EMT Chapter 13/15*65 Shock and Medical Overview

Afterload

The force or resistance against which the heart pumps.

anaphylactic shock

Severe shock caused by an allergic reaction.

Anaphylaxis

An extreme, life-threatening systemic allergic reaction that may include shock and respiratory failure.

Aneurysm

A swelling or enlargement of a part of an artery, resulting from weakening of the arterial wall.

autonomic nervous system

The part of the nervous system that regulates involuntary activities of the body, such as heart rate, blood pressure, and digestion of food.

cardiac tamponade

Compression of the heart as the result of buildup of blood or other fluid in the pericardial sac, leading to decreased cardiac output.

cardiogenic shock

A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can be a severe complication of a large acute myocardial infarction, as well as other conditions.

Compensated shock

The early stage of shock, in which the body can still compensate for blood loss.

Cyanosis

A blue skin color discoloration that is caused by a reduced level of oxygen in the blood. Although paleness or a decrease in blood flow can be difficult to detect in dark skinned people, it may be observed by examining mucous membranes Inside the inner lower eyelid and capillary refill. On general observation, the patient may appear ashen or gray

Decompensated shock

The late stage of shock when blood pressure is falling; systolic <90 adult – CARDINAL SIGN; Mottled skin, labored resps, absent peripheral pulses

Dehydration

Loss of water from the tissues of the body.

Distributive shock

A condition that occurs when there is widespread dilation of the small arterioles, small venules, or both.

Edema

The presence of abnormally large amounts of fluid between cells in body tissues, causing swelling of the affected area.

Homeostasis

A balance of all systems of the body.

Hypothermia

A condition in which the internal body temperature falls below 95 degrees Fahrenheit(35 degrees Celsius)

Hypovolemic shock

A condition in which low blood volume, due to massive internal or external bleeding or extensive loss of body water, results in inadequate perfusion.

myocardial contractility

The ability of the heart muscle to contract.

Neurogenic shock

Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation; seen in patients with spinal cord injuries.

Obstructive shock

Shock that occurs when there is a block to blood flow in the heart or great vessels, causing an insufficient blood supply to the body's tissues.

Perfusion

The flow of blood through body tissues and vessels.

pericardial effusion

a collection of fluid between the pericardial sac and the myocardium

Preload

The precontraction pressure in the heart as the volume of blood builds up.

psychogenic shock

Shock caused by a sudden, temporary reduction in blood supply to the brain that causes fainting (syncope).

Pulmonary embolism

A blood clot that breaks off from a large vein and travels to the blood vessels of the lung, causing obstruction of blood flow.

Pulse pressure

difference between systolic and diastolic pressure

Sensitization

Developing a sensitivity to a substance that initially caused no allergic reaction.

Septic shock

Shock caused by severe infection, usually a bacterial infection.

Shock

A condition in which the circulatory system fails to provide sufficient circulation to enable every body part to perform its function; also called hypoperfusion.

Sphincters

Muscles arranged in circles and by contracting constrict a Duct tube or opening

Syncope

A fainting spell or transient loss of consciousness

communicable disease

A disease that can be spread from one person or species to another.

Epidemic

Occurs when new cases of a disease in a human population substantially exceed the number expected based on recent experience.

Herpes simplex

A common virus that is asymptomatic in 80% of people carrying it, but characterized by small blisters on the lips or genitals in symptomatic infections.

index of suspicion

Awareness that unseen life-threatening injuries may exist

Infectious disease

A medical condition caused by the growth and spread of small, harmful organisms within the body.

Influenza

A virus that has crossed the animal/human barrier and infected humans and that kills thousands of people every year.

Medical emergencies

emergencies that are not caused by an outside force; illnesses or conditions

Meningitis

An inflammation of the meningeal coverings of the brain and spinal cord; it is usually caused by a virus or a bacterium.

Meningococcal meningitis

An inflammation of the meningeal coverings of the brain and spinal cord; can be highly contagious.

Methicillin-resistant Staphylococcus aureus (MRSA)

A bacterium that causes infections in different parts of the body and is often resistant to commonly used antibiotics; can be found on the skin, in surgical wounds, in the bloodstream, lungs, and urinary tract

nature of illness (NOI)

The general type of illness a patient is experiencing.

Pandemic

An outbreak of a disease that spreads worldwide.

trauma emergencies

Emergencies that are the result of physical forces applied to a patient's body; injuries

Tuberculosis

A chronic bacterial disease, caused by Mycobacterium tuberculosis, that usually affects the lungs but can also affect other organs such as the brain and kidneys; it is spread by cough and can lie dormant in a person's lungs for decades and then reactivate.

Virulence

The strength or ability of a pathogen to produce disease.

Hypertension in a child with blunt or penetrating trauma is particularly significant because

it often indicates the loss of half of his or her blood volume

Which of the following patients is in decompensated shock?

A 20-year old female with absent radial pulses and dialated pupils

Distributive shock occurs when

widespread dialation of the blood vessels cause blood to pool in the vascular beds

Pulmonary edema and impaired ventilation occur during

cardiogenic shock

In infants and children, a capillary refill time that is greater than ____ seconds is a sign of poor peripheral perfusion

2

Which of the following injuries would most likely cause obstructive shock?

cardiac tamponade

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

Liver laceration

Clinical signs of compensated shock include all of the following except

absent peripheral pulses

Which of the following statements regarding anaphylactic shock is correct?

