ILO Theme 16: Shock

Question 1

Hypovolemic shock

Answer 1

Shock caused by low volume of blood. can b hemorrhagic or non-hemorrhagic

Question 2

cardiogenic shock

Answer 2

shock caused by the heart not being able to pump enough blood

Question 3

Distributive shock

Answer 3

Sepsis, anaphylaxis, neurogenic

Question 4

Shock definition

Answer 4

When tissue perfusion and oxygen delivery are insufficient to meet the metabolic demands of tissue

Question 5

Obstructive shock examples

Answer 5

Tamponade / PE / Tension
pneumothorax

Question 6

What is the initial stage of shock

Answer 6

hypoxia / lactic acidosis

Question 7

what is the compensatory stage of shock

Answer 7

physiological autoregulation

Question 8

what is progressive stage of shock

Answer 8

Failure of compensatory
mechanisms

Question 9

Refractory stage of shock

Answer 9

cell death

Question 10

Signs of shock

Answer 10

Cool, clammy, Pale skin. Prolonged capillary refill time, Tachycardia, Tachypnoea, Nausea or vomiting, Enlarged pupils, Decreased level of consciousness, Changes in mental status or behaviour, such as anxiousness or agitation

Question 11

Symptoms of shock

Answer 11

cold, breathless, heart racing, nausea or vomiting, weak, dizzy, syncope, feeling agitates or anxious

Question 12

How do we measure BP

Answer 12

BP = Cardiac output x vascular resistance

Question 13

Aortic compliance

Answer 13

refers to the aorta’s ability to stretch and recoil, acting as a buffer for blood pressure (BP)

Question 14

Reduced aortic compliance

Answer 14

lowers diastolic pressure and increases systolic compliance

Question 15

What kind of fluid is given to shock patients

Answer 15

called fluid bolus, a relatively large amount of fluid typically 500 ml of crystalloid over less than 15 minutes to treat shock

Question 16

How do you increase stroke volume in shock patients

Answer 16

Fluid bolus

Question 17

How does the body try to compensate when SV drops in shock

Answer 17

Venoconstriction: auto- transfusion. Vasoconstriction. Cold peripheries

Question 18

How does the body try and compensate when vascular resistance decreases

Answer 18

increase vasoconstriction and cold peripheries

Question 19

why do shock patients get catheters

Answer 19

for urgent monitoring, medication administration, and fluid management

Question 20

Arterial catheters measure

Answer 20

Blood Pressure, Arterial Blood sampling, Cardiac output monitoring

Question 21

Urinary catheters measure

Answer 21

Urine output to assess kidney perfusion

Question 22

Swan-ganz catheter (PAC)

Answer 22

a thin, balloon-tipped tube inserted into a major vein (neck, leg, or chest) and guided through the right heart chambers into the pulmonary artery

Question 23

CVP catheter measures what

Answer 23

Right atrial pressure to assess fluid status

Question 24

What does the wave form look like when floating a PA catheter and reaching the pulmonary artery

Answer 24

Increased diastolic pressure and appearance of the dicrotic notch.

Question 25

Vasopressors

Answer 25

Cause vasoconstriction to rapidly increase blood pressure

Question 26

what type of fluid is largely used for Fluid resuscitation

Answer 26

Crystalloids ate widely used

Question 27

What is the significance of being trapped in a state of shock?

Answer 27

Can lead to rhabdomyolysis (muscle fiber breakdown)

Question 28

how is rhabdomyolysis tested for

Answer 28

creatine kinase levels (CK), shows release of muscle contents into blood

Question 29

why is 0.9% saline used

Answer 29

Paper in 1883 said is causes minimal disruption of red corpuscles and maintains similar freezing point to mammalian serum

Question 30

Normal/indifferent saline

Answer 30

0.9% saline

Question 31

Balanced crystalloids

Answer 31

closely mimic human plasma electrolyte composition and are generally preferred for large-volume resuscitation to avoid acidosis

Question 32

Issue with 0.9% saline

Answer 32

contain high chloride, which can cause kidney injury when used heavily

Question 33

Hyperchloraemic Acidosis

Answer 33

a common, often iatrogenic, complication of rapid or large-volume administration of 0.9% normal saline. Chloride load far exceeds physiological serum levels

Question 34

Balanced fluids

Answer 34

Lactated ringers and Hartmanns solutions

Question 35

First step in active major hemorrhage potocol

Answer 35

1:1:1 Blood : FFP : Platelets