NREMT Paramedic Practice

What physiological change occurs during the refractory stage of shock?

1. Vasodilation

2. Intravascular clotting

3. Increased perfusion to organs

4. Enhanced diastolic return

The correct answer is: Intravascular clotting

During the refractory stage of shock, significant physiological changes occur as the body's compensatory mechanisms start to fail, leading to a condition called multiple organ dysfunction syndrome (MODS). In this critical phase, the blood flow may become impaired primarily due to the systemic inflammatory response and associated mechanisms. Intravascular clotting is particularly notable during this stage because coagulation factors become activated in response to tissue hypoperfusion and injury. As the body attempts to combat the ischemic effects of shock, inappropriate activation of the coagulation cascade can occur. This can lead to disseminated intravascular coagulation (DIC), which results in both microclots forming throughout the vasculature and, paradoxically, increased bleeding tendencies, compounding the overall state of shock. Understanding this process is crucial as it highlights how shock progresses from a compensatory response—where vasodilation or increased blood pressure may be expected—to a state where the body's mechanisms start to fail, resulting in severe complications that compromise organ perfusion and function.