EMT Chapter 13- Shock Practice

cyanosis

bluish discoloration of the skin

what do white blood cells do?

fight infection

The "perfusion triangle" consists of the:

heart, blood vessels, blood

Which of the following organs is the MOST tolerant of low blood flow?

skin

Cardiogenic shock may result from all of the following, EXCEPT: A. heart attack. B. increased afterload. C. increased preload. D. poor contractility.

C

You suspect your patient is in shock. You note the patient's skin is pale. This is likely due to ___________. A. an increased heart rate B. peripheral vasodilation C. peripheral vasoconstriction D. hypothermia

C

sphincters

Circular muscles that encircle and, by contracting, constrict a duct, tube, or opening.

pericardial effusion

Collection of fluid in the pericardial space

Sensitization

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

diffusion

Passive process in which molecules move from an area with a higher concentration of molecules to an area of lower concentration

psychogenic shock

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

cardiogenic shock

Shock caused by inadequate function of the heart, or pump failure; not enough oxygen is delivered to the tissues of the body

septic shock

Shock caused by severe infection, usually a bacterial infection.

myocardial contractility

The ability of the heart muscle to contract.

Perfusion

The flow of blood through body tissues and vessels.

Afterload

The force or resistance against which the heart pumps.

decompensated shock

The late stage of shock when blood pressure is falling

autonomic nervous system

The part of the nervous system that regulates involuntary functions

Preload

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

edema

abnormal accumulation of fluid in interstitial spaces of tissues; causes swelling

cardiac tamponade

acute compression of the heart caused by fluid accumulation in the pericardial sac leading to decreased cardiac output

examples of obstructive shock (2)

cardiac tamponade, tension pneumothorax

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.

What do platelets do?

help blood clot

hypovolemic shock

low blood volume, due to massive internal or external bleeding or extensive loss of body water result of fluid or blood loss

types of distributive shock (4)

neurogenic, anaphylactic, septic, psychogenic

obstructive shock

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.

Shock is the result of: A. hypoperfusion to the cells of the body. B. the body's maintenance of homeostasis. C. temporary dysfunction of a major organ. D. widespread constriction of the blood vessels.

A

To protect vital organs, the body compensates by directing blood flow away from organs that are more tolerant of low flow, such as A. the skin. B. the heart. C. the brain. D. the lungs.

A

Homeostasis

A balance of all systems of the body.

syncope

A fainting spell or transient loss of consciousness.

Your patient has a decreased cardiac output and poor myocardial contractility. This will likely lead to ___________. A. septic shock B. neurogenic shock C. hypovolemic shock D. cardiogenic shock

D

anaphylactic shock

Severe shock caused by an allergic reaction.

distributive shock

widespread dilation of the small arterioles, small venules, or both; caused by poor vessel function

compensated shock

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

pulse pressure

systolic - diastolic pressure

A 70-year-old female was recently discharged from the hospital following a total hip replacement. Today, she presents with restlessness, tachycardia, and a blood pressure of 100/64 mm Hg. Her skin is warm and moist. You should be MOST suspicious that she is experiencing: A. septic shock. B. pump failure. C. a local infection. D. decompensated shock.

A

Hypovolemic shock caused by severe burns is the result of a loss of: A. plasma. B. platelets. C. whole blood. D. red blood cells.

A

Neurogenic shock occurs when: A. failure of the nervous system causes widespread vasodilation. B. the spinal cord is severed and causes massive hemorrhaging. C. there is too much blood to fill a smaller vascular container. D. massive vasoconstriction occurs distal to a spinal cord injury.

A

Patients develop septic shock secondary to: A. poor vessel function and severe volume loss. B. an infection that weakens cardiac contractions. C. failure of the blood vessels to adequately dilate. D. weak vessel tone due to nervous system damage.

A

When perfusion to the core of the body decreases: A. blood is shunted away from the skin. B. decreased cardiac contractility occurs. C. blood is diverted to the gastrointestinal tract. D. the voluntary nervous system releases hormones.

A

Which of the following patients is in decompensated shock? A. a 20-year-old female with absent radial pulses and dilated pupils B. a 23-year-old restless male with cool, clammy skin and tachycardia C. a 28-year-old female with pale skin and rapid, shallow respirations D. a 32-year-old male with anxiety and a systolic blood pressure of 110 mm Hg

A

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: A. determine if she was injured when she fainted. B. provide emotional support regarding her sister. C. advise her that she needs to go to the hospital. D. obtain baseline vital signs and a medical history.

A

Your patient is in shock, but the body's defense mechanisms are currently able to maintain adequate circulation. This is called ___________. A. compensated shock B. decompensated shock C. late shock D. irreversible shock

A

pulmonary embolism

A blood clot in the blood vessels of the lung, causing obstruction of blood flow.

distributive shock

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

aneurysm

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

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: A. acute myocardial infarction. B. cardiogenic hypoperfusion. C. severe septic hypoperfusion. D. a ruptured aortic aneurysm.

B

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. assisted ventilation, thermal management, and elevation of the lower extremities. C. oxygen via nonrebreathing mask, thermal management, and elevation of his legs. D. assisted ventilation, preventing hyperthermia, and elevating his lower extremities.

B

As you approach a patient lying at the side of the roadway, you observe severe bleeding from the leg. What should your first action be? A. Open the airway. B. Control the bleeding. C. Administer oxygen. D. Check for a pulse

B

Clinical signs of compensated shock include all of the following, EXCEPT: A. cool and clammy skin. B. absent peripheral pulses. C. restlessness or anxiety. D. rapid, shallow breathing.

