Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Critical Care - Shock & Cardiac Arrest > 324 Approach to shock > Flashcards

324 Approach to shock Flashcards

1
Q

Shock defined as

A

clinical syndrome from inadequate tissue perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clinical shock is usually accompanied by hypotension with a value of

A

MAP < 60 mmHg in previously normotensive person

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

MAP value when autoregulation fails

A

MAP < 60 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Classification of Shock (7)

A 
Hypovolemic
Traumatic
Cardiogenic - Intrinsive or compressive
Septic - Hyperdynamic or Hypodynamic
Neurogenic
Hypoadrenal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Early septic shock is also called as

A

Hyperdynamic septic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Late septic shock is also called as

A

Hypodynamic septic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Represents a common end-stage pathophysiologic pathway in various forms of shock

A

Cell membrane dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Released in increased response to adrenergic discharge and reduced perfusion of juxtaglomerular apparatus in the kidney.

A

Renin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Induces the formation of Angiotensin I

A

Renin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

An extremely potent VASOCONSTRICTOR and stimulator of aldosterone and vasopressin

A

Angiotensin II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Contributes to the maintenance of intravascular volume by enhancing renal tubular reabsorption of Na

A

Aldosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Has a direct action on vascular smooth muscle leading to vasoconstriction; acts on renal tubules to enhance water reabsorption

A

Vasopressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Three variables that control stroke volume

A

pre-load (ventricular filling)
afterload (resistance to ventricular ejection)
Myocardial contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Major determinant of tissue perfusion

A

Cardiac output

CO = SV x HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Systemic vascular resistance is (increased ? decreased?) in hyperdynamic septic shock and neurogenic shock?

A

Decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Serves as dynamic reservoir for autoinfusion of blood

A

Venous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does septic shock cause heart failure?

A

Septic shock -> increase pulmonary vascular resistance -> RIGHT heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Renal responses to shock

A

Conserve salt and water
Decrease renal blood flow
Increase afferent arteriolar resistance
Reduced urine formation (low GFR, increased aldosterone and vasopressin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

This diagnostic test will represent an innefficient cycling of substrate with minimal net energy production / measure of anaerobic metabolism and reflects inadequate tissue perfusion

A

Plasma lactate/ pyruvate ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

TXA2 is a potent _

A

vasoconstrictors

Contributes to pulmonary hypertension and ATN of shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PGI2 PGE2 are potent _

A

vasodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

LTB4

A

A potent neutrophil chemoattractant and secretagogue that stimulates the formation of ROS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Produced by activated macrophages, promotes hypotension, lactic acidosis and respiratory failure

A

Tumor necrosis factor a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

PAC / Swan-Ganz catheter did not alter mortality, lenght of stay or cost for ICU. True or false.

A

True

25
Q

Serves as an approximation of Left atrial pressure

A

Pulmonary capillary wedge pressure (PCWP)

26
Q

Normal cardiac output per L/min

A

4-8 L/min

27
Q

Stroke volume per mL /beat

A

50-100 mL/beat

28
Q

O2 carrying capacity of hemoglobin

A

1.39 mL/g

29
Q

What type of shock?

CVP and PCWP ↓
CO ↓
SVR↑

A

Hypovolemic

Table 324-4 p. 1748

30
Q

What type of shock?

CVP and PCWP ↑
CO ↓
SVR↑

A

Cardiogenic

Table 324-4 p. 1748

31
Q

What type of shock?

CVP and PCWP ↑↓
CO ↓
SVR↑

A

Septic shock :Hypodynamic

Table 324-4 p. 1748

32
Q

What type of shock?

CVP and PCWP ↑↓
CO ↑
SVR (decreased)

A

Septic shock: Hyperdynamic

Table 324-4 p. 1748

33
Q

What type of shock?

CVP and PCWP ↓
CO ↓
SVR↓

A

Neurogenic or Hypoadrenal

(In hypoadrenal shock, SVR may be normal)

Table 324-4 p. 1748

34
Q

Most common form of shock

A

Hypovolemic shock

35
Q

Approximately how many blood loss does the patient have if he/she has mild tachycardia, relatively few external signs?

A

<20%

36
Q

Approximately how many bloodloss does the patient have if he/she has become increasingly anxious, tachycardic, with significant postural hypotension and tachycardia? (BP may be normal on supine position)

A

20-40%

37
Q

Approximate blood loss if there is hypotension, unstable in supine position, marked tachycardia, oliguria, agitation?

A

> 40%

38
Q

Ominous clinical sign in shock

A

Mental obtundation/ altered sensorium

39
Q

As the attending physician at the ER, you are considering hypovolemic shock in a patient; what monitoring should you do if patient is unstable, HR >120 and SBP <90?

A

Central monitoring, do CVP

40
Q

Upon monitoring of a shock patient, you noted that CVP is <15, what is your next step?

A

Administer colloid/ blood

HCT <30, CVP >15

41
Q

Upon monitoring of a shock patient, you noted that CVP is >15, what is your next step?

A

ECHO and treat appropriately

Differentials: cardiac dysfunction or tamponade

42
Q

Despite hydration in a Shocky patient, unstable VS and acidosis worsens; what is your next step?

A

Insert PAC

43
Q

In monitoring a shocky patient, PCWP is <15, what’s next?

A

Administer crystalloid, blood

44
Q

In monitoring a shocky patient, PCWP is 20, what’s next?

A

Administer 500mL boluses until preload and monitor

45
Q

In monitoring a shocky patient, PCWP is >20, what’s next?

A

Give inotropes, do ECHO

46
Q

Infusion of how many Liters salt solution will restore normal hemodynamic parameters?

A

2-3 L over 20 - 30 minutes.

47
Q

True or false. EARLY administration of component therapy during massive transfusion (FFP and platelets) approacing to a ratio of 1:1 of PRBC/ FFP appears to IMPROVE survival.

A

True.

48
Q

Pulsus paradoxus defined as

A

Inspiratory reduction in systolic pressure of >10mmHg

49
Q

Best inotropic agent for Neurogenic shock.

A

Norepinephrine or Phenylephrine

50
Q

Anesthetic agent which may cause hypoadrenal shock.

A

Etomidate.

51
Q

Hypoadrenal shock is characterized by (3)

A

decreased vascular resistance, hypovolemia and reduced cardiac output.

52
Q

Diagnosis of adrenal insufficiency is established by

A

ACTH stimulation test.

53
Q

Treatment for Hypoadrenal shock - empirically

A

Dexamethasone 4mg IV

Because unlike hydrocortisone - it does not alter your ACTH test

54
Q

Treatment for hypoadrenal shock - after establishing diagnosis

A

Hydrocortisone 100mg IV q6

55
Q

Inotropic with simultaneous afterload reduction - minimizing cardiac -o2 consumption increase as cardiac output increases.

A

Dobutamine

56
Q

Inotropic and chronotropic which supports vascular resistance in those whose blood pressure will not tolerate peripheral vascular dilation.

A

Dopamine

57
Q

Supports blood pressure through vasoconstriction and increases myocardial oxygen consumption; inotropic without chronotropy.

A

Norepinephrine.

58
Q

Being used to increase afterload and may better protect vital organ blood flow and prevent pathologic vasodilation.

A

Arginine-vasopressin.

Critical Care - Shock & Cardiac Arrest (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions