Shock ☺️

Question 1

What are the signs and symptoms of shock

• CV
• Resp
• Neuro
• Renal
• Psych

Answer 1

CV

• high HR, low BP => weak pulse
• clottability

Neuro
-SNS activation => pale, clammy

Resp
-increased RR, cyanotic

Renal

• oliguria, polydipsia
• acidosis, nausea

Psych
-anxiety, restless, confused, aggression, coma

Question 2

Haemorrhagic shock

• compensatory mechanism
• management

Answer 2

Blood loss
Baroreceptors after 1/3 lost => VC, flow distribution to brain, heart

Systemic acidosis => chemoreceptors increase SNS stimulation

BP U50 => CNS ischemic response reinforce SNS

Renal hypoperfusion => RAAS, NA/A, ADH
-VC, BV, CARDIAC STIMULATION

Capillary hypotension => reabsorption, haemodilution

ABCDE
-fluid replacement
-blood
-Hartmanns
Address underlying cause

Question 3

Decompensatory mechanism pathway for haemorrhagic shock

Answer 3

Hypotension => ischemia => hypoxia, acidosis, DIC

Lead to falling CO, decreased vascular tone
Increased permeability to tissue => loss of oncotic gradient

Also leads to multi-organ failure

Question 4

What are the 4 stages of hypovolemic shock

• blood loss
• BP change
• pulse
• RR
• confusion

Answer 4

I (up to 15% loss)

• BP ok and alert
• pulse ok
• 14-20 RR

II (15-30% loss)

• BP ok and alert
• narrow pulse
• 20-30 RR

III (30-40% loss)

• hypotensive and confused
• narrow pulse
• 30-40 RR

IV (40%+ loss)

• hypotensive and confused
• narrow pulse
• 35+ RR

Question 5

What are the effects of poor organ perfusion to the

• brain
• heart
• kidney
• tissue

Answer 5

Brain
-hypoxia => LOC

Heart
-decreased coronary flow => MI

Kidney
-Ischemia and low GFR => ATN
=> renal failure, oliguria, increased CR, acidosis

Tissue
-increased lactate prod and decreased clearance => acidosis

Question 6

Septic shock

• criteria
• management

Answer 6

Infection that triggers systemic inflammatory response => 2+ elements 
-fever
-high HR, RR
-WBC out of range
If also low BP => shocked

GIVE O2, ABx, fluids
TAKE blood cultures, urine, lactate
-if surgical patient => restore normal physiology before definitive management

Question 7

Anaphylactic shock

• presentation
• dosage

Answer 7

Airway - swollen throat, tongue => hoarse voice, stridor
Breathing - wheeze, SOB
Circulation - low BP, high HR
-can also present with generalised itch, rash

IM Adrenaline in anterolateral thigh every 5mins

• U6 = 150ug
• 6-12 = 300ug
• 12+ = 500ug

Question 8

Cardiogenic shock

• pathophysiology
• management

Answer 8

MAIN CAUSE - CVD, direct myocardial trauma

• Sustained low CO => stimulates SNS, baroreceptors, RAAS
• Does not increase CO => pulmonary, systemic edema

Treat underlying cause

Question 9

Neurogenic shock

-how does this differ from spinal shock

Answer 9

Spinal shock - temporary loss of motor/sensory function due to spinal injury

SC injury above T5 - excessive PNS activity over SNS

• systemic VD => low BP, HR
• warm peripheries, cold trunk

A-E management

• IV fluids if needed
• atropine - bradycardia
• dobutamine - vasopressors

Question 10

Obstructive shock

Answer 10

Cardiac tamponade
Pulmonary embolism
Tension pneumothorax
-high JVP, peripheral edema, SOB

ALL LEAD TO UNDERFILLED LV => LOW CO

• low CO, BP => cold extremities
• poor organ perfusion

Address underlying cause!