NREMT Paramedic Level Flashcards: Shock States And Hemodynamic Management

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This deck focuses on Shock States And Hemodynamic Management, giving you a quick way to review the definitions, rules, and examples that matter most for NREMT Paramedic Level.

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Work through these flashcards in short sessions. Try to answer each prompt before flipping the card, then revisit any cards you miss until the explanation feels automatic.

Flashcard 1: Calculate MAP for $SBP=90$ and $DBP=50$ using $MAP \approx \frac{SBP+2(DBP)}{3}$.

Answer: $63\ \text{mmHg}$. Formula weights diastolic phase to approximate cycle-averaged pressure for perfusion assessment.

Flashcard 2: What is the preferred initial crystalloid strategy for septic shock after IV access is obtained?

Answer: Rapid isotonic crystalloid bolus; reassess frequently for fluid responsiveness. Fluid resuscitation aims to restore intravascular volume in sepsis-induced capillary leak and vasodilation.

Flashcard 3: What bedside finding most strongly suggests obstructive shock from tension pneumothorax?

Answer: Severe respiratory distress with unilateral absent breath sounds and hypotension. Mediastinal shift from pressure buildup compresses structures, impairing venous return and ventilation.

Flashcard 4: Identify the classic hemodynamic profile of hypovolemic shock (preload, SVR, CO).

Answer: Preload low, SVR high, CO low. Hypovolemia reduces venous return, triggering compensatory vasoconstriction and decreased output.

Flashcard 5: Calculate shock index for $HR=120$ and $SBP=100$; what value do you obtain?

Answer: $1.2$. Elevated index above 0.9 suggests occult shock by reflecting compensatory tachycardia relative to pressure.

Flashcard 6: What is the formula for shock index used to screen for occult shock?

Answer: $Shock\ Index = \frac{HR}{SBP}$. Shock index helps detect early hypoperfusion by quantifying the ratio of heart rate to systolic pressure.

Flashcard 7: What is the primary immediate goal of hemodynamic management in any shock state?

Answer: Restore adequate perfusion and oxygen delivery to vital organs. Management targets reversal of hypoperfusion to prevent irreversible cellular damage and organ failure.

Flashcard 8: What is the key prehospital management priority for massive pulmonary embolism shock?

Answer: Support oxygenation/ventilation and perfusion; rapid transport for definitive therapy. Prehospital care stabilizes hemodynamics while expediting access to anticoagulation or thrombolysis.

Flashcard 9: Identify the classic hemodynamic profile of obstructive shock (preload, SVR, CO).

Answer: Preload variable, SVR high, CO low due to impaired filling/outflow. Obstruction impedes cardiac filling or ejection, prompting compensatory responses with reduced output.

Flashcard 10: What is the formula for mean arterial pressure (MAP) used in shock assessment?

Answer: $MAP \approx \frac{SBP + 2(DBP)}{3}$. MAP estimates average arterial pressure throughout the cardiac cycle, crucial for assessing perfusion in shock.

Flashcard 11: Identify the shock type: hypotension with JVD and muffled heart sounds after chest trauma.

Answer: Obstructive shock from cardiac tamponade. Trauma causes pericardial filling, impairing output with signs of low flow and venous backup.

Flashcard 12: What triad is classically associated with cardiac tamponade causing obstructive shock?

Answer: Beck triad: hypotension, JVD, muffled heart sounds. Pericardial effusion restricts diastolic filling, reducing stroke volume and causing venous congestion.

Flashcard 13: Identify the shock type: hypotension with bradycardia and warm dry skin after spinal injury.

Answer: Neurogenic shock. Spinal injury disrupts sympathetic outflow, causing vasodilation without compensatory tachycardia.

Flashcard 14: Which vasopressor is first-line for septic shock with persistent hypotension after fluids?

Answer: Norepinephrine. Norepinephrine provides alpha-adrenergic support to counteract vasodilation in refractory septic hypotension.

Flashcard 15: Which inotrope is commonly used for cardiogenic shock with low cardiac output and congestion?

Answer: Dobutamine. Dobutamine enhances myocardial contractility to improve output in pump failure with fluid overload.

Flashcard 16: Which vasopressor is preferred for anaphylactic shock with airway or hypotension involvement?

Answer: Epinephrine. Epinephrine counters histamine-mediated vasodilation and bronchospasm in anaphylaxis.

Flashcard 17: What is the most reliable early sign of shock in many adult patients before hypotension occurs?

Answer: Tachycardia with cool, clammy skin and delayed capillary refill. Compensatory sympathetic activation causes these signs as early indicators of hypoperfusion.

Flashcard 18: Identify the classic hemodynamic profile of cardiogenic shock (preload, SVR, CO).

Answer: Preload high, SVR high, CO low. Cardiac pump failure increases filling pressures with compensatory resistance but inadequate output.

Flashcard 19: What is the immediate definitive prehospital intervention for tension pneumothorax shock?

Answer: Needle decompression (followed by chest tube in-hospital). Decompression relieves intrathoracic pressure, restoring venous return and cardiac output.

Flashcard 20: Identify the shock type: warm flushed skin, hypotension, bounding pulses early, fever suspected.

Answer: Septic (distributive) shock. Sepsis induces systemic vasodilation and hyperdynamic state with inflammatory signs like fever.