ITLS Shock – Questions & Detailed Solutions
Upon successful completion of this chapter, you should be able to:
1. List the four components of the vascular system necessary for normal tissue
perfusion.
2. Describe the symptoms and signs of shock in the order that they develop,
from the very
least to the very worst.
3. Describe the three common clinical shock syndromes.
4. Explain the pathophysiology of hemorrhagic shock, and compare it to the
pathophysiology of mechanical and neurogenic shock.
5. Describe the management of the following:
a. Hemorrhage that can be controlled
b. Hemorrhage that cannot be controlled
c. Nonhemorrhagic shock syndromes
6. Discuss the use of hemostatic agents for uncontrolled extremity
hemorrhage.
7. Discuss the current indications for the use of IV fluids in the treatment of
hemorrhagic
shock
The normal perfusion of body tissues requires four intact components. They
are
as follows: ■ Adequate volume of fluid in the vascular system: red blood
cells and plasma
■ Functioning pump: the heart
■ Intact vascular system to deliver oxygenated blood throughout the body: the
blood vessels
■ Adequate air exchange in the lungs to allow oxygen to enter the blood:
oxygenation
Blood Pressure = Cardiac Output x Peripheral Vascular Resistance
Cardiac Output = Heart Rate x Stroke Volume
Thus, if cardiac output falls (either due to falling heart rate or lowered stroke
volume) or if peripheral vascular resistance falls (such as in the dilated
arteries
that occur in neurogenic shock), then blood pressure will fall.
, The preservation of these components can be related to the basic rules of
shock management, which are:
(4) ■ Maintain the airway.
■ Maintain oxygenation and ventilation.
■ Control bleeding where possible.
■ Maintain circulation through an adequate heart rate and intravascular
volume.
An important point to remember is that the positive pressure breaths you give
when you ventilate someone actually can ? decrease blood return to the
heart, lowering cardiac output
The term shock describes a condition that occurs when ? the perfusion
of the body's tissues with oxygen, electrolytes, glucose, and fluid becomes
inadequate to meet the body's needs.
Several processes cause this drop in perfusion. For example,
the loss of red blood cells in hemorrhaging patients results in ? to the body
tissues.
Decreased circulating blood volume leads to ?
fluid volume, and electrolytes to the cells.
Those circulatory disturbances result in
the cells of the body becoming "shocked," and grave changes in body tissue
begin to occur. less oxygen transport
lowered glucose,
Deprived of oxygen, cells begin to use "backup" processes, which use energy
less efficiently and produce toxic by-products such as lactic acid.
The backup (?) processes may postpone cellular death for a time. However,
the lack of oxygen is compounded by those toxic by-products because they can
poison
certain cellular functions, such as the ?
Upon successful completion of this chapter, you should be able to:
1. List the four components of the vascular system necessary for normal tissue
perfusion.
2. Describe the symptoms and signs of shock in the order that they develop,
from the very
least to the very worst.
3. Describe the three common clinical shock syndromes.
4. Explain the pathophysiology of hemorrhagic shock, and compare it to the
pathophysiology of mechanical and neurogenic shock.
5. Describe the management of the following:
a. Hemorrhage that can be controlled
b. Hemorrhage that cannot be controlled
c. Nonhemorrhagic shock syndromes
6. Discuss the use of hemostatic agents for uncontrolled extremity
hemorrhage.
7. Discuss the current indications for the use of IV fluids in the treatment of
hemorrhagic
shock
The normal perfusion of body tissues requires four intact components. They
are
as follows: ■ Adequate volume of fluid in the vascular system: red blood
cells and plasma
■ Functioning pump: the heart
■ Intact vascular system to deliver oxygenated blood throughout the body: the
blood vessels
■ Adequate air exchange in the lungs to allow oxygen to enter the blood:
oxygenation
Blood Pressure = Cardiac Output x Peripheral Vascular Resistance
Cardiac Output = Heart Rate x Stroke Volume
Thus, if cardiac output falls (either due to falling heart rate or lowered stroke
volume) or if peripheral vascular resistance falls (such as in the dilated
arteries
that occur in neurogenic shock), then blood pressure will fall.
, The preservation of these components can be related to the basic rules of
shock management, which are:
(4) ■ Maintain the airway.
■ Maintain oxygenation and ventilation.
■ Control bleeding where possible.
■ Maintain circulation through an adequate heart rate and intravascular
volume.
An important point to remember is that the positive pressure breaths you give
when you ventilate someone actually can ? decrease blood return to the
heart, lowering cardiac output
The term shock describes a condition that occurs when ? the perfusion
of the body's tissues with oxygen, electrolytes, glucose, and fluid becomes
inadequate to meet the body's needs.
Several processes cause this drop in perfusion. For example,
the loss of red blood cells in hemorrhaging patients results in ? to the body
tissues.
Decreased circulating blood volume leads to ?
fluid volume, and electrolytes to the cells.
Those circulatory disturbances result in
the cells of the body becoming "shocked," and grave changes in body tissue
begin to occur. less oxygen transport
lowered glucose,
Deprived of oxygen, cells begin to use "backup" processes, which use energy
less efficiently and produce toxic by-products such as lactic acid.
The backup (?) processes may postpone cellular death for a time. However,
the lack of oxygen is compounded by those toxic by-products because they can
poison
certain cellular functions, such as the ?
