exam 2 paramedic coach

What is perfusion?

The successful circulation of blood to the body's tissues.

What is hypoperfusion?

A lack of successful circulation of blood to the body's tissues; the guide equates hypoperfusion with shock.

What happens when tissues and organs do not receive enough blood flow and oxygen?

They begin to fail.

What is the key idea for understanding shock?

A disease or emergency causes the shock; identify the type of shock and then the stage of shock.

What three systems must work together for perfusion to occur?

The heart, blood vessels, and lungs.

What can happen if the heart, blood vessels, or lungs fail in their role in perfusion?

Shock can occur.

What are the three stages of shock in this guide?

Compensated shock, uncompensated shock, and irreversible shock.

What is compensated shock?

The first stage of shock, when the body is still compensating for acute hypoperfusion and blood pressure is not yet low.

What are the main signs and symptoms of compensated shock?

Tachycardia, altered mental status, delayed capillary refill, cool skin, and no hypotension yet.

Why is blood pressure often still normal in compensated shock?

The body activates compensatory responses to maintain circulation and blood pressure.

What three major compensatory responses are described in compensated shock?

Sympathetic nervous system response, hormonal response, and adrenal response.

What does the sympathetic nervous system do during compensated shock?

Increases heart rate, contractility, and cardiac output and causes vasoconstriction.

Why does tachycardia occur in compensated shock?

The sympathetic nervous system increases heart rate to help maintain cardiac output.

Why does vasoconstriction occur in compensated shock?

To help preserve blood pressure and direct circulation toward vital organs.

What does ADH do during compensated shock?

Helps the kidneys retain water.

Where is ADH released from according to the guide?

The pituitary gland.

What does aldosterone do during compensated shock?

Helps the kidneys retain sodium and water.

Where is aldosterone released from according to the guide?

The adrenal gland.

What does the adrenal response release during compensated shock?

Epinephrine.

What effect does epinephrine have during compensated shock?

Causes further vasoconstriction and helps increase arterial pressure to the heart and brain.

What is uncompensated shock?

The stage when the body can no longer maintain normal blood pressure and tissue hypoxia worsens.

What happens to blood pressure in uncompensated shock?

It decreases, leading to hypotension.

What happens to cerebral blood flow in uncompensated shock?

It decreases.

What happens to pulse pressure in uncompensated shock?

It decreases.

What are the main signs and symptoms of uncompensated shock?

Increasing tachycardia, confusion or unconsciousness, cold/cyanotic extremities, hypotension, and unstable vital signs.

Why do extremities become cold and cyanotic in uncompensated shock?

Massive vasoconstriction shunts blood toward the core.

Can uncompensated shock still be reversed?

Yes. With appropriate EMS and hospital treatment, it can still be reversible.

What is irreversible shock?

The final stage of shock before death, when damage to cells and tissues is too severe to recover.

Why is irreversible shock called irreversible?

Too much cellular and tissue damage has occurred for recovery even with resuscitation.

What are the main signs and symptoms of irreversible shock?

Bradycardia, severe hypotension, cold skin, and coma.

What happens to vital organ cells in irreversible shock?

They die, and necrosis becomes inevitable.

What are the four main types of shock in this guide?

Cardiogenic, obstructive, distributive, and hypovolemic shock.

What are the three subtypes of distributive shock?

Anaphylactic, septic, and neurogenic shock.

What is cardiogenic shock?

Shock caused by failure of the heart as a pump.

What are major underlying causes of cardiogenic shock listed in the guide?

Acute heart failure events and myocardial infarction.

What is the memory phrase for cardiogenic shock?

Cardiogenic shock is the heart's fault; the heart made the shock happen.

What are signs and symptoms of acute heart failure listed in the guide?

Bilateral rales, jugular vein distension, chest pain and/or difficulty breathing, and pink frothy sputum with productive cough.

What are signs and symptoms of myocardial infarction listed in the guide?

Chest pain, left arm pain radiating to the jaw, difficulty breathing, nausea, vomiting, and back pain.

What is obstructive shock?

Shock caused by a physical obstruction that disrupts normal blood flow and perfusion.

Is obstructive shock primarily caused by the heart itself failing?

No. The heart is usually affected by an outside mechanical force or obstruction.

What three causes of obstructive shock are listed in the guide?

Tension pneumothorax, cardiac tamponade, and pulmonary embolism.

How can a tension pneumothorax cause obstructive shock?

Increasing air pressure in the chest puts pressure on the heart and disrupts its ability to pump effectively.

What are signs and symptoms of tension pneumothorax listed in the guide?

Absent or decreased breath sounds on one side, jugular vein distension, tracheal deviation, hypotension, chest pain, and difficulty breathing.

What are signs and symptoms of pulmonary embolism listed in the guide?

Sharp sudden chest pain, difficulty breathing, tachycardia with hypoxia, and low SpO2.

What factors does the guide say increase pulmonary embolism risk?

Smoking and long periods of stasis, such as travel or bed rest.

What is Beck's triad for cardiac tamponade?

Jugular vein distension, hypotension, and muffled heart sounds.

What other findings of cardiac tamponade are listed in the guide?

Narrowing pulse pressure and chest pain.

What is distributive shock?

Shock caused by massive peripheral vasodilation that leads to a major drop in blood pressure.

What is the hallmark feature shared by distributive shock types?

Massive vasodilation.

Why does blood pressure fall in distributive shock?

The blood vessels dilate and cannot adequately constrict to maintain vascular tone and pressure.

What three forms of distributive shock are listed?

Anaphylactic, septic, and neurogenic.

