Shock and Hypovolemic Shock Overview
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Questions and Answers

What is the main indicator that a patient may have ongoing occult hemorrhage after initial treatment?

  • Deterioration after initial response (correct)
  • Improvement in hypotension
  • Decrease in heart rate
  • Increased blood pressure immediately

    • Which of the following symptoms is NOT associated with clinical manifestations of severe fluid deficit?

  • Cold extremities
  • Increased urination (correct)
  • Palpitations
  • Fainting

    • When should blood transfusion be considered in a patient with suspected hemorrhage?

  • When there is significant tachycardia only
  • If hemorrhage exceeds 25% of total blood volume (correct)
  • When hypotension is evident
  • If hemorrhage is more than 15% of total blood volume

    • What should be done if the patient's blood pressure begins to rise after starting fluid therapy?

    <p>Slow the rate of fluid administration</p> Signup and view all the answers

    Which of the following describes cardiogenic shock?

    <p>Advanced cardiac failure with inadequate peripheral tissue perfusion</p> Signup and view all the answers

    What condition is characterized by decreased perfusion of the tissues in the body?

    <p>Shock</p> Signup and view all the answers

    Rheumatic heart disease typically arises from which initial condition?

    <p>Rheumatic fever</p> Signup and view all the answers

    Which type of shock results from excessive hemorrhage and fluid loss?

    <p>Hypovolemic shock</p> Signup and view all the answers

    What is a potential complication of shock?

    <p>Renal failure</p> Signup and view all the answers

    Which type of shock is NOT classified under the distributive category?

    <p>Obstructive shock</p> Signup and view all the answers

    What is one of the causes of hypovolemic shock?

    <p>Excessive trauma</p> Signup and view all the answers

    Which factor increases the risk for rheumatic heart disease?

    <p>Untreated strep infections</p> Signup and view all the answers

    Which of the following is NOT a type of distributive shock?

    <p>Cardiogenic shock</p> Signup and view all the answers

    What initial action should be taken in the management of an allergic reaction?

    <p>Stop any potential trigger administration</p> Signup and view all the answers

    What is the correct dosage for Adrenaline when managing severe allergic reactions?

    <p>50 µg IV increments at a rate of 100 µg/min</p> Signup and view all the answers

    Which of the following statements is true about the complications of severe allergic reactions?

    <p>They can lead to circulatory and respiratory arrest.</p> Signup and view all the answers

    What is a common clinical manifestation associated with latex allergy?

    <p>Severe hypotension</p> Signup and view all the answers

    Which symptom indicates the most severe possible reaction from latex allergy?

    <p>Angioedema</p> Signup and view all the answers

    What factors influence the choice of antibiotics?

    <p>Source of infection</p> Signup and view all the answers

    Which medication is used for the prevention of stress gastric ulcers in critically ill patients?

    <p>Omeprazole</p> Signup and view all the answers

    What is the primary reason for referring a patient if urinary output starts failing?

    <p>Evidence of organ failure</p> Signup and view all the answers

    Which of the following is NOT a complication listed?

    <p>Diabetes Mellitus</p> Signup and view all the answers

    Which of the following is a common cause of anaphylactic shock?

    <p>Insect stings</p> Signup and view all the answers

    Which class of medications is known to potentially cause anaphylactic reactions?

    <p>Antibiotics</p> Signup and view all the answers

    What is a major characteristic of anaphylactic shock?

    <p>Life-threatening allergic reaction</p> Signup and view all the answers

    What is crucial to monitor in critically ill patients to prevent complications?

    <p>Urinary output and serum levels</p> Signup and view all the answers

    What is the primary characteristic of 'warm hypotension' in patients?

    <p>Low blood pressure with warm skin</p> Signup and view all the answers

    Which laboratory investigation is commonly used to evaluate kidney function?

    <p>Urea and creatinine</p> Signup and view all the answers

    What is the recommended empirical antibiotic therapy for septic patients after cultures have been obtained?

    <p>Ceftriaxone and Gentamicin</p> Signup and view all the answers

    Which vasopressor is commonly recommended as a first-line treatment for hypotension?

