GMCH Chandigarh - 2019
Medical & Surgical Nursing
Medium
Ms. Babita is in the emergency room after being involved in a traffic accident. What would be an early sign of hemorrhagic shock?
Appeared in: GMCH Chandigarh - 2019
Explanation
- In early hemorrhagic shock, the body activates the sympathetic nervous system to compensate for the loss of blood volume.
- This response causes the release of catecholamines, which directly increase the heart rate (tachycardia) to maintain cardiac output (Cardiac Output = Heart Rate × Stroke Volume).
- Tachycardia is one of the earliest and most reliable clinical signs of shock, often appearing before a significant drop in blood pressure occurs.
- The body attempts to maintain perfusion to vital organs by increasing the speed of circulation.
Why Other Options Were Wrong
- Option A: Blood pressure is typically maintained within the normal range during the early (compensated) stage of shock. A drop in blood pressure (hypotension) is a sign of later, decompensated shock when compensatory mechanisms fail.
- Option B: While pallor (pale skin) due to peripheral vasoconstriction is also an early sign of shock, tachycardia is a more immediate and sensitive indicator of the body's primary compensatory response to volume loss.
- Option D: The initial respiratory response to shock is an increased rate (tachypnea), which is often shallow. This is the body's attempt to compensate for developing metabolic acidosis by blowing off carbon dioxide.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Early signs of hemorrhagic shock as background academic context rather than a clinical decision trigger.
- A nurse must recognize tachycardia as a critical early warning sign for hemorrhage, even if the patient's blood pressure is still within the normal range. This is a key assessment finding in any trauma patient.
- Promptly reporting an increasing pulse rate can trigger earlier interventions, such as initiating fluid resuscitation with large-bore IVs and controlling the source of bleeding, which can prevent the patient from progressing to irreversible shock.
- What if? If the patient was taking a beta-blocker medication (e.g., metoprolol), their heart rate might not increase significantly in response to blood loss. In this scenario, the nurse must be vigilant for other subtle signs of shock, such as cool skin, anxiety, a narrowing pulse pressure, or decreased urine output.
How to Approach the Question
- Identify the core of the question: It asks for an early sign of hemorrhagic shock following trauma.
- Recall the pathophysiology of shock. The body's initial response to volume loss is to compensate.
- Analyze the primary compensatory mechanism: The sympathetic nervous system is activated, causing the heart to beat faster to maintain blood circulation and pressure.
- Evaluate the options based on this mechanism:
- Increased pulse (tachycardia) is a direct result of this compensation.
- Increased blood pressure is incorrect because BP is maintained initially and falls later.
Concept Tested & Keywords
- Concept Tested: Early signs of hemorrhagic shock
- Stem keywords: emergency room, traffic accident, hemorrhagic shock, early sign
- Lead-in keywords: What would be
- Clinical cues: The keyword 'early' is critical, as it directs you to identify compensatory signs rather than signs of decompensation.
- Negative lead-in flag: false
Question ID
Q6wuCJloxToxWx_JOJGOQn
Reference Book
E6 Physiology Ganong 27e Vol 2 Part 1 p. 95-97
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 652-654
Practise the full GMCH Chandigarh - 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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