Overview of Shock Types

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Questions and Answers

What is the primary effect of prolonged shock on cellular function?

Decreased formation of proinflammatory mediators

Increased ATP production through aerobic metabolism

Loss of normal electrical gradient in cell membranes (correct)

Enhanced ability to maintain water balance

Which type of shock is characterized by cold and clammy skin?

Distributive shock

Obstructive shock

Cardiogenic shock (correct)

Hypovolemic shock

What compensatory mechanisms are typical in the pre-shock stage?

Increased metabolic acidosis and tachypnea

Warm and dry skin with normal blood pressure

Decreased heart rate and blood pressure

Tachycardia and peripheral vasoconstriction (correct)

What lab finding is likely to indicate metabolic acidosis during shock?

Elevated lactic acid levels (A) Signup and view all the answers

How does shock typically progress if left untreated?

Development of end-organ dysfunction and potential death (C) Signup and view all the answers

Which intervention is NOT part of the ABCs of shock management?

Administering early antibiotics (D) Signup and view all the answers

What is the primary cause of hypovolemic shock?

Fluid loss from trauma or hemorrhage (D) Signup and view all the answers

What change occurs in systemic vascular resistance during distributive shock?

Decreased vascular resistance (C) Signup and view all the answers

What is a common clinical finding in the shock state?

Hypotension and altered mental status (A) Signup and view all the answers

What is the role of pulmonary capillary wedge pressure in assessing shock?

It helps assess left ventricular filling and mitral valve function. (B) Signup and view all the answers

What is the primary goal of pRBC transfusion?

To increase oxygen carrying capacity (C) Signup and view all the answers

What is the recommended hemoglobin level to initiate transfusion in actively bleeding patients?

Hb < 7 g/dL (D) Signup and view all the answers

In which scenario should a higher hemoglobin threshold of Hb < 10 g/dL be considered for transfusion?

Patients with pulmonary disease (B) Signup and view all the answers

What does a 'Type and Screen' test determine?

Presence of major/minor autoantibodies (C) Signup and view all the answers

What should be done first if a patient exhibits signs of a transfusion reaction?

Stop the transfusion (D) Signup and view all the answers

Which complication occurs if symptoms develop 2-4 hours post transfusion?

Transfusion-related lung injury (TRALI) (C) Signup and view all the answers

What is the primary use of a Swan-Ganz catheter?

To assess pulmonary artery pressure (C) Signup and view all the answers

Which of the following is NOT a sign of fatal hemolysis?

Hypokalemia (B) Signup and view all the answers

Which type of shock is characterized by warm, dry skin and decreased systemic vascular resistance?

Distributive shock (A) Signup and view all the answers

What is a common treatment for severe allergic reactions during blood transfusion?

Bronchodilators and steroids (A) Signup and view all the answers

In cardiogenic shock, what is the effect on cardiac output?

It decreases significantly (C) Signup and view all the answers

What is a defining feature of neurogenic shock?

Warm skin and hypotension (D) Signup and view all the answers

What type of blood product contains clotting factors and may be used during transfusion?

Fresh frozen plasma (FFP) (B) Signup and view all the answers

Which electrolyte abnormality is commonly associated with blood transfusion?

Hypocalcemia (D) Signup and view all the answers

Which treatment is indicated for anaphylactic shock?

Immediate epinephrine administration (B) Signup and view all the answers

What often causes obstructive shock?

Cardiac tamponade (D) Signup and view all the answers

Which symptom is commonly associated with hypovolemic shock?

Reduced skin turgor (A) Signup and view all the answers

What is the hemodynamic consequence of adrenal insufficiency in shock?

Hypotension due to reduced peripheral resistance (B) Signup and view all the answers

How does tension pneumothorax typically present?

Hypotension with decreased breath sounds on one side (B) Signup and view all the answers

Which parameter is calculated using the formula MAP = CO x TPR?

Mean arterial pressure (A) Signup and view all the answers

What is a common sign of obstructive shock?

Cold and clammy skin (C) Signup and view all the answers

Which of the following conditions is NOT typically classified as distributive shock?

Cardiogenic shock (B) Signup and view all the answers

What is commonly noted in a cardiac echo for pericardial tamponade?

Muffled heart sounds (A) Signup and view all the answers

What defines the wedge pressure in healthcare terms?

Pressure in the left atrium (A) Signup and view all the answers

Study Notes

Shock Overview

Life-threatening condition involving circulatory failure
Decreased oxygen delivery, increased oxygen consumption, or impaired oxygen utilization leading to cell and tissue hypoxia.
Inadequate end-organ perfusion results in cell death and organ dysfunction

Shock Classifications

Hypovolemic Shock: Caused by fluid loss, such as from bleeding or dehydration.
Cardiogenic Shock: Caused by heart failure, resulting in reduced blood flow.
Obstructive Shock: Caused by obstruction of blood flow, such as a pulmonary embolism or cardiac tamponade.
Distributive Shock: Characterized by widespread vasodilation, leading to decreased blood pressure.

