EMT Chapter 12: Shock

Clinical signs of compensated shock include all of the following, EXCEPT:

absent peripheral pulses.

The action of hormones such as epinephrine an norepinephrine stimulates ___________ to maintain pressure in the system and, as a result, perfusion of all vital organs.

an increase in heart rate, an increase in the strength of cardiac contractions, vasoconstriction in nonessential areas.

Noncardiovascular causes of shock include respiratory insufficiency and ______.

anaphylaxis.

You respond to a residence for a patient with a severe leg injury following an accident with a chainsaw. When you arrive, you find the patient, a 44-year-old male, lying supine in the backyard. He has a partial amputation of his right lower leg that is actively bleeding. The patient is conscious and breathing adequately; however, he is restless and his skin is diaphoretic. You should:

apply direct pressure to the wound.

Inadequate circulation of the blood throughout the body is called? hypotesion shock perfusion hypoxia

b

a 20 year old male has a large laceration to his wrist he is holding a blood soaked towel over the wound but in continues to bleed rapidly you should apply pressure to the brachial artery apply a tourniquet proximal to the wrist administer high flow supplemental oxygen wrap the towel with pressure bandages

b

as you approch a patient lying at the side of the roadway you observe severe bleeding from the leg. What should your first action be? check for a pulse control the bleeding open the airway administer oxygen

b

foods, medications, and insects are common causes of septic shock anaphylactic shock cardiogenic shock neurogenic shock

b

when assessing a patient with signs and symptoms of shock it is important to remember that a.the patient's respirations are deep during the early stages of shock b. blood pressure may be the last measurable factor to change in shock c. multiple fractures are the most common cause of hypovolemic shock d. irreversible shock often responds well to prompt blood transfusion

b

which of the following injuries would MOST likely cause obstructive shock? liver laceration Cardiac Tamponade Simple Pneumothroax spinal cord injury

b

your patient has a decreased cardiac output and poor myocardial contractility. this will likely lead to? hypovolemic shock cardiogenic shock neurogenic shock septic shock

b

non cardiovascular causes of shock include respiratory insufficiency and sepsis metabolism anaphylaxis hypovolemia

c

pulmonary edema and impaired ventilation occur during? septic shock neurogenic shock cardiogenic shock anaphylactic shock

c

regulation of blood flow is determined by oxygen intake systolic pressure cellular need diastolic pressure

c

which of the following is the ONLY action that can prevent eventual death from a tension pneumothorax? early administration of high flow oxygen rapid administration of intravenous fluids decompression of the injured side of the chest positive pressure ventilation with bvm

c

you suspect your patient is in shock you note the patients skin is pale. This is likely due to ? an increased heart rate peripheral vasodilation peripheral vasoconstriction hypothermia

c

When treating a suspected shock patient, vital signs should be recorded approximately every ___ minutes.

5.

You should suspect shock in all of the following except

A mild allergic reaction.

Neurogenic shock is caused by

A radical change in the size of the vascular system.

Shock refers to:

A state of collapse and failure of the cardiovascular system.

Perfusion requires having a working cardiovascular system as well as

Adequate oxygen exchange in the lungs, adequate nutrients in the form of glucose in the blood, adequate waste removal.

The force or resistance against which the heart pumps

Afterload

A swelling of a part of an artery, resulting from weaking of the arterial wall.

Aneurysm

Which of the following MOST accurately describes septic shock?

Bacterial damage to the vessel wall, leaking blood vessels, and vasodilation

_____ pressure is the pressure in the blood vessels at all times.

Blood (Page 383).

Shock cause by inadequate function of the heart is called ____ shock.

Cardiogenic

_____ develops when the heart muscle can no longer generate enough pressure to circulate the blood to all organs.

Cardiogenic Shock.

What is obstructive shock?

Caused by mechanical obstruction which prevents adequate blood volume from filling heart chambers

Neurogenic shock usually results from damage to the spinal cord at the _____.

Cervical Level.

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

Compensated

Pressure in the arteries during cardiac ______ is known as systolic pressure.

Contraction. (Page 383)

Bluish color of the skin resulting from poor oxygenation of the circulating blood

Cyanosis

Signs of cardiogenic shock include?

Cyanosis, Nausea, Anxiety.