    <p>Dopamine</p> Signup and view all the answers

    What is the initial step in managing a patient showing signs of septic shock?

    <p>Begin resuscitation measures</p> Signup and view all the answers

    When is it recommended to administer Hydrocortisone in cases of septic shock?

    <p>If blood pressure responds poorly to resuscitation</p> Signup and view all the answers

    What is the target mean arterial pressure (MAP) for patients requiring vasopressors?

    <p>65 mmHg</p> Signup and view all the answers

    What type of mechanical ventilation strategy is suggested for patients with ARDS?

    <p>High PEEP and permissive hypercapnia</p> Signup and view all the answers

    Study Notes

    Shock

    • Syndrome characterized by decreased tissue perfusion
    • If prolonged, leads to multi-organ failure
    • Types:
      • Hypovolemic: Due to loss of intravascular fluid volume (blood and/ or fluid loss)
      • Cardiogenic: Advanced cardiac failure with inadequate peripheral tissue perfusion
      • Distributive:
        • Obstructive
        • Anaphylactic
        • Neurogenic
        • Septic
        • Respiratory shock

    Hypovolemic Shock

    • Caused by excessive haemorrhage, fluid loss, or intestinal obstruction
    • Symptoms:
      • Fainting
      • Palpitations
      • Sweating
      • Restlessness, clouding of consciousness
    • Signs:
      • Pallor
      • Cold extremities
      • Tachycardia
      • Hypotension: Systolic BP < 30ml/hr
    • Fluid bolus should be given with close monitoring of BP, pulse, and urine output, blood transfusions may be required

    Rheumatic Heart Disease

    • Occurs when heart valves are permanently damaged by rheumatic fever
    • Rheumatic fever is an inflammatory disease affecting connective tissues, especially the heart
    • Untreated or under-treated Strep infections increase risk

    Septic Shock

    • Clinical Manifestation:
      • Low blood pressure but warm skin (“warm hypotension”)
      • General malaise, chills
      • Fatigue, weakness, pain
      • Nausea and vomiting
      • Skin signs: petechiae, haematoma
      • Confusion
      • Unexplained worsening of underlying illness
    • Investigations:
      • CBC, Urea, Creatinine, Electrolytes, Blood sugar, Blood and body fluid culture, Liver function tests, Coagulation tests, Chest X-ray, ABG
    • Management:
      • Commence resuscitation measures
      • Start broad-spectrum antibiotics within 1 hour
      • Fluid replacement, monitor urea, creatinine, electrolytes
      • Consider hydrocortisone for septic shock patients
      • Vasopressors for hypotension
      • Oxygenotherapy and mechanical ventilation if needed
      • Manage disseminated intravascular coagulopathy, stress gastric ulcers, DVT

    Anaphylactic Shock

    • Life-threatening allergic reaction with respiratory difficulties and circulatory failure
    • Causes:
      • Foods: nuts, fish, seafood, etc.
      • Drugs: antibiotics, analgesics, ACE inhibitors
      • Vaccines and serum
      • Insect stings
      • Radiographic contrast media, blood products, allergenic products
      • Natural rubber (latex allergy)
      • Physical exercise (rarely)
    • Clinical Manifestation:
      • Erythema
      • Angioedema
      • Rash
      • Urticaria
      • Bronchospasm
      • Cardiovascular collapse
      • severe hypotension
    • Management:
      • Stop administration of potential trigger
      • Maintain airway, give O2 100%
      • Elevate the legs
      • Give Adrenaline
      • Give IV fluid (Crystalloid)
    • Complications:
      • Circulatory and respiratory arrest

    Complications of Shock (General)

    • Renal Failure
    • Hepatic Failure
    • Metabolic Acidosis
    • Coma, Death - ARDS
    • Acute Kidney Disease
    • DIC
    • Liver Failure

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    Description

    This quiz covers the syndrome of shock, focusing on its classification, particularly hypovolemic shock. It delves into symptoms, signs, and treatment approaches, providing an essential understanding for medical students. Explore how prolonged shock can lead to multi-organ failure and the critical signs that indicate the need for urgent care.

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