TCRN Review - Special Situations
(Shock, Psychosocial Issues Related To
Trauma, SIRS & MODS) (22 Questions
On Exam)
Describe the process of Obstructive Shock. - ANSWER- Myocardium contracts against
high afterload -> Sympathetic over activity leads to vasoconstriction in order to maintain
BP -> Despite normal BP, organs are poorly perfused due to a reduction in blood flow ->
Back pressure leads to venous congestion
List the 4 Classifications of Shock - ANSWER- Hypovolemic
Distributive
Cardiogenic
Obstructive
Describe hypovolemic shock - ANSWER- Lack of Volume
Describe distributive shock - ANSWER- Mal-distribution of blood (vasodilation)
Describe obstructive shock - ANSWER- Inability of blood to enter or exit the heart
adequately
What is another name for early hypovolemic shock? - ANSWER- Compensatory Shock
The adrenergic system is active during the _____ phase of shock. - ANSWER-
Compensatory
The _____ system is active after the phase of shock has passed to bring the body back
to a state of homeostasis. - ANSWER- Cholinergic
Another name for the sympathetic system is _____. - ANSWER- Adrenergic system
Another name for the parasympathetic system is _____. - ANSWER- Cholinergic
system
What is the name of the process in which glycogen stores in the liver are broken down
into glucose? - ANSWER- Glycogeonolysis
,What is the process in which glucose in the serum is converted to glycogen for storage
in the liver? - ANSWER- Glyconeogenesis
What is the term for the speed at which electricity moves through the heart? -
ANSWER- Automaticity
What is the role of alpha receptors in the adrenergic (sympathetic) system? - ANSWER-
Vasoconstriction, Glycogeonolysis, Diaphoresis
What is the role of the alpha receptors in the cholinergic (parasympathetic) system? -
ANSWER- Vasodilation, Glyconeogenesis, Dry Skin
Sympathetic vs. Parasympathetic is also known as what? - ANSWER- Fight or Flight;
respectively
What is the role of Beta-One receptors in the adrenergic (sympathetic) system? -
ANSWER- Increased: heart rate, contractility, automaticity
What is the role of Beta-One receptors in the cholinergic (parasympathetic) system? -
ANSWER- Decreased: heart rate, contractility, automaticity
What is the role of Beta-Two receptors in the adrenergic (sympathetic) system? -
ANSWER- Increased respiratory rate
Bronchodilation
What is the role of Beta-Two receptors in the cholinergic (parasympathetic) system? -
ANSWER- Decreased respiratory rate
Bronchoconstriction
What is another term for late shock? - ANSWER- Decompensated shock
What occurs during late or decompensated shock? - ANSWER- Activation of the
inflammatory system
During late or decompensated shock and the activation of the inflammatory system,
what do inflammatory mediators cause? (3 things) - ANSWER- Vasodilation
Increased capillary permeability
Increased coagulation
What are the signs of early or compensated hypovolemic shock? (8 signs/symptoms) -
ANSWER- Deceptively normal or slightly elevated blood pressure
Narrowing Pulse Pressure
Tachycardia (weak and thready)
Tachypnea (deep and rapid)
Normal serum lactate levels
Cool and clammy skin
, CNS: anxious and restless
Decreased urinary output
What are the signs of late or decompensated hypovolemic shock? (7 signs/symptoms) -
ANSWER- Decreased blood pressure
Tachycardia (may not be palpable peripherally)
Tachypnea (shallow and rapid)
Serum Lactate > 2-4 mmol/L
Cool, clammy and mottled skin
CNS: loss of consciousness
Anuria
What is the average blood volume of an adult? - ANSWER- 4700-5500 ml
What is the average blood loss of a thoracic injury? - ANSWER- 2000 ml
What is the average blood loss of an intra-abdominal injury? - ANSWER- 2000 ml
What is the average blood loss of a tibial fracture? - ANSWER- 650 ml
What is the average blood loss of a femur fracture? - ANSWER- 1000 ml
What is the average blood loss of a pelvic fracture? - ANSWER- 3000 ml
How many classes of hypovolemic shock are there? - ANSWER- 4
Describe Class I hypovolemic shock: (8 answers) - ANSWER- <750 ml of blood loss
<15% of blood loss
Pulse <100
Normal Blood Pressure
RR is 14-20
Urinary Output >30 ml/hr
CNS: slightly anxious
Fluid Replacement: Crystalloid
Describe Class II hypovolemic shock: (8 answers) - ANSWER- 750-1500 ml of blood
loss
15-30% of blood loss
Pulse 100-120
Normal Blood Pressure
RR is 20-30
Urinary Output 20-30 ml/hr
CNS: Mildly anxious
Fluid Replacement: Crystalloid
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