_____ pressure occurs during cardiac relaxation, while _____ pressure occurs during cardiac contractions.

Diastolic, systolic (Page 383).

What is Compensated Shock?

Early Stages of Shock.

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

Edema

What is syncope?

Fainting.

True or False. A person in shock, left untreated, will most likely survive.

False, after time the body loses the ability to compensate for shock.

True or False. Bleeding is the most common cause of cardiogenic shock following an injury.

False, bleeding is not the most common cause.

True or False. Decompensated shock occurs when the systolic blood pressure falls below 120 mm Hg.

False, decompensated shock occurs when hypoperfusion can no longer be supported by the body

True or False. Metabolism is the cardiovascular system's circulation of blood and oxygen to all cells in different tissues and organs of the body.

False, metabolism is not circulation

True or False. Compensated shock is related to the last stages of shock.

False, one of the last stages of shock is dropping BP

True or False. Shock occurs only with massive blood loss from the body.

False, shock occurs for four different reasons

The cardiovascular system consists of the ______, _____, and _____.

Heart; vessels; blood (Page 382).

A balance of all systems of the body

Homeostasis

What is another term for Shock?

Hypoperfusion.

______ refers to the the failure of the cardiovascular system.

Hypoperfusion. (Page 381)

A condition in which the internal body temperature falls below 95 degree Farenheit (35 degree Celsius)

Hypothermia

The autonomic nervous system controls the _____ actions of the body.

Involuntary (Page 383).

The final stage of shock, resulting in death, is called ____ shock.

Irreversible

Hypovolemic shock is a result of

Low volume.

Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels is called ____ shock.

Neurogenic

An insufficient concentration of ______ in the blood can produce shock as rapidly as vascular causes.

Oxygen.

Blood pressure is a rough measurement of _____.

Perfusion. (Page 383)

The precontraction presuure in the heart as the volume of blood builds up

Preload

What does Blood Pressure provide us?

Provides a rough messure of perfusion.

______ is a sudden reaction of the nervous system that produces temporary vascular dilation and fainting.

Psychogenic Shock

What do Sphincters do?

Regulate blood flow in capillaries.

What does the Autonomic Nervous System do?

Regulates involuntary body functions.

Shock caused by severe infection is called ____ shock.

Septic

What is Septic Shock?

Severe Bacterial Infection.

What is Anaphylaxis?

Severe allergic reaction.

Inadequate circulation that does not meet the body's needs is known as ______.

Shock (Hypoperfusion) (Page 382).

______ are circular muscle walls in capillaries, causing the walls to _____ and ______.

Sphincters; contract; dilate (Page 383).

Which of the following statements regarding anaphylactic shock is correct?

Subsequent exposure after sensitization often produces a more severe reaction.

What is Perfusion?

Sufficient circulation to meet cell needs.

Blood flow throught the capillary beds is regulated by what?

The Capillary Sphincters

In septic shock

There is an insufficient volume of fluid in the container, the fluid that has leaked out often collects in the respiratory system, there is a larger-than-normal vascular bed to contain the smaller-than-normal volume of intravascular fluid.

The body responds to shock by directing blood flow away from organs that are more ____ of low flow.

Tolerant. (Page 382)

True or False. Life-threatening allergic reactions can occur in response to almost any substance that a patient may encounter.

True, allergic reactions can occur

True or False. An injection of epinephrine is the only really effective treatment for anaphylactic shock.

True, epinephrine is the main antidote for histamine

True or False. Septic shock is a combination of vessel and content failure.

True, it is a combination

True or False. Shock occurs when oxygen and nutrients cannot get to the body's cells.

True, lack of oxygen and nutrients to cells do contribute to shock

True or False. Shock occurs when oxygen and nutrients cannot get to the body's cells.

