CERTIFIED EMERGENCY MANAGER -
WEEK 4 EXAM QUESTIONS WITH 100%
CORRECT ANSWERS!!
Shock
State of impaired tissue perfusion resulting from circulatory failure.
Hypovolemic Shock
Decreased cellular perfusion secondary to lack of circulating volume or not ENOUGH GAS.
Cardiogenic Shock
Decreased cellular perfusion secondary to maldistribution of oxygen to the periphery. Its like
adding a larger engine without increasing the size of the tank.
Obstructive shock
Decreased cellular perfusion secondry to obstruction of blood into or out of the ventricles (eg.
pulmonary emboli, tamponade, tension pneumo. Like getting dirt or blockage in the fuel line.
Prolonged lactic acidosis leads to:
microvascular thrombosis
disseminated intravascular coagulation (DIC)
Compensated Shock
When patient is able to maintain blood pressure. Body attempting to maintain homeostasis.
Increases perfusion to brain, decreases blood flow to kidneys.
Uncompensated Shock
Shock at cellular level. Intracellular fluid leaks into interstitium causing third spacing and edema,
bp decreases, hr increases, respiratory rate increases,
Hypovolemic Shock
Blood or fluid loss reduces circulating blood volume and cardiac output.
,Mean Arterial Pressure
MAP = (Systolic pressure + 2(Diastolic) / 3
Want a MAP above 60
Hypovolemic shock interventions
Airway control, control bleeing or fluid loss, restore volume, NS 0.9%, Adult 1-2L bolus, Pedi
20ml/kg. Never use Dextrose
Cardiogenic Shock
Inadequate tissue perfusion as a result of decreased cardiac output despite adequate intravascular
volume. Most common is MI. Pump Failure
Cardiogenic Shock Interventions
Airway with PEEP will force pulmonary edema fluid out of the lung interstitium. Decrease
preload by position, nitro, diuretics, morphine. Cardiac cath, angioplasty.
Distributive Shock
Abnormal distribution of intravascular volume. Can me anaphylactic, septic, neurogenic
Distributive Shock (Anaphylaxis)
Acute life threatening allergic reaction to individuals exposed to an antigen to which they have
become hypersensitive.
Anaphylactic Shock Interventions
IM epi 1:1000 repeat in 15-20 min as needed. Albuterol, H1 abd H2 blockers, Corticosteroids.
Septic Shock
Systemic Inflammatory response syndrome (SIRS). Sepsis with organ dysfunction, cardio failure
leading to hypotension, Resp failure leading to hypoxia, Renal failure leading to oliguria and
azotemia. MODS, multiple organ dysfumction syndrome.
Septic Shock Interventions
Positive inotropes, vasopressors, fluid resuscitation, antibiotics
, Neurogenic Shock
Loss of the sympathetic nervous system "fight or flight" response is lost and the rest of digest
system is unopposed. Bradycardia, bradypnea, hypotension, priapism.
Neurogenic shock interventions
abc's, fluids, vasopressors, atropine for bradycardia, high dose corticosteroids not recommended.
Obstructive shock
cardiac output and tissue perfusion are inadequate because of resistance to ventricular filling.
Causes pericardial tamponade, tension pneumo, pulmonary embolism
Obstructive shock interventions
correct underlying condition, pericardial tamponade, pericardiocentesis and subsequent surgical
repair, tension pneumo-immediate needle thoracotomy, PE-thrombolytics
CVP
8-12mm Hg
Geriatric considerations
tachycardia during shock may be masked by medications (beta blockers), prone to dehydration,
decreased thirst, avoid fluid overload
CO=SV X HR
SNS sympathetic nervous system
heart rate is increased by stimulation of the sns, which occurs from stress, anxiety, acute pain,
release of catecholamines, hypotension and drugs with positive chronotropic effects.
PNS parasympathetic nervous system
heart rate decreases by stimulation of the pns, which can occur with vagus nerve stimulation,
cardiac conduction abnormalities and drugs with negative chronotropic effects.
