TNCC Shock Recognition 2 — Questions and Answers
Question 1: A trauma patient has a BP of 88/60 mmHg, HR 128 bpm, and cool, mottled skin after a stab wound to the abdomen. Which shock classification best fits this presentation?
- Class I hemorrhagic shock
- Class II hemorrhagic shock
- Class III hemorrhagic shock (Correct answer)
- Class IV hemorrhagic shock
Correct answer: Class III hemorrhagic shock
Class III hemorrhagic shock involves 30–40% blood volume loss and presents with marked tachycardia, hypotension, and altered perfusion signs.
Question 2: Which parameter is the MOST sensitive early indicator of hemorrhagic shock in a healthy adult?
- Systolic blood pressure
- Heart rate (Correct answer)
- Respiratory rate
- Urine output
Correct answer: Heart rate
Heart rate rises early as a compensatory mechanism before blood pressure drops, making it the most sensitive early indicator.
Question 3: A patient in neurogenic shock following spinal cord injury would MOST likely present with:
- Tachycardia and hypertension
- Bradycardia and hypotension with warm skin (Correct answer)
- Tachycardia and hypotension with cool skin
- Bradycardia and hypertension with flushed skin
Correct answer: Bradycardia and hypotension with warm skin
Loss of sympathetic tone in neurogenic shock causes bradycardia, hypotension, and vasodilation resulting in warm, dry skin.
Question 4: Obstructive shock from tension pneumothorax is BEST distinguished from other shock types by the presence of:
- Tachycardia and hypotension
- Absent breath sounds and tracheal deviation (Correct answer)
- Distended neck veins and muffled heart sounds
- Diaphoresis and altered mental status
Correct answer: Absent breath sounds and tracheal deviation
Absent or diminished breath sounds with tracheal deviation away from the affected side are hallmark signs of tension pneumothorax causing obstructive shock.
Question 5: The MOST immediate intervention for a trauma patient in decompensated hemorrhagic shock is:
- Obtaining a 12-lead ECG
- Controlling the source of hemorrhage (Correct answer)
- Administering IV corticosteroids
- Placing a Foley catheter to monitor UO
Correct answer: Controlling the source of hemorrhage
Hemorrhage control is the definitive intervention in hemorrhagic shock because ongoing blood loss cannot be corrected with fluids alone.
Question 6: Which finding would help differentiate cardiogenic shock from hemorrhagic shock in a trauma patient?
- Hypotension and tachycardia
- Elevated jugular venous distension (JVD) (Correct answer)
- Pale, cool, diaphoretic skin
- Decreased level of consciousness
Correct answer: Elevated jugular venous distension (JVD)
Elevated JVD indicates elevated central venous pressure consistent with cardiogenic or obstructive shock, not volume-depleted hemorrhagic shock.
Question 7: In the TNCC shock index, which value indicates significant hemodynamic instability?
- Shock index > 0.5
- Shock index > 1.0 (Correct answer)
- Shock index > 1.5
- Shock index > 2.0
Correct answer: Shock index > 1.0
A shock index (HR ÷ systolic BP) greater than 1.0 indicates significant hemodynamic compromise and predicts the need for massive transfusion.
TNCC Shock Recognition 2
A trauma patient has a BP of 88/60 mmHg, HR 128 bpm, and cool, mottled skin after a stab wound to the abdomen.
Which shock classification best fits this presentation?