EMT-chapter 13-Shock

A 20 year old male has a large laceration to his wrist. He is holding a blood- soaked towel over the wound, but it continues to bleed rapidly. You should

A. Apply pressure to the brachial artery.

B. Administer high-flow supplemental oxygen

C. Apply a tourniquet proximal to the wrist

D. Wrap the towel with pressure bandages

Apply a tourniquet proximal to the wrist

Patients develop septic shock secondary to:

A. poor vessel function and severe volume loss

B. weak vessel tone caused by nervous system damage

C. failures of the blood vessels to adequately dilate

D. an infection that weakens cardiac contractions

A. poor vessel function and severe volume loss

A construction worker fell approximately 30 feet. He is semiconscious with rapid, shallow respirations. Further assessment reveals deformity to the thoracic region of his spine. His blood pressure is 70/50 mm Hg, his pulse is 66 beats/min and weak, and his skin is warm and dry. In addition to spinal immobilization and rapid transport, the MOST appropriate treatment for this patient includes:

A. oxygen via nonrebreathing mask, blankets for warmth, and elevation of his head

B. oxygen via nonrebreathing mask, thermal management, and elevation of his legs

C. assisted ventilation, preventing hyperthermia, and elevating his lower extremities

D. assisted ventilation, thermal management, and elevation of the lower extremities

D. assisted ventilation, thermal management, and elevation of the lower extremities

a 25-year-old unrestrained female struck the steering wheel with her chest when her car hit a tree while traveling at a high rate of speed. she has signs and symptoms of shock, which you suspect are the result of intrathoracic bleeding. which of the following interventions will provide this patient with the greatest chance of survival

A. intravenous fluid administration

B. high-flow oxygen administration

C. full immobilization of her spine

D. rapid transport to a trauma center

D. rapid transport to a trauma center

Temporary, widespread vasodilation and syncope caused by a sudden nervous system reaction MOST accurately describes:

A. psychogenic shock

B. vasovagal shock

C. neurologic shock

D. psychogenic shock

D. psychogenic shock

when assessing a patient with signs and symptoms of shock, it is important to remember that

A. multiple fractures are the most common cause of hypovolemic shock

B. blood pressure may be the last measurable factor to change in shock

C. the patient's respirations are deep during the early stages of shock

D. irreversible shock often responds well to a prompt blood transfusion

B. blood pressure may be the last measurable factor to change in shock

A 70 year-old female was recently discharge from the hospital following a total hip replacement. Today, she presents with restlessness, tachycardia, and a blood pressure of 90/64 mm HG. her skin is hot and moist. You should be most suspicious that she is experiencing:

A. decompensated shock

B. a local infection

C. septic shock

D. pump failure

C. septic shock

All of the following conditions should make you suspect shocked, EXCEPT:

A. severe infection

B. anaphylaxis

C. ischemic stroke

D. Spinal injury

C. ischemic stroke

Capillary sphincters are:

A. circular muscular walls that regulate blood flow through the capillaries

B. under complete control of the voluntary portion of the nervous system

C. capable of dilating in order to increase perfusion to crucial body organs

D. responsible for constricting to compensate for decreased cell perfusion

A. circular muscular walls that regulate blood flow through the capillaries

cardiogenic shock may result from all of the following, EXCEPT

A. increased afterload

B. increased preload

C. heart attack

D. poor contractility

B. increased preload

clinical signs of compensated shock include all of the following, except

A. restlessness or anxiety

B. rapid, shallow breathing

C. absent peripheral pulses

D. cool and clammy skin

C. absent peripheral pulses

Distributive shock occurs when

A. severe bleeding causes tachycardia in order to distribute blood to the organs faster

B. temporary but severe vasodilation causes a decrease in blood supply to the brain

C. widespread dilation of the blood vessels causes blood to pool in the vascular beds

D. an injury causes restriction of the heart muscle and impairs its pumping function

C. widespread dilation of the blood vessels causes blood to pool in the vascular beds

hypovolemic shock caused by severe burns is the result of a loss of

A. platelets

B. whole blood

C. plasma

D. red blood cells

C. plasma

In an acute injury setting, neurogenic shock is commonly accompanied by:

A. hypothermia

B. tachycardia

C. hypovolemia

D. diaphoresis

A. hypothermia

Neurogenic shock occurs when

A. failure of the nervous system causes widespread vasodilation

B. there is to much blood to fill a smaller vascular container

C. the spinal cord is severed and causes massive hemorrhaging

D. massive vasoconstriction occurs distal to a spinal cord injury

A. failure of the nervous system causes widespread vasodilation

Pulmonary edema and impaired ventilation occur during:

A. neurogenic shock

B. anaphylactic shock

C. cardiogenic shock

D. septic shock

C. cardiogenic shock

Shock is the result of:

A. widespread constriction of the blood vessels

B. the body's maintenance of homeostasis

C. temporary dysfunction of a major organ

D. hypoperfusion to the cells of the body

D. hypoperfusion to the cells of the body

One of the primary waste products of normal cellular metabolism that must be removed from the body by the lungs is:

a. Carbon monoxide.

b. Pyruvic acid.

c. Carbon dioxide.

d. Lactic acid.

c. Carbon dioxide.

to protect vital organs, the body compensated by directing blood flow away from the organs that are more tolerant of low flow, such as

A. the brain

B. the heart

C. the skin

D. the lungs

C. the skin

which of the following injury would most likely cause obstructive shock?

