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