1. What is the definition of shock?

Shock is a state of inadequate perfusion, that is inadequate supply of oxygen to the

tissues
2. What are some basic signs of shock?
The general order that progressive shock changes vitals: HR increase à
hypotension à signs of end organ perfusion issues
3. What are the three (or four, depending on how you look at them) basic categories
of shock?
It is easiest to think of three major systems that give problems – the heart, the
vessels, and
the blood volume. These respectively are associated with cardiogenic, vasogenic,
and
hypovolemic shock. Some authors (and I think this is a good idea, because it
prompts you to
look for correctable causes) add obstructive shock to these three (tension PTX,
tamponade,
PE, etc.).
4. What are some other causes of vasogenic (distributive) shock?
Sepsis and neurogenic shock are also relatively specific vasogenic shock states.
Sepsis is
shock due to a flood of toxins and inflammatory markers. The effects are
widespread.
Neurogenic shock can occur with high spinal cord injuries and other CNS issues
– lack of
innervation causes the vessels to lose their tone and dilate.
5. For the pediatric patients in shock, which one of your routine tests should never
be missed?
Glucose. A recent series from St. Paul Children’s showed that nearly 20% of their
critically ill
patients were hypoglycemic. This child is highly likely to be hypoglycemic due
to the nature of
his illness (poor intake and high metabolic demand). 2mL/kg of D25 (D50 cut
1:1 with NS)
should be given if the glucose is low – check with medical control if unsure.
6. An otherwise healthy 70-year-old man receives 12 units of packed red blood cells
for persistent diffuse bleeding during a suprapubic prostatectomy. Hemoglobin
concentration is 11 g/dL; platelet count is 55,000/mm3; plasma fibrinogen
concentration is 180 mg/dL; prothrombin time is 14 sec; and partial
thromboplastin time is 35 sec.
Platelets
7. What is hypovolaemic shock?
Hypovolaemic shock is inadequate tissue perfusion due to reduced circulating
blood volume
8. What is the normal blood volume for an 80kg man? What about for a 60kg
woman?
Normal blood volume is 70mls/kg. That is 5600ml total blood volume for an
80kg person and 4200ml for a 60kg person.
9. What clinical signs are used to assess the degree of blood loss?
Clinical signs to assess extent of blood loss include; blood pressure, heart rate,
capillary refill, respiratory rate, urine output, mental state, colour of extremities
 and complexion.
10. What are the main goals of initial management of massive haemorrhage?
The main goals of initial management of massive haemorrhage are haemostasis,
restoration of circulating blood volume, and blood component replacement.
11. What blood products can be used in severe haemorrhage?
Blood products used in severe haemorrhage include red blood cells, fresh frozen
plasma, and cryoprecipitate. Albumin, antifibrinolytics and recombinant Factor
VIIa are sometimes used.
12. What are the main complications from massive haemorrhage?
The main complications from massive haemorrhage include coagulopathy,
acidosis, hypothermia and death
13. Hypovolemic Clinical findings

cold and clammy skin

Treatment
intravenous fluids
14. there are 4 types of shock
cardiogenic
hypovolemic
distributive
obstructive
15. : Damage control shock resuscitation

1. Shock packs with 1:1:1 ratios

2. Resus with limited systolic blood pressure of 90 mmHg
3. Limited crystalloid use
4. Avoid vasoconstrictors
5. Anti-fibrinolytics
6. Calcium (target > 1.0)
7. Potassium (treat hyperkalaemia actively)
8. Factor VIIa (NovoSeven®)
9. Fresh whole blood
10. Avoid hypothermia (< 36°C)