Stroke volume
WEEK 4 EXAM QUESTIONS WITH 100%
CORRECT ANSWERS!!
Shock
State of impaired tissue perfusion resulting from circulatory failure.
Hypovolemic Shock
Decreased cellular perfusion secondary to lack of circulating volume or not ENOUGH GAS.
Cardiogenic Shock
Decreased cellular perfusion secondary to maldistribution of oxygen to the periphery. Its like
adding a larger engine without increasing the size of the tank.
Obstructive shock
Decreased cellular perfusion secondry to obstruction of blood into or out of the ventricles (eg.
pulmonary emboli, tamponade, tension pneumo. Like getting dirt or blockage in the fuel line.
Prolonged lactic acidosis leads to:
microvascular thrombosis
disseminated intravascular coagulation (DIC)
Compensated Shock
When patient is able to maintain blood pressure. Body attempting to maintain homeostasis.
Increases perfusion to brain, decreases blood flow to kidneys.
Uncompensated Shock
Shock at cellular level. Intracellular fluid leaks into interstitium causing third spacing and edema,
bp decreases, hr increases, respiratory rate increases,
Hypovolemic Shock
Blood or fluid loss reduces circulating blood volume and cardiac output.
,Mean Arterial Pressure
MAP = (Systolic pressure + 2(Diastolic) / 3
Want a MAP above 60
Hypovolemic shock interventions
Airway control, control bleeing or fluid loss, restore volume, NS 0.9%, Adult 1-2L bolus, Pedi
20ml/kg. Never use Dextrose
Cardiogenic Shock
Inadequate tissue perfusion as a result of decreased cardiac output despite adequate intravascular
volume. Most common is MI. Pump Failure
Cardiogenic Shock Interventions
Airway with PEEP will force pulmonary edema fluid out of the lung interstitium. Decrease
preload by position, nitro, diuretics, morphine. Cardiac cath, angioplasty.
Distributive Shock
Abnormal distribution of intravascular volume. Can me anaphylactic, septic, neurogenic
Distributive Shock (Anaphylaxis)
Acute life threatening allergic reaction to individuals exposed to an antigen to which they have
become hypersensitive.
Anaphylactic Shock Interventions
IM epi 1:1000 repeat in 15-20 min as needed. Albuterol, H1 abd H2 blockers, Corticosteroids.
Septic Shock
Systemic Inflammatory response syndrome (SIRS). Sepsis with organ dysfunction, cardio failure
leading to hypotension, Resp failure leading to hypoxia, Renal failure leading to oliguria and
azotemia. MODS, multiple organ dysfumction syndrome.
Septic Shock Interventions
Positive inotropes, vasopressors, fluid resuscitation, antibiotics
, Neurogenic Shock
Loss of the sympathetic nervous system "fight or flight" response is lost and the rest of digest
system is unopposed. Bradycardia, bradypnea, hypotension, priapism.
Neurogenic shock interventions
abc's, fluids, vasopressors, atropine for bradycardia, high dose corticosteroids not recommended.
Obstructive shock
cardiac output and tissue perfusion are inadequate because of resistance to ventricular filling.
Causes pericardial tamponade, tension pneumo, pulmonary embolism
Obstructive shock interventions
correct underlying condition, pericardial tamponade, pericardiocentesis and subsequent surgical
repair, tension pneumo-immediate needle thoracotomy, PE-thrombolytics
CVP
8-12mm Hg
Geriatric considerations
tachycardia during shock may be masked by medications (beta blockers), prone to dehydration,
decreased thirst, avoid fluid overload
CO=SV X HR
SNS sympathetic nervous system
heart rate is increased by stimulation of the sns, which occurs from stress, anxiety, acute pain,
release of catecholamines, hypotension and drugs with positive chronotropic effects.
PNS parasympathetic nervous system
heart rate decreases by stimulation of the pns, which can occur with vagus nerve stimulation,
cardiac conduction abnormalities and drugs with negative chronotropic effects.
Stroke volume
