TNCC Shock Recognition 3 — Questions and Answers
Question 1: A cyclist is brought in after a high-speed crash with suspected pelvic fracture. He is diaphoretic, HR 136, BP 74/50. What type of shock is MOST likely?
- Distributive shock
- Obstructive shock
- Hemorrhagic shock (Correct answer)
- Neurogenic shock
Correct answer: Hemorrhagic shock
Pelvic fractures can cause massive retroperitoneal hemorrhage, making hemorrhagic shock the most likely etiology.
Question 2: Which laboratory value is the BEST early marker of tissue hypoperfusion in shock?
- Serum sodium
- Serum lactate (Correct answer)
- BUN/creatinine ratio
- White blood cell count
Correct answer: Serum lactate
Elevated serum lactate reflects anaerobic metabolism from tissue hypoperfusion and is an early, sensitive marker of shock severity.
Question 3: During the compensatory phase of shock, the body attempts to maintain perfusion by:
- Decreasing systemic vascular resistance
- Releasing vasodilatory mediators
- Activating the sympathetic nervous system (Correct answer)
- Increasing urine output
Correct answer: Activating the sympathetic nervous system
Sympathetic nervous system activation causes vasoconstriction, increased heart rate, and redistributed blood flow to maintain perfusion to vital organs.
Question 4: A patient presents with JVD, muffled heart sounds, and hypotension after a penetrating chest wound. This triad is known as:
- Virchow's triad
- Beck's triad (Correct answer)
- Cushing's triad
- Charcot's triad
Correct answer: Beck's triad
Beck's triad — JVD, muffled heart sounds, and hypotension — is the classic presentation of cardiac tamponade causing obstructive shock.
Question 5: In a pediatric trauma patient, which of the following is a LATE sign of hemorrhagic shock?
- Tachycardia
- Hypotension (Correct answer)
- Increased capillary refill time
- Irritability
Correct answer: Hypotension
Children have robust compensatory mechanisms and can maintain normal blood pressure until 25–30% of blood volume is lost, making hypotension a late and ominous sign.
Question 6: The primary goal of permissive hypotension in hemorrhagic shock management is to:
- Maximize urine output
- Prevent dilutional coagulopathy and avoid clot disruption (Correct answer)
- Reduce the risk of pulmonary edema
- Maintain cerebral perfusion pressure above 70 mmHg
Correct answer: Prevent dilutional coagulopathy and avoid clot disruption
Allowing a lower-than-normal BP prevents dislodging forming clots and diluting clotting factors, reducing ongoing hemorrhage.
Question 7: Which assessment finding BEST indicates that a trauma patient's shock is being adequately resuscitated?
- Systolic BP returns to 120 mmHg
- Urine output of 0.5–1 mL/kg/hr is established (Correct answer)
- Heart rate decreases to 100 bpm
- Skin color improves to pink
Correct answer: Urine output of 0.5–1 mL/kg/hr is established
Adequate urine output (0.5–1 mL/kg/hr) reflects restored renal perfusion and is a reliable endpoint for resuscitation.
TNCC Shock Recognition 3
A cyclist is brought in after a high-speed crash with suspected pelvic fracture.
He is diaphoretic, HR 136, BP 74/50.
What type of shock is MOST likely?