Shock Diagnosis

​Shock Diagnosis

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.

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

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

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

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