Shock Type Chart

Hypovolemic Shock: Skin - ↓↓; Wedge Pressure (preload) - ↑; SVR (afterload) - ↓; Cardiac Output - ↓
Cardiogenic Shock: Skin - Cold and clammy; Wedge Pressure (preload) - ↑; SVR (afterload) - ↑; Cardiac Output - ↓
Obstructive Shock: Wedge Pressure (preload) - ↓ or ↑; SVR (afterload) - ↑; Cardiac Output - ↔ or ↓
Distributive Shock: Skin - Warm and dry; Wedge Pressure (preload) - ↔ or ↓; SVR (afterload) - ↓↓; Cardiac Output - ↓ or ↑

Cellular Level Effects of Shock

Cells shift to anaerobic metabolism, leading to inefficient ATP production and lactic acidosis.
Prolonged shock causes cell membrane damage, loss of electrical gradient, and release of inflammatory mediators.
Uncorrected, this process progresses to end-organ damage and multiple organ failure.

Stages of Shock

Pre-shock (Compensated Shock): Body compensates for decreased perfusion with tachycardia, vasoconstriction, and maintained blood pressure.
Shock (Decompensated Shock): Hypotension, tachycardia, tachypnea, altered mental status, cold/clammy skin, oliguria, and metabolic acidosis occur. Early organ dysfunction is present.
End-Organ Dysfunction: Irreversible damage, multiorgan failure, and death occur.

Shock Treatment

Airway Management: Ensure a patent airway (A)
Breathing Support: Ensure adequate breathing (B)
Circulation Restoration: Restore blood flow (C)
Identify and Treat Cause: Address the underlying cause of shock.

Wedge Pressure

Reflects left ventricular filling pressure and left atrial pressure.
Measured via Swan-Ganz catheter.

Systemic Vascular Resistance (SVR)

The amount of force blood encounters as it flows through the vasculature.
Formula: MAP = CO x SVR

Cardiac Output (CO)

The amount of blood pumped by the heart per minute.
Formula: CO = SV x HR

Distributive Shock

Caused by widespread peripheral vasodilation.
Examples: Anaphylactic shock, neurogenic shock, septic shock.
Leads to decreased SVR, initially with increased CO, but eventually decreases CO.

Septic Shock

A subtype of distributive shock caused by infection.
Characterized by systemic inflammatory response syndrome (SIRS).

Neurogenic Shock

Caused by loss of sympathetic nervous system tone.
Common with spinal cord injuries above T6.
Leads to hypotension and bradycardia.

Anaphylactic Shock

Severe allergic reaction mediated by IgE antibodies.
Triggers release of histamine, heparin, and serotonin, leading to vasodilation.
Common triggers: Foods, drugs, insect stings, pollen.

Adrenal Insufficiency

Inability of the adrenal glands to produce adequate cortisol.
Results in hypotension due to decreased SVR.
Commonly seen in prolonged stress states, sepsis, and elderly patients.

Cardiogenic Shock

Caused by heart failure, resulting in inadequate blood flow.
Characterized by decreased CO and systemic hypoperfusion.
Commonly caused by myocardial infarction, cardiomyopathy, arrhythmias, and mechanical heart problems.

Obstructive Shock

Caused by obstruction of blood flow outside the heart.
Examples: Cardiac tamponade, pulmonary embolism, tension pneumothorax.

Pulmonary Embolism

A blood clot in the pulmonary arteries.
Often migrates from deep vein thrombosis (DVT).
Treatment: Hemodynamic stabilization, anticoagulation, thrombolytics in extreme cases.

Pericardial Tamponade

Caused by fluid buildup in the pericardial sac, constricting the heart.
Leads to Beck’s Triad: Hypotension, muffled heart sounds, and distended neck veins.
Treatment: Pericardiocentesis or surgical decompression.

Tension Pneumothorax

Air trapped in the pleural space, compressing the lung and heart.
Causes: Trauma, infections, mechanical ventilation, iatrogenic procedures.

Hypovolemic Shock

Caused by decreased intravascular volume, leading to decreased preload.
Hemorrhagic type: Trauma, gastrointestinal bleeding, vascular rupture.
Non-hemorrhagic type: Gastrointestinal losses, skin losses, third spacing, renal losses.

Blood Transfusion

Used to increase oxygen carrying capacity and treat active bleeding.
Goal Hgb: 7-10 g/dL for active bleeding, higher for certain conditions.
Type and Screen (T&S) vs Type and Cross (T&C) for blood compatibility.
Whole blood vs Blood components (FFP, platelets, cryoprecipitate).

Transfusion Reactions

Febrile Reactions: Fever, chills, +/- antipyretics.
Allergic Reactions: Urticaria, pruritis, +/- antihistamines. Severe cases: Bronchospasm, wheezing, anaphylaxis.
Transfusion-associated Circulatory Overload (TACO): Respiratory distress, pulmonary edema, +/- diuretics.
Transfusion-related Acute Lung Injury (TRALI): Acute hypoxemic respiratory distress, supportive care.
Fatal Hemolysis: Fever, chills, back pain, flushing, dyspnea, tachycardia, and shock. Stop transfusion, IV fluids, cardiorespiratory support, hemolytic workup.
Electrolyte Abnormalities: Hypocalcemia, Hyperkalemia, Hypokalemia.
Infections: HIV, Hepatitis C, etc.

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Description

Explore the critical concept of shock in medical emergencies, focusing on its classifications and physiological impacts. This quiz covers hypovolemic, cardiogenic, obstructive, and distributive shock, highlighting their causes and symptoms. Test your knowledge on recognition and management of these life-threatening conditions.