100714 shock

Question 1

shock definition

Answer 1

inadequate tissue perfusion marked by decreased delivery of required metabolic substrates and inadquate removal of cell waste

Question 2

classification of shock

Answer 2

hypovolemic
cardiogenic
septic
neurogenic
traumatic
obstructive

Question 3

ex of obstructive shock

Answer 3

cardiac tamponade, pulmonary embolus

MAP is reduced

Question 4

stages of shock

Answer 4

initial
compensatory
progressive
refractory

Question 5

what stage is hyperventilation?

Answer 5

compensatory stage of shock

Question 6

refractory stage of shock

Answer 6

irreversible organ damage, cell death, degradation of ATP to adenosine

Question 7

physiological response to shock

Answer 7

progressive vasoconstriction (NE, epinephrine)
increased blood flow to vital organs (shunting away from skin, acral regions, splanchnic system)

increase in respiratory rate and tidal volume
reduced urine production
reduced GI activity

Question 8

pathophysiology of cardiogenic shock

Answer 8

inadequate myocardial perfusion (decreased duration of diastole due to compensatory tachycardia)

excessive increase in myocardial oxygen consumption (tachycardia and increased myocardial wall tension)

metabolic derangement (lactic acidosis, leading to cardiac dysfxn)

Question 9

in cardiogenic shock, compensatory mechanisms result in

Answer 9

increased pre and afterload (lead to further increase in myocardial oxygen consumption and progression of shock). worsening of cardiac fxn

Question 10

management of cardiogenic shock

Answer 10

optimize ventricular filling

improve coronary perfusion pressure with vasopressors (ne, phenyepinephrine), inotropics (dobutamine, epinephrine, milrinone), IABP/mechanical circulatory support (LVAD, RVAD)

if acute MI-coronary agiography and immediate revascularization

Question 11

what adrenergic receptor causes vasoconstriction?

Answer 11

alpha 1

Question 12

SIRS

Answer 12

at least 2 of the following criteria:

tachypnea
WBC 12000 cells/mm3
HR>90
fever >38 (100.4 F) or hypothermia <36 (96.8 F)

Question 13

sepsis

Answer 13

SIRS with an infec

on top of SIRS, at least 1 of the following showing inadequate organ perfusion is included:

• altered mental state
• hypoxemia
• elevated plasma lactate
• oliguria

Question 14

severe sepsis

Answer 14

sepsis induced hypoperfusion or organ dysnfxn

Question 15

septic shock

Answer 15

has all of the findings of SIRS, sepsis, and severe sepsis BUT has also persistent arterial hypotension in severe sepsis DESPITE ADEQUATE FLUID RESUSCITATION or by tissue hypoperfusion not explained by other causes

culture positive bacteremia exists in only 30-50 % of cases

Question 16

multi organ dysfxn syndrome

Answer 16

beyond severe sepsis

there’s primary and secondary MODS

primary: direct result of insult
secondary: consequences of host response (ex is cytokine release). inflam response to toxins and other components of microorganisms, leading to clinical manifestations of sepsis

Question 17

causes of septic and vasodilatory shock

Answer 17

infec
noninfec systemic inflam
pancreatitis
burns
anaphylaxis
acute adrenal insuff
prolonged, severe hypoten
hemorrhagic shock
cardiogenic shock
cardiopulmonary bypass
metabolic-hypoxia, lactic acidosis
carbond monoxide posioning

Question 18

recommendations in sepsis

Answer 18

initial resuscitation
screening of at risk pts
diagnosis
antimicrobial therapy (empiric started within 1 hr)
source control-draining abscesses, etc
infec prevention

Question 19

initial fluid resuscitation

Answer 19

crystalloids or albumin (if require excessive amts)

Question 20

therapy for hemorrhagic shock

Answer 20

volume therapy

Question 21

neurogenic shock

Answer 21

profound vasodilation of arterial and venous blood vessels

causes are injury of brain stem, sp cord, or traumatic brain injury

Question 22

in higher doses, epinephrine is a

Answer 22

alpha mimetic, leading to vasoconstriction

Question 23

intraarterial balloon pump

Answer 23

inflates during diastole-use to increase diastolic perfusion pressure to coronary arteries

Question 24

what do you want to do for shock pts?

Answer 24

optimize milieu
control rate and rhythm
optimize preload
enhance contractility
decrease or increase SVR

Question 25

what to consider when giving beta adrenergic agents

Answer 25

heart rate

systemic vascular resistance

Question 26

for hypotension that does not respond to initial fluid resuscitation, what will you do?

Answer 26

vasopressors

measure CVP, central venous oxygen saturation

Question 27

diaphoresis can be seen in

Answer 27

shock

also MI

Question 28

loss of bladder control could indicate

Answer 28

anaphylactic shock