Subsequent exposure after sensitization often produces a more severe reaction

Neurogenic shock occurs when

failure of the nervous system causes widespread vasodialation

Which of the following clinical signs is unique to anaphylactic shock?

Wheezing

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

carbon dioxide

Patients develop septic shock secondary to

poor vessel function and severe volume loss

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

hypothermia

Capillary sphincters are

circular muscular walls that regulate blood flow through the capillaries

Temporary, widespread vasodialation and syncope caused by a sudden nervous system reaction most accurately describes

psychogenic shock

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

the skin

Cardiogenic shock may result from all of the following, except:

increased preload

All of the followind conditions should make you suspect shock, except:

ischemic stroke

Which of the following most accurately describes septic shock?

Bacterial damageto the vessel wall, leaking blood vessels, and vasodialation

Upon initial contact with a patient who appears to be unconcious, you should

attempt to elicit a verbal response by talking to the patient

Factors that increase the risk for developing methicillin-resistant Staphylococcus aureus (MRSA) include

prolonged hospitalization, especially in an intensive care unit

Which of the following questions would be the most pertinent to ask a patient who recently returned from Europe and is now ill?

Is anyone else in your travel party sick?

In contrast to the assessment of a trauma patient, assessment of a medical patient

is focused on the NOI, the cheif's complaint, and his or her symptoms

Hep B is more virulent than Hep C, which means it

has a greater ability to produce disease

The secondary assessment of a medical patient

is not practical if the patient is critically ill or your transport time is short

When caring for your patient with an altered patient status and signs of circulatory compromise, you should

limit your time to 10 min or less, if applicable

When performing you general impression of a patient with a medical complaint, it is important to remember that

the conditions of many medical patients may not appear serious at first

Which of the following conditions often require transport to a hospital with specialized capabilities that may not be available at the closest hospital?

Stroke and heart attack

After sizing up the scene of a patient with a possible infectious disease, your next priority should be to

take standard precautions

Which of the following will most reliabily allow you to determine the nature of a patient's illness?

asking questions related to the chief complaint

Which of the following medications would the EMT be least likely to administer to a patient with a medical complaint?

Ibuprofen

The best way to prevent infection from whooping cough is to

get vaccinated against diphtheria, tetanus, and pertussis

Which of the following conditions is not categorized as a psychiatric condition?

substance abuse

In addition to obtaining SAMPLE history and asking questions related to the chief complaint, what else should you specifically inquire about when assessing a patient with a potential infectious disease?

recent travels

The primary prehospital treatment for most medical emergencies

addresses the patient's symptoms more than the actual actual disease process

A patient who presents with a headache, fever, confusion, and red blotches on his or her skin should be suspected of having

meningitis

Assessment of a patient's BP with an autonomic BP cuff reveals that is 204/120 mmHg. The patient is conscious and alert and denies any symptoms. The EMT should

obtain a manual BP

An idex of suspicion is most accurately defined as

your awareness and concern for potentially serious underlying and unseen injuries or illnesses

Which of the following statements regarding HIV is correct?

The risk of HIV infection is greatest when deposited on a mucous membrane or directly into the bloodstream

The term “shock” is MOST accurately defined as

cardiovascular collapse leading to inadequate perfusion

Anaphylactic shock is typically associated with

urticaria

Signs of compensated shock include all of the following, EXCEPT

weak or absent peripheral pulses

When treating a trauma patient who is in shock, LOWEST priority should be given to

splinting fractures

Potential causes of cardiogenic shock include all of the following, EXCEPT

severe bacterial infection

A 60-year-old woman presents with a BP of 80/60 mm Hg, a pulse rate of 110 beats/min, mottled skin, and a temperature of 103.9°F. She is MOST likely experiencing

septic shock

A patient with neurogenic shock would be LEAST likely to present with

tachycardia

A 20-year-old man was kicked numerous times in the abdomen during an assault. His abdomen is rigid and tender, his heart rate is 120 beats/min, and his respirations are 30 breaths/min. You should treat this patient for

hypovolemic shock

A 33-year-old woman presents with a generalized rash, facial swelling, and hypotension approximately 10 minutes after being stung by a hornet. Her BP is 70/50 mm Hg and her heart rate is 120 beats/min. In addition to high-flow oxygen, this patient is in MOST immediate need of

epinephrine

All of the following are potential causes of impaired tissue perfusion, EXCEPT

increased number of red blood cells

A seizure patient is having what kind of medical emergency?

Neurologic

If an injury distracts an EMT from assessing a more serious underlying illness, the EMT has suffered from

tunnel vision

If a “frequent flier” calls 9-1-1 because of a suspected head injury, you should NEVER

assume you know what the problem is; every case is different, and you don’t want to miss a potentially serious problem

If your medical patient is not in critical condition, how long should you spend on scene?

However long it takes to gather as much information as possible

Your patient is having respiratory difficulty and is not responding to your treatment. What is the best method of transport?

With lights and siren, to the closest hospital