A patient presents to the emergency with a history of multiple bee stings and a blood pressure of 80/50 mm Hg. He is having:

Appeared in: GMCH - 2016

Explanation

Anaphylactic shock is a type of distributive shock caused by a severe allergic reaction.
The patient's history of multiple bee stings (exposure to an allergen) directly correlates with the cause of anaphylaxis.
The release of histamine and other mediators causes widespread vasodilation, leading to the profound hypotension (80/50 mm Hg) seen in the patient.
This combination of allergen exposure and rapid onset of severe hypotension is characteristic of anaphylactic shock.

Option A: Hypovolemic shock is caused by a loss of fluid volume (e.g., dehydration, burns). The patient's history does not indicate significant fluid loss.
Option B: Spinal shock results from a spinal cord injury, which disrupts the sympathetic nervous system. There is no indication of trauma or spinal injury in this scenario.
Option C: Hemorrhagic shock is a form of hypovolemic shock caused by major blood loss. The patient's condition is due to an allergic reaction, not bleeding.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Identification of shock types based on clinical presentation in acute care settings.
A nurse's primary role in this situation is rapid recognition and immediate intervention. Anaphylactic shock is a medical emergency where minutes count.
Priority nursing actions include administering epinephrine intramuscularly, securing the airway, providing high-flow oxygen, and establishing IV access for fluid resuscitation.
Patient safety involves monitoring vital signs continuously and preparing for potential complications like biphasic reactions (a second wave of symptoms).

How to Approach the Question

First, identify the key information in the clinical scenario: the trigger (multiple bee stings) and the primary sign (severe hypotension, BP 80/50 mm Hg).
Connect the trigger to its most likely physiological consequence. Bee stings are a well-known cause of allergic reactions.
Evaluate the options based on this connection. An allergic reaction causing shock is, by definition, anaphylactic shock.
Rule out other shock types by considering their primary causes. Hypovolemic/hemorrhagic shock requires fluid/blood loss, and spinal shock requires a spinal injury. Neither is present in the scenario.
Therefore, the clinical picture of an allergen trigger leading to cardiovascular collapse strongly indicates anaphylactic shock.

Concept Tested & Keywords

Concept Tested: Identification of shock types based on clinical presentation
Stem keywords: multiple bee stings, blood pressure of 80/50 mm Hg, shock
Lead-in keywords: He is having
Clinical cues: History of multiple bee stings is a classic trigger for a severe allergic reaction.
Clinical cues: Blood pressure of 80/50 mm Hg indicates severe hypotension, a hallmark of distributive shock.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 646-648

E6 Physiology Guyton 4SAE Part 2A pp. 30-32, 33-34

Practise the full GMCH - 2016

Attempt every question from this paper in a timed mock, then review the full solution for each one.