FP-C Shock Management and Resuscitation 2 — Questions and Answers
Question 1: Which finding on physical exam is MOST consistent with early (Class I) hemorrhagic shock?
- Anxiety, normal BP, pulse less than 100 bpm (Correct answer)
- Hypotension, tachycardia >120 bpm
- Marked tachycardia, altered mental status
- Undetectable BP and absent radial pulse
Correct answer: Anxiety, normal BP, pulse less than 100 bpm
Class I hemorrhagic shock (less than 15% blood loss) presents with minimal changes: slight anxiety, normal BP, and HR under 100 bpm.
Question 2: A post-cardiac arrest patient is being transported. Which target MAP should be maintained to optimize cerebral perfusion per post-ROSC care guidelines?
- ≥65 mmHg (Correct answer)
- ≥80 mmHg
- ≥55 mmHg
- ≥90 mmHg
Correct answer: ≥65 mmHg
Post-ROSC guidelines recommend maintaining MAP ≥65 mmHg to optimize systemic and cerebral perfusion pressure during transport.
Question 3: A patient in cardiogenic shock has cool extremities, pulmonary edema, and a BP of 78/50 mmHg. Which combination of interventions is most appropriate?
- Vasopressor support, judicious fluid bolus if hypovolemic component, and consider inotrope (Correct answer)
- Aggressive fluid resuscitation with 2L NS
- High-dose beta-blocker to reduce myocardial work
- Nitrates to reduce preload
Correct answer: Vasopressor support, judicious fluid bolus if hypovolemic component, and consider inotrope
Cardiogenic shock management centers on vasopressors (norepinephrine or dopamine) to restore perfusion pressure, with inotropes (dobutamine) to improve cardiac output, while avoiding excessive fluid.
Question 4: Which lab value is the most sensitive indicator of inadequate tissue perfusion and guides resuscitation efficacy in shock?
- Serum lactate (Correct answer)
- Base excess
- Serum pH
- Central venous oxygen saturation
Correct answer: Serum lactate
Serum lactate is the most sensitive and widely used marker of tissue hypoperfusion; elevated levels indicate anaerobic metabolism from inadequate oxygen delivery.
Question 5: An anaphylactic patient remains hypotensive after 2 doses of IM epinephrine and 2L IV fluid. What is the next pharmacological intervention?
- Epinephrine IV infusion at 0.1-0.5 mcg/kg/min (Correct answer)
- Diphenhydramine 50 mg IV
- Methylprednisolone 125 mg IV
- Glucagon 1 mg IV if on beta-blockers
Correct answer: Epinephrine IV infusion at 0.1-0.5 mcg/kg/min
Refractory anaphylactic shock unresponsive to IM epinephrine requires IV epinephrine infusion for continuous vasopressor and bronchodilatory support.
Question 6: When performing resuscitative thoracotomy in the field for traumatic arrest, which patient has the best chance of neurologically intact survival?
- Penetrating thoracic trauma with witnessed loss of vital signs within 15 minutes (Correct answer)
- Blunt trauma with asystole on scene arrival
- Penetrating abdominal trauma with no vital signs for 30 minutes
- Blunt trauma with 10-minute downtime and PEA
Correct answer: Penetrating thoracic trauma with witnessed loss of vital signs within 15 minutes
EDT has the highest survival for penetrating thoracic wounds with witnessed cardiac arrest or vital signs lost within 15 minutes of arrival.
FP-C Shock Management and Resuscitation 2
Which finding on physical exam is MOST consistent with early (Class I) hemorrhagic shock?