Shock in Medical Emergency
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Questions and Answers

What is a result of decreased cardiac output and hypotension?

  • Increased blood pressure
  • Impaired cellular metabolism (correct)
  • Increased tissue perfusion
  • Increased cardiac output

    • What helps return blood to the heart?

  • The ability of the blood to flow faster
  • The ability of the heart to pump more blood
  • The ability of blood vessels to dilate
  • The ability of blood vessels to constrict (correct)

    • What is distributive shock caused by?

  • Loss of parasympathetic tone
  • Loss of sympathetic tone
  • Release of biochemical mediators from cells
  • All of the above (correct)

    • What is anaphylactic shock characterized by?

    <p>Massive vasodilation and increased capillary permeability</p> Signup and view all the answers

    What can cause neurogenic shock?

    <p>Spinal cord injury or spinal anesthesia</p> Signup and view all the answers

    What is septic shock a response to?

    <p>A documented or suspected infection</p> Signup and view all the answers

    What is a characteristic of neurogenic shock?

    <p>Dry, warm skin and bradycardia</p> Signup and view all the answers

    What can cause respiratory distress in anaphylactic shock?

    <p>Both A and B</p> Signup and view all the answers

    What is the primary outcome of inadequate tissue perfusion during shock?

    <p>Cellular, metabolic, and hemodynamic derangements</p> Signup and view all the answers

    What is the primary reason for hypovolemic shock?

    <p>Loss of intravascular fluid volume</p> Signup and view all the answers

    What is the main cause of cardiogenic shock?

    <p>Impaired myocardial contractility</p> Signup and view all the answers

    What is the primary goal of managing shock and hemorrhage in emergency and trauma situations?

    <p>To prevent organ failure and death</p> Signup and view all the answers

    What is the definition of shock according to Sole, Klein, and Moseley (2017)?

    <p>A clinical syndrome characterized by inadequate tissue perfusion</p> Signup and view all the answers

    What is the term for the movement of fluid from the vascular space to the extravascular space?

    <p>Third spacing</p> Signup and view all the answers

    What is the average pressure at which blood moves through the vasculature to perfuse vital organs?

    <p>Mean arterial pressure (MAP)</p> Signup and view all the answers

    What is the outcome of shock if left untreated?

    <p>Organ failure and death</p> Signup and view all the answers

    What is the primary function of the circulatory system in relation to shock?

    <p>To deliver oxygen and nutrients to vital organs</p> Signup and view all the answers

    What is the term for shock that occurs when there is a physical impairment to adequate circulatory blood flow?

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

    What are the primary effects of shock on the body?

    <p>Cellular, metabolic, and hemodynamic derangements</p> Signup and view all the answers

    What is the leading cause of death from acute myocardial infarction (MI)?

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

    What is the primary goal of nursing management in shock?

    <p>To outline corresponding nursing diagnoses and management</p> Signup and view all the answers

    What is necessary for tissue perfusion?

    <p>A balance of adequate cardiac pump function, effective vasculature, sufficient blood volume, and blood flow</p> Signup and view all the answers

    What is the definition of shock according to Brunner et al. (2004)?

    <p>A condition in which systemic blood pressure is inadequate</p> Signup and view all the answers

    What is an example of a cause of obstructive shock?

    <p>Cardiac tamponade</p> Signup and view all the answers

    What percentage of sepsis cases and sepsis-related deaths worldwide occur in low- and middle-income countries?

    <p>85%</p> Signup and view all the answers

    Which of the following is a characteristic of septic shock?

    <p>Hypotension with elevated lactate despite adequate fluid resuscitation</p> Signup and view all the answers

    In critically ill patients, which of the following is the most common source of nosocomial infections?

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

    What is the by-product of anaerobic metabolism in cells?

    <p>Lactic acid</p> Signup and view all the answers

    What is the consequence of impaired sodium-potassium pump function in cells?

    <p>Cell membrane becomes more permeable</p> Signup and view all the answers

    What is the ultimate consequence of cellular damage due to septic shock?

    <p>Cell death</p> Signup and view all the answers

    What is the primary cause of lactic acid buildup in the initiation stage of shock?

