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ATCN Chapter 3 Shock.
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ATCN Chapter 3 Shock.
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ATCN Chapter 3 ShockWhat is the first step in managing shock in trauma patients? - ANS-The first step in
managing shock in trauma patients is to recognize it.
Define Shock - ANS-An abnormality of the circulatory system that results in inadequate
oxygen perfusion and tissue oxygenation.
List the second step in managing shock - ANS-Is to identify the probable cause of shock
and adjust treatment accordingly.
List the four type of shock? - ANS-Cardiogenic Shock
Obstructive Shock
Neurogenic Shock
Septic shock
Cardiogenic Shock caused by? - ANS-(Caused by blunt cardiac injury) Suspect blunt
cardiac injury when the mechanism of injury to the thorax involves rapid deceleration.
List three causes of Cardiogenic shock - ANS-Cardiac Tamponade
Is most commonly encountered in patients with penetrating thoracic trauma, it can
result from blunt injury to the thorax
1. Tachycardia
2. Muffled heart sounds
3. Dilated / engorged neck veins with hypotension and insufficient response to fluid
therapy suggest cardiac tamponade
Air Embolism
Myocardial Infarction
Obstructive Shock - Consider these diagnosis with injuries above the diaphragm -
ANS-Tension Pneumothorax - reduces venous return resulting in Obstructive shock
I. Acute Respiratory Distress
II. Sub - Q emphysema
III. Absent Unilateral breath Sounds
IV. Hyper resonance to percussion
V. Tracheal Shift
Cardiac Tamponade - blood in the pericardial sac inhibits cardiac contractility
, Neurogenic shock - list potential causes - ANS-A. Injury to the cervical or thoracic spinal
cord resulting in loss of sympathetic tone and subsequent vasodilation
B. Isolated intracranial injuries do not cause shock, unless the brain stem is required
C. The classic presentation of neurogenic shock is hypotension without tachycardia or
cutaneous vasoconstriction.
D. The failure of fluid resuscitation to restore organ perfusion and tissue oxygenation
suggests either continuing hemorrhage or neurogenic shock
Septic Shock - Define - ANS-Patients with early septic shock can have normal
circulation volume, modest tachycardia, warm skin, near normal systolic blood pressure,
and wide pulse pressure.
In which group of patients, may be the underlying reason or precipitating cause of
traumatic injury be be an unrecognized infection, commonly a urinary tract infection. -
ANS-In Elderly, the underlying reason or precipitating cause of traumatic injury be be an
unrecognized infection, commonly a urinary tract infection.
____________________________ is the most common cause of shock in trauma
patients - ANS-Hemorrhage
Cardiac Output is comprised of what two things? - ANS-Cardiac Output = Heart rate x
stroke volume
Stroke Volume is classically determined by: - ANS-Preload, myocardial contractility, and
afterload
Define Preload - - ANS-Is the filling of the ventricles, volume of venous blood returning
to the left and right side fo the heart, is determined by venous capacitance, volume
status, and the difference between mean venous systemic pressure and right arterial
pressure.
Nearly __________________% of the bodies total blood volume is estimated to be in
the venous circuit - ANS-70% of the blood volume
Compliance of the venous system involves a relationship between
_________________________________ and venous return to the heart. -
ANS-Compliance of the venous system involves a relationship between venous volume
and venous return to the heart. This pressure gradient drives blood flow and therefore
the volume of venous return to the heart.
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