ATCN 2024 CHAPTER 3 SHOCK
QUESTIONS AND ANSWERS WITH
SOLUTIONS
What is the first step in managing shock in trauma patients? - ANSWER The first step in managing shock
in trauma patients is to recognize it.
Define Shock - ANSWER An abnormality of the circulatory system that results in inadequate oxygen
perfusion and tissue oxygenation.
List the second step in managing shock - ANSWER Is to identify the probable cause of shock and adjust
treatment accordingly.
List the four type of shock? - ANSWER Cardiogenic 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 - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER 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. - ANSWER 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 - ANSWER
Hemorrhage
Cardiac Output is comprised of what two things? - ANSWER Cardiac Output = Heart rate x stroke volume
Stroke Volume is classically determined by: - ANSWER Preload, myocardial contractility, and afterload
QUESTIONS AND ANSWERS WITH
SOLUTIONS
What is the first step in managing shock in trauma patients? - ANSWER The first step in managing shock
in trauma patients is to recognize it.
Define Shock - ANSWER An abnormality of the circulatory system that results in inadequate oxygen
perfusion and tissue oxygenation.
List the second step in managing shock - ANSWER Is to identify the probable cause of shock and adjust
treatment accordingly.
List the four type of shock? - ANSWER Cardiogenic 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 - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER 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. - ANSWER 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 - ANSWER
Hemorrhage
Cardiac Output is comprised of what two things? - ANSWER Cardiac Output = Heart rate x stroke volume
Stroke Volume is classically determined by: - ANSWER Preload, myocardial contractility, and afterload