B

In infants and children, a capillary refill time (CRT) that is greater than ______ second(s) is a sign of poor peripheral perfusion. A. 1 B. 2 C. 3 D. 4

B

Inadequate circulation of blood throughout the body is called ________. A. hypotension B. shock C. perfusion D. hypoxia

B

One of the primary waste products of normal cellular metabolism that must be removed from the body by the lungs is: A. lactic acid. B. carbon dioxide. C. pyruvic acid. D. carbon monoxide.

B

When assessing a patient with signs and symptoms of shock, it is MOST 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 a prompt blood transfusion.

B

When the body senses a state of hypoperfusion, the sympathetic nervous system releases epinephrine, the effects of which include: A. tachypnea. B. tachycardia. C. vasodilation. D. restlessness.

B

Which of the following injuries would MOST likely cause obstructive shock? A. liver laceration B. cardiac tamponade C. simple pneumothorax D. spinal cord injury Answer: B

B

Which of the following would MOST likely result in hemorrhagic shock? A. severe vomiting B. liver laceration C. excessive sweating D. repeated diarrhea

B

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: A. immediately evaluate his airway. B. apply direct pressure to the wound. C. assess the rate and quality of his pulse. D. administer 100% supplemental oxygen.

B

A 19-year-old male was stung multiple times by fire ants. He is experiencing obvious signs and symptoms of anaphylactic shock. You administer 100% oxygen and give him epinephrine via subcutaneous injection. Upon reassessment, you determine that his condition has not improved. You should: A. transport him immediately and provide supportive care while en route. B. consider that he may actually be experiencing an acute asthma attack. C. repeat the epinephrine injection after consulting with medical control. D. request a paramedic unit that is stationed approximately 15 miles away.

C

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. wrap the towel with pressure bandages. B. apply pressure to the brachial artery. C. apply a tourniquet proximal to the wrist. D. administer high-flow supplemental oxygen.

C

A 27-year-old male was stabbed in the chest during a disagreement at a poker game. As you approach him, you see that a knife is impaled in his chest. Before you make physical contact with the patient, it is MOST important to: A. form a general impression. B. call for an ALS ambulance. C. follow standard precautions. D. ask bystanders what happened.

C

Hypotension in a child with blunt or penetrating trauma is particularly significant because: A. it typically develops earlier in children than it does in adults. B. the most likely cause of the hypotension is respiratory failure. C. it often indicates the loss of half of his or her blood volume. D. most children with hypotension die in the prehospital setting.

C

Pulmonary edema and impaired ventilation occur during: A. septic shock. B. neurogenic shock. C. cardiogenic shock. D. anaphylactic shock.

C

Temporary, widespread vasodilation and syncope caused by a sudden nervous system reaction MOST accurately describes: A. vasovagal shock. B. neurogenic shock. C. psychogenic shock. D. neurologic shock.

C

Which of the following MOST accurately describes septic shock? A. bacterial infection of the nervous system with widespread vasodilation B. widespread vasoconstriction and plasma loss due to a severe viral infection C. bacterial damage to the vessel wall, leaking blood vessels, and vasodilation D. viral infection of the blood vessels, vascular damage, and vasoconstriction

C

Which of the following clinical signs is unique to anaphylactic shock? A. pallor B. dizziness C. wheezing D. hypotension

C

You are transporting a 33-year-old male who was involved in a 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: A. take his vital signs in 15 minutes. B. arrange for an ALS rendezvous. C. reassess his condition in 5 minutes. D. repeat your secondary assessment.

C

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 for survival? A. 100% oxygen administration B. full immobilization of her spine C. application of the pneumatic antishock garment (PASG) D. rapid transport to a trauma center

D

A 59-year-old male presents with severe vomiting and diarrhea of 3 days' duration. He is confused and diaphoretic, and his radial pulses are absent. His blood pressure is 78/50 mm Hg. After applying 100% supplemental oxygen, you should: A. perform a head-to-toe exam. B. allow him to drink plain water. C. obtain a repeat blood pressure in 5 minutes. D. prepare for immediate transport.

D

All of the following conditions would make you suspect shock, EXCEPT: A. anaphylaxis. B. heart attack. C. severe infection. D. tachycardia.

D

Capillary sphincters are: A. under complete control of the voluntary portion of the nervous system. B. capable of dilating in order to increase perfusion to crucial body organs. C. responsible for constricting to compensate for decreased cell perfusion. D. circular muscular walls that regulate blood flow through the capillaries.

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 causes blood to pool in the vascular beds.

D

In an acute injury setting, neurogenic shock is commonly accompanied by: A. hypovolemia. B. tachycardia. C. diaphoresis. D. hypothermia.

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 patient's central nervous system usually reacts more briskly to compensate for shock. C. medications older patients take for hypertension often cause an unusually fast heart rate. D. changes in gastric motility may delay gastric emptying, which increases the risk for vomiting.

D

Which of the following is the ONLY action that can prevent eventual death from a tension pneumothorax? A. Early administration of high-flow oxygen B. Rapid administration of intravenous fluids C. Positive-pressure ventilation with a bag-valve mask D. Decompression of the injured side of the chest

D

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. Each subsequent exposure following sensitization often produces a more severe reaction.

D

Anaphylaxis

Life threatening allergic reaction that may include shock and respiratory failure