Shock Types and Phases

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Questions and Answers

What type of fluids is preferred for burn patients?

Lactated Ringers (correct)

Packed Red Blood Cells

Colloids

Normal Saline

What is a caution when treating a patient in hypovolemic shock who is actively bleeding?

Give packed red blood cells immediately

Use oral rehydration solutions

Avoid giving fluids (correct)

Administer any fluids

Which of the following is an indicator for fluid responsiveness when monitoring a patient?

Stroke Volume Variation (correct)

Mean Arterial Pressure

Systemic Vascular Resistance

Cardiac Output

In the event of hypovolemic shock, what is the ‘poor man’s’ way to assess cardiac output?

Evaluate urine output Signup and view all the answers

Which of the following is NOT a common cause of cardiogenic shock?

Septic shock Signup and view all the answers

What is the main result of cardiogenic shock?

Decreased tissue perfusion Signup and view all the answers

What formula is commonly used to calculate fluid replacement in burn patients?

Parkland Formula Signup and view all the answers

Which symptom would NOT be expected in a patient experiencing hypovolemic shock?

Increased urine output Signup and view all the answers

What complication can arise from fluid resuscitation in a bleeding patient?

Coagulopathy Signup and view all the answers

When oral administration of fluids is not feasible, what should be done?

Use IV fluids Signup and view all the answers

Which phase of shock is characterized by decreased cardiac output and RAAS activation?

Decreased cardiac output Signup and view all the answers

What is the primary goal of medical management in shock?

Restore tissue perfusion Signup and view all the answers

In hypovolemic shock, what is the initial step in management?

Administer crystalloids or fluids Signup and view all the answers

Which type of shock is associated with massive fluid loss due to hemorrhage or trauma?

Hypovolemic shock Signup and view all the answers

What is a common symptom of shock that relates to skin condition?

Cool and clammy skin Signup and view all the answers

Which physiological response initially increases during the shock phase?

Heart rate Signup and view all the answers

Which type of shock is characterized specifically by infection leading to vasodilation?

Septic shock Signup and view all the answers

What can be a consequence of inadequate perfusion during shock?

Acute kidney injury Signup and view all the answers

Which component is considered a hallmark of distributive shock in anaphylaxis?

Vasodilation Signup and view all the answers

What intervention is indicated in cardiogenic shock to improve cardiac output?

Fill the tank and optimize contractility Signup and view all the answers

Study Notes

Shock Types

Hypovolemic shock is caused by loss of blood volume
- Examples include hemorrhage, trauma, burns, dehydration, and athletic activity
Cardiogenic shock is caused by failure of the heart to effectively pump blood
- Most common causes are post myocardial infarction (MI), cardiac tamponade, pulmonary embolism (PE), septal rupture, and valvular heart disease.
Distributive shock is caused by vasodilation and increased permeability of blood vessels
- Types of distributive shock include anaphylactic, septic, and neurogenic

Shock Phases

Phase 1: Decreased cardiac output, increased renin-angiotensin-aldosterone system (RAAS) activation
Phase 2: Increased sympathetic nervous system (SNS) activation
Phase 3: Initially increased heart rate and initially increased respiratory rate
Phase 4: Lactic acidosis
Phase 5: Vasodilation with increased permeability
Phase 6: Hypotension, organ failure, death

Medical Management of Shock

Goal: Improve tissue perfusion and preserve organ function
Hypovolemic shock: Restore fluid volume
Cardiogenic shock: Optimize cardiac output and preload
Distributive shock: Fill the tank and optimize cardiac output

Hypovolemic Shock

Cause: Loss of blood volume due to hemorrhage, trauma, burns, dehydration, or athletic activity
Management:
- Fluid resuscitation: Crystalloids (normal saline (0.9% NaCl), Plasmalyte A, Lactated Ringer's)
- Colloids: Albumin
- Blood products: Packed red blood cells, massive transfusion protocol (MTP)
Key Points:
- Replace what was lost
- If the patient was bleeding, they will likely need blood products, not just intravenous fluids
- Patients in shock may be hypotensive, tachycardic, have lactic acidosis, decreased urine output (acute kidney injury), and cool, clammy skin
- Monitor urine output, passive leg raise, and hemodynamics to assess fluid responsiveness and guide treatment

Cardiogenic Shock

Cause: Heart fails to effectively pump blood
Manifestations:
- Decreased systolic blood pressure (SBP)
- Cool, pale, moist skin
- Increased heart rate
- Decreased urine output

### Hypovolemic Shock Management

Fluid Resuscitation:
- Use intravenous (IV) fluids if possible
- Use oral (PO) fluids under certain circumstances, such as when the patient is vomiting, intubated, or PO intake is not feasible.
- If the patient is vomiting and has been given Zofran, PO might be a better option
Assessment of Volume Responsiveness:
- Utilize Foley catheter to monitor urine output (no pee = no bueno). This can also be indicative of the need for extra volume expansion.
- Perform passive leg raise, take the wait, then measure the change in mean arterial pressure (MAP)
- If responding, increase fluids. If not responding, start hemodynamic monitoring.
Hemodynamic Monitoring:
- Use an arterial line and monitor stroke volume variation (SVV) and central venous pressure (CVP)
- Monitor the patient for development of coagulopathy.

Hypovolemic Shock: Different Causes

Dehydration: Replace the lost fluids, provide oral fluids if tolerated.
Burns: Use the Parkland formula to calculate fluid resuscitation needs. Consider MTP for fluid resuscitation as well as other interventions like electrolytes, coagulation factors, etc.
Hemorrhage: Provide blood products, utilize MTP if needed, and monitor for coagulopathy and possible complications.
- Look at the patient's urine output for clues into adequacy of treatment.

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Description

Explore the various types of shock including hypovolemic, cardiogenic, and distributive shock in this quiz. Understand the phases of shock progression and their physiological implications. Test your knowledge on causes, effects, and management strategies.