Post on 16-Nov-2015
description
S H O C K
ROLANDO E. CABATU, M.D.
UST Department of Surgery
Definition of terms
Types of Shock
Diagnosis
Signs/symptoms
Prevention
Management
Complications
Endpoint of Resuscitation
DEFINITION
a failure to meet the
metabolic demands of cells
and tissues and the
consequences that ensue.
inadequate tissue perfusion
inadequate removal of cellular
waste products
RECOGNITION
Blood pressure
pulse rate
Pallor
Temperature
Mentation
Urine output
Central Venous Pressure / PCWP
1. A 19-year -old man presents to
the emergency department by
ambulance with a stab wound
adjacent to the left nipple
region. His blood pressure is
50/30 mm Hg and he is
unresponsive.
A. Cardiogenic shock due to extrinsic causes
B. Cardiogenic shock due to intrinsic causes
C. Hypovolemic shock secondary to blood loss
D. Hypovolemic shock secondary to third space losses
E. Hypovolemic shock secondary to insensible losses
F. Septic shock G. Neurogenic shock
2. A 23-year -old medical student
suddenly becomes faint and
dizzy while observing a right
inguinal hernia repair in the
operating room. The student
collapses and during evaluation
is noted to have a blood
pressure of 85/50 mm Hg.
A. Cardiogenic shock due to extrinsic causes
B. Cardiogenic shock due to intrinsic causes
C. Hypovolemic shock secondary to blood loss
D. Hypovolemic shock secondary to third space losses
E. Hypovolemic shock secondary to insensible losses
F. Septic shock G. Neurogenic shock
3. A 42-year -old, obese woman
presents with a 2 3 day history of
persistent nausea and vomiting. Her
blood pressure is 80/50 mm Hg with
a heart rate of 140 beats/min. She is
noted to have an unreducible
umbilical hernia on examination.
Abdominal radiograph reveals a
high -grade small bowel obstruction.
During operative repair of the
incarcerated hernia, there is no
evidence of strangulation
A. Cardiogenic shock due to extrinsic causes
B. Cardiogenic shock due to intrinsic causes
C. Hypovolemic shock secondary to blood loss
D. Hypovolemic shock secondary to third space losses
E. Hypovolemic shock secondary to insensible losses
F. Septic shock G. Neurogenic shock
4. A 25-year -old man is admitted to the neurosurgery intensive care unit after a motor vehicle accident. On admission the patient is noted to have a blood pressure of 120/80 mm Hg with a heart rate of 105 beats/min. Upon evaluation he is found to have a complete spinal cord injury at the sixth cervical vertebrae, as well as a bruise on his abdomen in the distribution of his seatbelt and a bruise on his chest from hitting the steering wheel. Six hours after admission the patient's blood pressure gradually falls to 60/40 mm Hg and the patient becomes unresponsive.
A. Cardiogenic shock due to extrinsic causes
B. Cardiogenic shock due to intrinsic causes
C. Hypovolemic shock secondary to blood loss
D. Hypovolemic shock secondary to third space losses
E. Hypovolemic shock secondary to insensible losses
F. Septic shock G. Neurogenic shock
5. A 35-year -old man sustains a
50% full -thickness burn injury
to his torso and lower
extremities during a house
fire. Over the next 2 days, the
patient develops a worsening
paralytic ileus and a gradual
decrease in his blood pressure
to 80/60 mm Hg despite
following the Parkland formula
for determining the amount of
fluid to give after a burn
injury.
A. Cardiogenic shock due to extrinsic causes
B. Cardiogenic shock due to intrinsic causes
C. Hypovolemic shock secondary to blood loss
D. Hypovolemic shock secondary to third space losses
E. Hypovolemic shock secondary to insensible losses
F. Septic shock G. Neurogenic shock
6.During placement of a
triple lumen catheter in
a 72-year -old woman,
the patient suddenly
becomes hypotensive
with a blood pressure of
60/30 mm Hg during
advancement of the
guidewire .
A. Cardiogenic shock due to extrinsic causes
B. Cardiogenic shock due to intrinsic causes
C. Hypovolemic shock secondary to blood loss
D. Hypovolemic shock secondary to third space losses
E. Hypovolemic shock secondary to insensible losses
F. Septic shock G. Neurogenic shock