Shock Diagnosis
Presentation
•
Health Sciences
•
University
•
Practice Problem
•
Easy
Daniel Robles
Used 33+ times
FREE Resource
8 Slides • 11 Questions
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Clinical Case
You are at the emergency department when a 25-year-old male is brought in after a motorcycle accident. He was found lying on the road with visible bleeding from his right thigh.
Vital signs upon arrival:
Heart rate: 124 bpm
Blood pressure: 90/60 mmHg
Respiratory rate: 26/min
SpO₂: 95% on room air
Temperature: 36.8°C
Capillary refill time: 4 seconds. He is anxious, pale, and sweating, with cold extremities.
There is an open wound on the right thigh with active bleeding.
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4
Multiple Choice
What is the MOST appropiate step that should be made by the Paramedic to try to stabilize the patient?
Administer oxygen via nasal cannula
Establish two large-bore IV lines and start crystalloids
Apply direct pressure to the wound
Order laboratory studies
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Multiple Choice
Question 1
Based on these findings upon his arrival, what is the most likely type of shock this patient is developing?
Cardiogenic shock
Distributive (septic) shock
Hypovolemic shock
Neurogenic shock
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Multiple Choice
Question 2
Which vital sign change, best indicates that the patient’s body is trying to compensating for hypovolemia?
Decreased heart rate
Increased heart rate (tachycardia)
Decreased respiratory rate
Decreased Blood Pressure
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After 10 minutes, the patient becomes drowsy and restless.
His skin is cool and clammy, and his radial pulse is weak and rapid.
Updated vital signs:
HR: 136 bpm
BP: 80/50 mmHg
RR: 30/min
SpO₂: 94%
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Multiple Choice
Question 3
What does this change in mental status (restlessness, confusion) indicate?
The patient is improving
Decreased cerebral perfusion due to worsening shock
Side effects of medication
Emotional distress
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Multiple Choice
Question 4
Which physical finding supports a diagnosis of hypoperfusion?
Warm skin and bounding pulses
High urine output
Cold, clammy skin with delayed capillary refill
Normal mental status
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You order initial laboratory tests.
Test | Result | Normal Range |
|---|---|---|
Hemoglobin | 8.0 g/dL | 13–17 g/dL |
Hematocrit | 24% | 40–50% |
Lactate | 4.5 mmol/L | <2 mmol/L |
Base deficit | –7 | 0 ± 2 |
pH | 7.30 | 7.35–7.45 |
Urine output | 10 mL/hr | >30 mL/hr |
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Multiple Choice
Question 5
Which laboratory result indicates tissue hypoperfusion?
Low hemoglobin
Low hematocrit
Elevated lactate level
Low pH
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Multiple Choice
Question 6
The patient’s urine output is low (10 mL/hr). What does this suggest?
Normal renal function
Decreased renal perfusion
Excessive hydration
Obstructed urinary tract
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You estimate that the patient has lost around
1.5–2 liters of blood.
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Multiple Choice
Question 7
Based on the estimated blood loss and clinical signs, what class of hypovolemic shock is most consistent with this presentation?
Class I (≤15% volume loss)
Class II (15–30% volume loss)
Class III (30–40% volume loss)
Class IV (>40% volume loss)
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Multiple Choice
Question 8
Which of the following mechanisms primarily causes hypovolemic shock in this patient?
Decreased myocardial contractility
Peripheral vasodilation
Loss of intravascular volume due to hemorrhage
Spinal cord injury causing loss of tone
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Compensatory Mechanism
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Multiple Choice
Question 9
Which physiological mechanism helps maintain perfusion during early hypovolemia?
Decreased heart rate and vasodilation
Sympathetic activation causing tachycardia and vasoconstriction
Parasympathetic stimulation and bradycardia
Decreased systemic vascular resistance
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Multiple Choice
Question 10
If the body’s compensatory mechanisms fail, what happens to cellular metabolism?
Oxygen delivery increases
Cells switch to anaerobic metabolism, producing lactic acid
ATP production rises
Cellular oxygen use remains constant
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