Chapter 13 Shock

Question 1

What is defined as inadequate cellular perfusion?

Answer 1

Shock (hypoperfusion)

In the early stages of shock, the body attempts to compensate by maintaining homeostasis.

Question 2

What are the basic causes of shock?

Answer 2

• Pump failure
• Poor vessel function
• Low fluid volume

These causes can lead to various types of shock.

Question 3

What is required for adequate perfusion?

Answer 3

• Oxygen
• Nutrients
• Waste removal

Compromise in perfusion can lead to cellular injury or death.

Question 4

What is the process called where molecules move from an area of higher concentration to an area of lower concentration?

Answer 4

Diffusion

This process is how oxygen and carbon dioxide cross the walls of the alveoli.

Question 5

What is the perfusion triangle composed of?

Answer 5

• Heart (pump)
• Blood vessels (container)
• Blood (content)

When a patient is in shock, one or more parts of this triangle are not functioning properly.

Question 6

What does systolic pressure represent?

Answer 6

Peak arterial pressure during heart contraction

Diastolic pressure is maintained while the heart rests between beats.

Question 7

What are the three ways carbon dioxide is transported in the blood?

Answer 7

• Dissolved in plasma
• Combined with water as bicarbonate
• Attached to hemoglobin

This transport is crucial for removing waste from tissues.

Question 8

What is cardiogenic shock caused by?

Answer 8

Inadequate function of the heart (pump failure)

It leads to backup of blood into pulmonary vessels, causing pulmonary edema.

Question 9

What is the major effect of obstructive shock?

Answer 9

Mechanical obstruction preventing adequate blood filling in heart chambers

Common examples include cardiac tamponade, tension pneumothorax, and pulmonary embolism.

Question 10

What is septic shock a result of?

Answer 10

Severe infections, usually bacterial

Toxins generated by bacteria lead to widespread vessel dilation and plasma loss.

Question 11

What is the first step in emergency medical care for shock?

Answer 11

Begin immediate treatment as soon as shock is suspected

Follow standard precautions and control all obvious external bleeding.

Question 12

True or false: Blood pressure is often the first measurable factor to change in shock.

Answer 12

FALSE

Blood pressure may be the last measurable factor to change; a drop indicates well-developed shock.

Question 13

What should be assessed in the primary assessment for a patient with suspected shock?

Answer 13

• Level of consciousness
• Life-threatening concerns
• Patient priority and transport

Address massive hemorrhage before airway management if necessary.

Question 14

What is the treatment for cardiogenic shock?

Answer 14

• High-flow oxygen
• Position to ease breathing
• Prompt transport

Patients in cardiogenic shock should not receive nitroglycerin.

Question 15

What is the treatment for anaphylactic shock?

Answer 15

• Administer epinephrine intramuscularly
• High-flow oxygen
• Immediate transport

Assist ventilations if necessary and identify the allergen.

Question 16

What is the role of capillary sphincters?

Answer 16

Regulate blood flow through capillary beds

They respond to autonomic nervous system control and various stimuli.

Question 17

What happens during neurogenic shock?

Answer 17

Widespread dilation of blood vessels due to spinal cord injury

This causes blood to pool and decreases perfusion.

Question 18

What is hypovolemic shock caused by?

Answer 18

Inadequate fluid or volume in the circulatory system

It can result from hemorrhagic or nonhemorrhagic causes.

Question 19

What are the signs and symptoms of cardiogenic shock?

Answer 19

• Weak, irregular pulse
• Cyanosis
• Anxiety
• Nausea

These symptoms indicate inadequate cardiac output.

Question 20

What is the importance of early recognition of shock?

Answer 20

Can save lives

Shock is life-threatening and requires rapid treatment.

Question 21

What is the most effective treatment for a severe, acute allergic reaction?

Answer 21

Administer epinephrine by way of intramuscular injection

A patient with anaphylaxis requires immediate transport and high-flow oxygen.

Question 22

What should be administered to a patient with anaphylaxis for respiratory support?

Answer 22

High-flow oxygen (10 to 15 L/min via a nonrebreathing mask)

Assist ventilations with a bag-mask device if necessary.

Question 23

True or false: A mild allergic reaction may worsen suddenly or over time.

Answer 23

TRUE

Always monitor the patient for changes in condition.

Question 24

What should you consider requesting for a patient with anaphylaxis due to potential airway compromise?

Answer 24

ALS backup

Advanced Life Support can provide additional resources for airway management.

Question 25

In an uncomplicated case of **fainting**, what happens once the patient becomes supine?

Answer 25

Circulation to the brain is restored ## Footnote This is important for recovery from psychogenic shock.

Question 26

How can **psychogenic shock** affect other types of shock?

Answer 26

It can worsen other types of shock ## Footnote Always assess for injuries, especially in older patients.

Question 27

What should you suspect if a patient reports not being able to walk after a fall thought to be related to **psychogenic shock**?

Answer 27

Another problem, such as head injury ## Footnote Always check for injuries in patients with loss of consciousness.

Question 28

What is the first step in treating **hypovolemic shock**?

Answer 28

Control all obvious external bleeding ## Footnote This is crucial for managing hypovolemic shock effectively.

Question 29

What should be maintained for a patient in **hypovolemic shock**?

Answer 29

An airway and respiratory support as necessary ## Footnote Rapid transport to the ED is also essential.

Question 30

Older patients generally have more serious complications than **younger patients**. True or false?

Answer 30

TRUE ## Footnote Many older patients take medications that could mask or mimic signs of shock.

Question 31

What is the protocol for treating a **pediatric or geriatric patient** in shock?

Answer 31

* Provide in-line spinal stabilization if indicated * Control life-threatening hemorrhage immediately * Suction as necessary * Provide high-flow oxygen * Maintain body temperature * Provide rapid transportation ## Footnote The treatment approach is similar to that of any other shock patient.