What causes anaphylactic shock?

Exposure to an allergen such as food, medication, or insects.

What are signs and symptoms of anaphylactic shock in the guide?

Bilateral wheezing, stridor, hives, nausea, vomiting, tachycardia, and hypotension as a late sign.

What respiratory findings should make you think of anaphylactic shock?

Wheezing and stridor, especially with hives or allergen exposure.

What causes septic shock according to the guide?

A serious systemic bacterial infection that the body fails to fight off.

What common infection sources for sepsis are listed?

Pneumonia, postoperative infections, and urinary infections.

What are signs and symptoms of septic shock listed in the guide?

History of illness/infection or recent surgery, warm or hot skin, fever, chills, tachycardia, and hypotension.

What causes neurogenic shock?

Traumatic injury causing loss of vasomotor tone below the level of injury.

What happens to the blood vessels in neurogenic shock?

They undergo massive vasodilation.

Which patients should raise concern for neurogenic shock according to the guide?

Patients with a high mechanism of injury and head injury patients.

What are signs and symptoms of neurogenic shock listed in the guide?

Fainting, hypotension, nausea, vomiting, headache, and bradycardia.

What pulse finding is especially important in neurogenic shock?

Bradycardia.

What is hypovolemic shock?

Shock caused by loss of circulating fluid volume.

What are the three major causes of hypovolemic shock shown in the guide?

Severe blood loss, severe burns, and severe dehydration.

Can hypovolemic shock occur without visible external bleeding?

Yes. Internal bleeding or other fluid loss may not be obvious.

How can vomiting and diarrhea cause hypovolemic shock?

They can cause severe dehydration and loss of circulating volume.

Why are severe burn patients at risk for hypovolemic shock?

Burns can cause major fluid loss, placing the patient at risk for hypovolemia.

What are the two main goals of treating shock?

Restore adequate oxygenation/perfusion to tissues and treat the underlying cause of shock.

What is the general starting point in managing a shock patient?

Secure the airway, provide adequate oxygenation, and continue to reassess circulation and vital signs.

Why is treating the underlying cause important in shock?

Shock is a consequence of another disease or emergency, so correcting the cause is necessary for successful treatment.

What treatment example is given for tension pneumothorax causing obstructive shock?

Needle decompression to allow trapped air to escape the chest.

What treatment example is given for severe septic-shock hypotension?

Vasopressors such as epinephrine may be used to raise blood pressure.

What treatments are shown for hypovolemic shock in the guide?

Stop bleeding, IV fluid resuscitation, and blood products.

What treatments are shown for septic shock in the guide?

IV boluses, antibiotics, and vasopressors such as an epinephrine IV drip.

What treatments are shown for anaphylactic shock in the guide?

Albuterol, IM epinephrine, Benadryl, IV fluids, and Zofran.

What treatments are shown for neurogenic shock in the guide?

IV fluids and vasopressors.

What treatments are shown for cardiogenic shock in the guide?

Vasopressors and surgery/stent for myocardial infarction.

What treatments are shown for obstructive shock in the guide?

IV fluids and treatment of the underlying emergency.

What common vasopressors are listed in the guide?

Epinephrine, norepinephrine, and dopamine.

What do vasopressors treat in shock patients according to the guide?

Severe hypotension.

What are the key shock-care reminders on page 15?

Maintain airway, provide oxygenation/ventilation as needed, expose and control major bleeding, use IV fluids/vasopressors at ALS level, keep the patient warm, monitor for EKG changes, and reassess en route.

Why should a shock patient be kept warm?

The guide states that shock patients are unable to control body temperature effectively.

Why should major bleeding be identified and controlled early?

Ongoing blood loss worsens hypoperfusion and shock.

Why should shock patients be reassessed frequently?

Their condition can change rapidly, so changes in circulation, vital signs, and overall status must be identified.

Why may cardiac monitoring be useful in shock patients?

The guide considers shock patients critical and recommends watching for EKG changes or lethal rhythms.

Scenario: A patient is tachycardic, cool, confused, has delayed capillary refill, but is not hypotensive. What stage of shock does the guide describe?

Compensated shock.

Scenario: A patient with shock now has falling blood pressure, worsening confusion, cold cyanotic extremities, and unstable vitals. What stage is this?

Uncompensated shock.

Scenario: A shock patient develops severe hypotension, bradycardia, cold skin, and coma. What stage is this?

Irreversible shock.

Scenario: Chest pain, bilateral rales, JVD, dyspnea, and pink frothy sputum with shock. What type should you think of?

Cardiogenic shock.

Scenario: Trauma patient with absent breath sounds on one side, JVD, tracheal deviation, hypotension, and dyspnea. What shock cause should you suspect?

Tension pneumothorax causing obstructive shock.

Scenario: Sudden sharp chest pain, dyspnea, tachycardia, hypoxia, and low SpO2 after prolonged immobility. What should you suspect?

Pulmonary embolism causing obstructive shock.

Scenario: JVD, hypotension, muffled heart sounds, and narrowing pulse pressure. What should you suspect?

Cardiac tamponade causing obstructive shock.

Scenario: Allergen exposure followed by wheezing, stridor, hives, vomiting, tachycardia, and hypotension. What type of shock?

Anaphylactic shock.

Scenario: Recent infection or surgery, fever, warm skin, tachycardia, and hypotension. What type of shock?

Septic shock.

Scenario: Major trauma followed by hypotension and bradycardia with loss of vascular tone. What type of shock?

Neurogenic shock.

Scenario: Severe blood loss, dehydration, or major burns followed by shock. What type of shock?

Hypovolemic shock.