpm, and his respirations are 30 breaths / min. You should treat this patient for: A. A lacerated liver B. A ruptured spleen C. Respiratory failure D. Hypovolemic shock

Answer 36

D. Hypovolemic shock

Question 37

A 33 year old woman presents with a generalized rash facial swelling and hypotension approximately 10 mins after being stung by a hornet. Her BP is 70/50 mmHg and her heart rate is 120bpm. In addition to high flow oxygen, this patient is in most immediate need of: A. Epinephrine B. Rapid transport C. An antihistamine D. IV fluids

Answer 37

A. Epinephrine

Question 38

All of the following are potential causes of impaired tissue perfusion except: A. Increased number of red blood cells B. Pump failure C. Low fluid volume D. Poor vessel function

Answer 38

A. Increased number of red blood cells