Shock Diagnosis

​Shock Diagnosis

Clinical Case

You are in 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 on 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.

Multiple Choice

Question 1
Based on these findings, what is the most likely type of shock this patient is developing?

• Cardiogenic shock

• Distributive (septic) shock

• Hypovolemic shock

• Neurogenic shock

Multiple Choice

Question 2
Which vital sign change best indicates that the patient’s body is compensating for hypovolemia?

• Decreased heart rate

• Increased heart rate (tachycardia)

• Decreased respiratory rate

• Decreased Blood Pressure

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%

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

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

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

Multiple Choice

Question 5

Which laboratory result indicates tissue hypoperfusion?

• Low hemoglobin

• Low hematocrit

• Elevated lactate level

• Low pH

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

You estimate that the patient has lost around
1.5–2 liters of blood.

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)

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

Compensatory Mechanism

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

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