ATCN 2020 Chapter 3 Shock Questions
& Answers(GRADED A+)
What is the first step in managing shock in trauma patients? - ANSWERThe first step
in managing shock in trauma patients is to recognize it.
Define Shock - ANSWERAn abnormality of the circulatory system that results in
inadequate oxygen perfusion and tissue oxygenation.
List the second step in managing shock - ANSWERIs to identify the probable cause
of shock and adjust treatment accordingly.
List the four type of shock? - ANSWERCardiogenic Shock
Obstructive Shock
Neurogenic Shock
Septic shock
Cardiogenic Shock caused by? - ANSWER(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 - ANSWERCardiac 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
Compliance of the venous system involves a relationship between
_________________________________ and venous return to the heart. -
ANSWERCompliance 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.
Myocardial Contractility Defined - ANSWERAll chambers contract. Starlings Law -
muscle fiber length is related to the contractile properties of myocardial tissue.
After Load - Defined - ANSWERPressure against the walls of the aorta and systemic
arteries. Simply stated, afterload is resistance to the forward flow of blood.
Obstructive Shock - Consider these diagnosis with injuries above the diaphragm -
ANSWERTension 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 - ANSWERA. 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 - ANSWERPatients 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.
- ANSWERIn 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 - ANSWERHemorrhage
Cardiac Output is comprised of what two things? - ANSWERCardiac Output = Heart
rate x stroke volume
Stroke Volume is classically determined by: - ANSWERPreload, myocardial
contractility, and afterload
Define Preload - - ANSWERIs 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 - ANSWER70% of the blood volume
Earlier circulatory responses to blood loss are compensatory and include: -
ANSWERProgressive vasoconstriction of cutaneous, muscular and visceral
circulation to preserve blood flow to the kidneys, heart and brain.
The usual response to acute circulation blood volume depletion is -
ANSWERTachycardia - in an attempt to preserve cardiac output
& Answers(GRADED A+)
What is the first step in managing shock in trauma patients? - ANSWERThe first step
in managing shock in trauma patients is to recognize it.
Define Shock - ANSWERAn abnormality of the circulatory system that results in
inadequate oxygen perfusion and tissue oxygenation.
List the second step in managing shock - ANSWERIs to identify the probable cause
of shock and adjust treatment accordingly.
List the four type of shock? - ANSWERCardiogenic Shock
Obstructive Shock
Neurogenic Shock
Septic shock
Cardiogenic Shock caused by? - ANSWER(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 - ANSWERCardiac 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
Compliance of the venous system involves a relationship between
_________________________________ and venous return to the heart. -
ANSWERCompliance 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.
Myocardial Contractility Defined - ANSWERAll chambers contract. Starlings Law -
muscle fiber length is related to the contractile properties of myocardial tissue.
After Load - Defined - ANSWERPressure against the walls of the aorta and systemic
arteries. Simply stated, afterload is resistance to the forward flow of blood.
Obstructive Shock - Consider these diagnosis with injuries above the diaphragm -
ANSWERTension 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 - ANSWERA. 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 - ANSWERPatients 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.
- ANSWERIn 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 - ANSWERHemorrhage
Cardiac Output is comprised of what two things? - ANSWERCardiac Output = Heart
rate x stroke volume
Stroke Volume is classically determined by: - ANSWERPreload, myocardial
contractility, and afterload
Define Preload - - ANSWERIs 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 - ANSWER70% of the blood volume
Earlier circulatory responses to blood loss are compensatory and include: -
ANSWERProgressive vasoconstriction of cutaneous, muscular and visceral
circulation to preserve blood flow to the kidneys, heart and brain.
The usual response to acute circulation blood volume depletion is -
ANSWERTachycardia - in an attempt to preserve cardiac output
