CFRN Shock and Hemodynamic Monitoring 2 — Questions and Answers
Question 1: A patient involved in a high-speed MVC presents with hypotension, bradycardia, and warm flushed skin below the level of injury. Which type of shock should the flight nurse suspect?
- Hypovolemic shock
- Septic shock
- Neurogenic shock (Correct answer)
- Anaphylactic shock
Correct answer: Neurogenic shock
Neurogenic shock from spinal cord injury causes loss of sympathetic tone, resulting in vasodilation (warm skin), hypotension, and paradoxical bradycardia.
Question 2: A patient receiving a blood transfusion develops sudden hypotension, urticaria, bronchospasm, and angioedema. The flight nurse's priority intervention is:
- Administer diphenhydramine 50 mg IV
- Administer epinephrine 0.3 mg IM to the lateral thigh (Correct answer)
- Increase the IV fluid rate and notify the receiving facility
- Stop the transfusion and administer methylprednisolone
Correct answer: Administer epinephrine 0.3 mg IM to the lateral thigh
Epinephrine IM is the first-line treatment for anaphylactic shock, reversing bronchospasm, vasodilation, and angioedema rapidly.
Question 3: Mixed venous oxygen saturation (SvO2) of 55% in a critically ill patient most likely indicates:
- Adequate oxygen delivery with normal tissue extraction
- Increased oxygen delivery exceeding tissue demand
- Inadequate oxygen delivery with increased tissue extraction (Correct answer)
- Left-to-right shunting increasing venous oxygenation
Correct answer: Inadequate oxygen delivery with increased tissue extraction
Normal SvO2 is 65–75%; a value of 55% reflects tissues extracting more oxygen due to inadequate delivery, signaling low cardiac output or severe hypoxia.
Question 4: A patient with tension pneumothorax is in obstructive shock. Which hemodynamic finding distinguishes obstructive from hypovolemic shock?
- Tachycardia and hypotension
- Elevated jugular venous distension (JVD) and tracheal deviation (Correct answer)
- Cool clammy extremities
- Decreased urine output
Correct answer: Elevated jugular venous distension (JVD) and tracheal deviation
Obstructive shock from tension pneumothorax causes elevated venous backpressure leading to JVD and tracheal deviation, absent in pure hypovolemia.
Question 5: Serum lactate levels are used in shock assessment primarily because elevated lactate indicates:
- Hyperglycemia from stress response
- Anaerobic metabolism from inadequate tissue perfusion (Correct answer)
- Renal failure with decreased excretion
- Hepatic overproduction during inflammation
Correct answer: Anaerobic metabolism from inadequate tissue perfusion
Elevated lactate reflects anaerobic metabolism occurring when tissues are underperfused, making it a key marker of shock severity and resuscitation adequacy.
Question 6: During flight transport of a hemorrhagic shock patient, which resuscitation strategy is recommended over large-volume crystalloid administration?
- Hypertonic saline 3% at 250 mL boluses
- Permissive hypotension with balanced blood product resuscitation (1:1:1 ratio) (Correct answer)
- Normal saline at 30 mL/kg over 30 minutes
- Colloid-only resuscitation with 5% albumin
Correct answer: Permissive hypotension with balanced blood product resuscitation (1:1:1 ratio)
Damage control resuscitation using balanced blood products (RBC:FFP:platelets 1:1:1) with permissive hypotension reduces coagulopathy and improves survival in hemorrhagic shock.
Question 7: The base deficit on an arterial blood gas in a trauma patient is -10 mEq/L. This finding correlates with:
- Mild metabolic alkalosis from hyperventilation
- Severe metabolic acidosis indicating significant tissue hypoperfusion (Correct answer)
- Respiratory acidosis from hypoventilation
- Compensated respiratory alkalosis
Correct answer: Severe metabolic acidosis indicating significant tissue hypoperfusion
A base deficit more negative than -6 mEq/L indicates severe metabolic acidosis from lactate accumulation due to profound tissue hypoperfusion in shock.
CFRN Shock and Hemodynamic Monitoring 2
A patient involved in a high-speed MVC presents with hypotension, bradycardia, and warm flushed skin below the level of injury.
Which type of shock should the flight nurse suspect?