True.

hypovolemic shock caused by sever burns is the result of a loss of plasma platelets whole blood red blood cells

a

neurogenic shock is caused by a radical change in the size of the vascular system massive vasoconstriction low volume fluid collecting around the spinal cord causing compression of the cord

a

shock i due to severe infection is called? septic sock neurogenic shock anaphylactic shock hypovolemic shock

a

to protect vital organs the body compensates by directing the flow away form the organs that are more tolerant of low flow such as? the skin the heart the brain the lungs

a

when should nonlifesaving interventions be preformed for your multisystem trauma patient? en route to the hospital prior to transport during the primary assessment immediately after the injuries are discovered

a

your patient is in shock but the body's defense mechanisms are currently able to maintain adequate circulation this is called? compensated shock decompensated shock late shock irreversable shock

a

A 56-year-old male is found semiconscious by his wife. Your assessment reveals that his respirations are rapid and shallow, his pulse is rapid and irregular, and his blood pressure is low. The patient's wife states that he complained of left arm pain and nausea the day before, but would not allow her to call 9-1-1. The MOST likely cause of this patient's present condition is:

cardiogenic hypoperfusion.

Regulation of blood flow is determined by

cellular need

Your assessment of an unresponsive patient reveals that her breathing is inadequate. Your MOST immediate action should be to:

check her airway for obstructions.

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 the patient the greatest chance of survival High flow oxygen administration full mobilization of her spine intravenous fluid administration rapid transport to a trauma center

d

Distributive shock occurs when: a. an injury causes restriction of the heart muscle and impairs its pumping function. b. severe bleeding causes tachycardia in order to distribute blood to the organs faster c. temporary but severe vasodilation causes a decrease in blood supply to the brain d. widespread dilation of the blood vessels cause blood to pool in the vascular beds

d

basic causes of shock include poor pump function blood or fluid loss blood vessel dilation all of the above

d

in an acute injury setting neurogenic shock is commonly accompanied by hypovolemia tachycardia diaphoresis hypothermia

d

the action of hormones such as epinephrine and norepinephrine stimulates _______ to maintain pressure in the system and as a result perfusion of all vital organs an increase in hear rate an increase in the strength of cardiac contractions vasoconstriction in nonessential areas all of the above

d

what are the three components of the perfusion triangle? arteries, veins, capillaries plasma, red blood cells, platelets heart, brain, lungs heart, blood vessels, blood

d

when treating an 80 year old patient who is in shock it is important to remember that a. compensation from the respiratory system usually manifests with increased tidal volume b. the older patients; central nervous system usually reacts more briskly to compensate for shock c. medications older patients take for hypertension often cause and unusually fast heart rate d. changes in gastric motility may delay gastric emptying which increases risk for vominiting

d

You are dispatched to a residence for a 40-year-old female who fainted. Upon your arrival, the patient is conscious and alert, and states that she is fine. Her husband tells you that she fainted after receiving news that her sister was killed in a car crash. You offer oxygen to the patient, but she refuses to accept it. At this point, your primary concern should be to:

determine if she was injured when she fainted.

Neurogenic shock occurs when:

failure of the nervous system causes widespread vasodilation.

Basic causes of shock include

poor pump function, blood or fluid loss, blood vessel dilation.

You are transporting a 33-year-old male who was involved in a major motor vehicle crash. You have addressed all immediate and potentially life-threatening conditions and have stabilized his condition with the appropriate treatment. With an estimated time of arrival at the hospital of 20 minutes, you should:

reassess his condition in 5 minutes

A 19-year-old male was stung multiple times by fire ants. He is experiencing obvious signs and symptoms of anaphylactic shock. You administer high-flow oxygen and give him epinephrine via intramuscular injection. Upon reassessment, you determine that his condition has not improved. You should:

repeat the epinephrine injection after consulting with medical control.

You are called to a construction site where a 27-year-old worker has fallen from the second floor. He landed on his back and is drifting in and out of consciousness. A quick assessment reveals no bleeding or blood loss. His blood pressure is 90/60 mm Hg with a pulse rate of 110 beats/min. His airway is open and breathing is within normal limits. You realize the patient is in shock. The patient's shock is due to an injury to the:

spinal cord.

The autonomic nervous system regulates involuntary functions by

sweating, digestion, constriction and dilation of capillary sphincters.

The Golden Period refers to the first 60 minutes after

the injury occurs.

You respond to the local nursing home for an 85-year-old woman who has altered mental status. During your assessment, you notice that the patient has an elevated body temperature. She is hypotensive and her pulse is tachycardic. The nursing staff tells you that she has been sick for several days and that they called because her mental status continued to decline. You suspect the patient is in septic shock. The shock is due to:

widespread dilation.

In anaphylactic shock, the combination of poor oxygenation and poor perfusion is a result of

widespread vasodilation.