A) liver laceration

B)simple pneumothorax

C)cardiac tamponade

D)spinal cord injury

C)cardiac tamponade

Which of the following clinical signs is unique to anaphylactic shock?Choose one answer.

a. hypotension

b. wheezing

c. pallor

d. dizziness

b. wheezing

which of the following is the only action that can prevent death from a tension pneumothorax

A. rapid administration of intravenous fluids

B. positive pressure ventilation with a bag valve mask

C. early administration of high flow oxygen

D. decompression of the injured side of the chest

D. decompression of the injured side of the chest

which of the following patients is in decompensated shock

A)a female with absent radial pulses and dilated pupils

B)restless male with cool, clammy skin and tachycardia

C)Female with pale skin and rapid, shallow respirations

D. Male with anxiety and systolic blood pressure of 110mm hg

A)a female with absent radial pulses and dilated pupils

which of the following statements regarding anaphylactic shock is most correct

.

A)anaphylactic shock occurs immediately after a person is sensitized to an allergen

B)sensitized people will experience less severe reactions upon subsequent exposure.

C)anaphylactic shock is the result of immune system failure due to a toxic exposure

.D) subsequent exposure following sensitization produces a more severe reaction.

D) subsequent exposure following sensitization produces a more severe reaction.

Which of the following would MOST likely result in hemorrhagic shock?

a. Excessive sweating

b. Repeated diarrhea

c. Severe vomiting

d. Liver laceration

d. Liver laceration

progression of shock for compensated

• agitation

• anxiety

• restlessness

• feeling of impending doom

• weak, rapid pulse

• clammy

• pallor

• shallow, rapid breathing

• nausea or vomiting

• capillary refill that is very long

• marked thirst

• narrowing pulse pressure

progression of shock for decompensated

• falling blood pressure

• declining mental status, altered level of consciousness

• labored or irregular breathing

• ashen, mottled, or cyanotic

• thready or absent pulse

• dull eyes, dilated pupils

• poor urinary output.

what are the three cause of shock

pump failure

poor vessel failure

low fluid volume

pump failure

part of cardiogenic and obstructive shock

• tension pneumothorax

• cardiac tamponade

• pulmonary embolism

poor vessel function

part of distributive shock

• septic shock

• neurogenic shock

• anaphylactic shock

• psychogenic shock

low fluid volume

part of hypovolemic shock

• hemorrhagic

• nonhemorrhagic shock

pericardial effusion

fluid between the pericardial sac and myocardium

cardiac tamponade

life threating condition caused by blunt or penetrating trauma that cause hemorrhage around the heart

distributive shock

when their is wide spread dilation of the small arterioles, small venules or both.

neurogenic shock

damage to the spinal cord, particularly at the upper cervical levels.

psychogenic shock

a sudden reaction of the nervous system that produces a temporary, generalized vasodilation, resulting in fainting.

syncope is life threating because

aneurysm

hypovolemic shock

inadequate amount in the circulatory system.

General treatment for a shock pt

1. open airway

2. ad mistered High-flow oxygen via nonrebreathing mask (or assisted ventilation via Bag-Valve Mask if breathing is inadequate or altered mental status is present). Target SpO2​≥94%.

3. control exteral bleeding

4. Place patient supine (flat on back). Exception: Patients in cardiogenic shock with pulmonary edema (fluid in lungs) who prefer sitting upright to breathe easier.

5. Prevent heat loss immediately by removing wet clothing and covering the patient with warm blankets.

6. rapid transport

treatment for cardiogenic shock

1. postion pt in semi -fowler’s if breathing is diffcult.

2. high flow oxygen or (CPAP if allowed)

3. DO NOT give nitroglycerin if BP is <100 mmhg

   1. request ALS and rapid transport

treatment for obstruction shock cause by tension pneumothorax

1. high - flow oxygen via non breather mask

2. assist ventilation with BVM if inadequate

3. request immediate ALS inerception for need chest decompression

   1. rapid transport

treatment for obstructive shock cause by cardiac tamponade

1. high flow oxygen

2. maintain airway and assist ventilation

3. keep warm and transport rapidly

   1. requires ALS

treatment for obstrucive shock cause by pulmonary embolism

1. high -flow oxygen via nonbreather mask

2. position of comfort

   1. rapid transport

treatment for septic shock

1. high flow oxygen

2. ventilation assistance PRN

3. keep patient warm

4. rapid transport and ALS for IV and antibiotics

treament for neurogenic shock

1. secure and maintain airway

2. provide spinal immobilization

3. high flow rate

4. prevent heat loss

   1. rapid transport

treatment of anaphylactic shock

1. administer epinephrine

2. high - flow oxygen vis non breather

3. maintain airway/ prepare to assist venilations

   1. rapid transport and consider ALS intercept

epi pen adult and child dosage

0.3 mg in IM - adult

0.15 in IM - child

treatment for psychogenic shock

1. place patient supine

2. assess for injuries caused by the fall

3. check vital signs and mental status

   1. if not regain consciousness quickly suspect other cause and transport

treatment for hemorrhagic hypovolemic shock

• direct pressure over wound

• apply tourniquet PRN

• high -flow

• keep warm, supine position, rapide transport

treatment for non-hemorrhagic hypovolemic shock (severe dehydration/burns)

1. high flow rate

2. keep warm and supine

   1. rapid transport for ALS fluid replacement

importance of thermal management in shock

hypothermia impairs blood clotting mechanisms and worsens acidosis.

primary reason NOT to give fluids of food by mouth to a shock patient

risk of aspiration and delayed emergency surgery

key difference in positioning between cardiogenic shock and neurogenic/hypovolemic shock

cardic is up right and neuro/hypo is supine.