    <p>Shift from aerobic to anaerobic metabolism</p> Signup and view all the answers

    At what stage of shock can the condition be reversed with minimal morbidity if appropriate interventions are initiated?

    <p>Compensatory stage</p> Signup and view all the answers

    What is the primary consequence of the deterioration of the cardiovascular system in the progressive stage of shock?

    <p>Perpetuation of shock symptoms</p> Signup and view all the answers

    What is the characteristic of the irreversible/refractory stage of shock?

    <p>Organ damage is severe and the patient does not respond to treatment</p> Signup and view all the answers

    What is the primary goal of interventions in the progressive stage of shock?

    <p>Prevent multiple organ dysfunction</p> Signup and view all the answers

    What is the outcome of the irreversible/refractory stage of shock?

    <p>Death is imminent</p> Signup and view all the answers

    Study Notes

    Definition and Objectives

    • Shock is a medical emergency that affects all body systems, making it life-threatening.
    • At the end of the presentation, students should be able to effectively manage shock and hemorrhage in emergency and trauma situations.

    Definition of Shock

    • Shock is a clinical syndrome characterized by inadequate tissue perfusion, resulting in cellular, metabolic, and hemodynamic derangements.
    • Shock can be defined as a condition in which systemic blood pressure is inadequate to deliver oxygen and nutrients to support vital organs and cellular function, leading to cellular and tissue injury.

    Review of Circulatory System

    • Tissue perfusion requires a balance of:
      • Adequate cardiac pump (myocardial contractility)
      • Effective vasculature (adequate vascular tone)
      • Sufficient blood volume
      • Blood flow (dependent on Mean Arterial Pressure, MAP)

    Classification of Shock

    Hypovolemic Shock

    • Occurs after a loss of intravascular fluid volume (whole blood, plasma, or water and electrolytes)
    • Can be either absolute or relative volume loss
    • Relative hypovolemia: fluid shift from vascular space to extravascular space (e.g., intracavitary space, third spacing)

    Cardiogenic Shock

    • Occurs when the heart's ability to contract and pump blood is impaired
    • Causes: coronary (myocardial infarction) or non-coronary (cardiac tamponade, dysrhythmias)
    • Leading cause of death from acute myocardial infarction

    Obstructive Shock

    • Occurs when there is a physical impairment to adequate circulatory blood flow
    • Causes: impaired diastolic filling, increased right ventricular afterload, increased left ventricular afterload
    • Obstruction of the heart or great vessels impedes venous return to the right side of the heart or prevents effective pumping action

    Distributive Shock

    • Caused by:
      • Anaphylactic shock (acute, life-threatening hypersensitivity reaction)
      • Neurogenic shock (loss of sympathetic tone, e.g., spinal cord injury, spinal anesthesia)
      • Sepsis (systemic inflammatory response to a documented or suspected infection)
    • Characterized by vasodilation, leading to inadequate tissue perfusion

    Pathophysiology of Shock at Cellular Level

    • Normal cellular metabolism: Fuel + Oxygen → Carbon dioxide + water + ATP
    • Reduced oxygen supply leads to anaerobic metabolism, producing less ATP and lactic acid
    • Lactic acid accumulation creates an acidotic intracellular environment, leading to cell damage and death

    Stages of Shock

    Initiation Stage

    • Shift from aerobic to anaerobic metabolism, causing lactic acid buildup
    • No obvious clinical indications of hypoperfusion
    • Decrease in cardiac output can be detected on invasive hemodynamic monitors

    Compensatory Stage

    • Body activates compensatory mechanisms to maintain blood flow to vital organs and restore homeostasis
    • Appropriate interventions can reverse shock with minimal morbidity

    Progressive Stage

    • Compensatory mechanisms can no longer maintain tissue perfusion
    • Deterioration of the cardiovascular system perpetuates symptoms of shock
    • Aggressive interventions are necessary to prevent MODS (Multiple Organ Dysfunction Syndrome)

    Irreversible/Refractory Stage

    • Point at which organ damage is so severe that the patient does not respond to treatment
    • Multiple organ dysfunction progressing to complete organ failure, with impending death

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    Description

    Learn about shock, a life-threatening medical emergency that affects all body systems, its causes, and clinical manifestations. Understand the effects of shock and its progression to organ failure and death.

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