Shock states/Hemodynamics

Question 1

CVP

Answer 1

Pressure in the RA: Indicates right heart function

0-6

Question 2

MAP

Answer 2

SBP+2(DBP)/3

Avg force in the arterial system

Question 3

PAP Pulmonary Artery Pressure

Answer 3

Measure of the systolic and diastolic pressures in the pulmonary artery

15-25 / 5-15

Question 4

In what conditions is the PAP elevated?

Answer 4

Increased fluid such as hypervolemia and pulmonary HTN

Question 5

In what conditions is the PAP decreased?

Answer 5

Decreased fluid such as hypovolemia

Question 6

PCWP Pulmonary capillary wedge pressure

Answer 6

Measure of the pressure in the LV at end-diastole

Measures maximal stretch

6-12

Question 7

PWCP is increased in what conditions?

Answer 7

Hypervolemia, stiff ventricle

Question 8

PWCP is decreased in what conditions?

Answer 8

Hypovolemia

Question 9

High PCWP is a reflection of the tendency to develop what condition?

Answer 9

Pulmonary edema

Keep # at lowest end possible that keeps adequate cardiac performance

Question 10

CO Cardiac Output

Answer 10

HR x SV

4-8 LPM

Question 11

What conditions increase CO?

Answer 11

Inotropic agents, hypervolemia

Question 12

What conditions decrease CO?

Answer 12

Drugs that decrease contractility, hypovolemia, BB

Question 13

CI Cardiac Index

Answer 13

CO / BSA

2.5 - 4 LPM

Measurement of contractility

Question 14

SVR Systemic Vascular Resistance

Answer 14

(MAP - mean CVP x 80)/ CO

800-1200

Question 15

SVO2 Mixed venous O2 Saturation

Answer 15

continuous measure of mixed venous O2 by the pulmonary artery catheter

60-80%

Continuously measures the effectiveness of peripheral O2 delivery

Question 16

Wht does SVO2 > 80% imply?

Answer 16

Decreased tissue extraction of O2

FiO2 > need,

Hypothermia

sepsis

Shift to left of oxyHg curve

Question 17

What does SVO2 < 60% imply?

Answer 17

Increased tissue extraction of O2

decreased FiO2

Anemia

increased O2 demand such as fever, increased work of breathing, shivering

Question 18

All numbers are low except SVR

Answer 18

Hypovolemic shock

loss of volume, SVR is high to compensate

Question 19

List four shock states

Answer 19

Hypovolemic

Cardiogenic

Distributive

Obstructive

Question 20

List 3 types of distributive shock

Answer 20

Septic

Anaphylactic

Neurogenic

Question 21

List two shock states with a high CVP

Answer 21

Obstructive

Cardiogenic

Question 22

Decreased CO/CI and SVO2, Increased CVP, PCWP, SVR

Answer 22

Cardiogenic shock

Question 23

Wht is the only shock state with an initially high PWCP?

Answer 23

Cardiogenic

Question 24

Shock state where all numbers are low?

Answer 24

Distributive

Question 25

Definition of distributive shock

Answer 25

Characterized by vasodilation, decreased intravascular volume, reduced PVR, loss of capillary integrity

Question 26

What type of distributive shock has initially high CI with everything else low?

Answer 26

Septic shock

Question 27

Decreased CO/CI and PCWP, increased CVP, PVR, SVR, SVO2

Answer 27

Obstructive Shock

Question 28

Most common cause of obstructive shock?

Answer 28

PE

Question 29

Why is the CVP elevated in obstructive shock?

Answer 29

Blood backs up creating higher pressure

Question 30

Why is the PCWP decreased in obstructive shock?

Answer 30

Blood can't get there due to obstruction so the # is low

Question 31

CVP PAP PCWP CO CI SVR SVO2

Answer 31

0-6 15-25 / 5-15 6-12 4-8 2.5-4 800-1200 60-80%

Question 32

List 4 common causes for hypovolemic shock

Answer 32

Bleeding/trauma Burns DKA/HHNK Dehydration

Question 33

List 5 causes for cardiogenic shock

Answer 33

MI Dysrhythmia Pericardial tamponade Pulmonary edema Acute valvular regurg Acute VSD or aneurysm

Question 34

Underlying cause of anaphylactic shock

Answer 34

IgE mediated reaction that occurs shortly after exposure to allergen

Question 35

1st line tx for anaphylactic shock?

Answer 35

Diphenhydramine Then Epi

Question 36

Underlying cause of neurogenic shock?

Answer 36

Loss of peripheral vascular tone due to spinal cord injury or regional anesthesia

Question 37

Underlying cause of Obstructive shock?

Answer 37

Inadequate cardiac output due to impaired ventricular filling

Question 38

What is the indiction for SQ epi in anaphylactic shock?

Answer 38

Respiratory distress / stridor

Question 39

Which hemodynamic measurement indicates right heart function?

Answer 39

CVP 0-6

Question 40

Which hemodynamic measurement indicates pressure in the LV at end diastole?

Answer 40

PCWP 6-12

Question 41

Which hemodynamic measurement indicates pressures in the pulmonary artery?

Answer 41

PAP 15-25 / 5-15

Question 42

Which type of shock includes bradycardia?

Answer 42

Neurogenic Any question with bradycardia=neurogenic (lack of feedback, body doesn't get the signal that they are vasodilated)

Question 43

Acute cardiac tamponade is what kind of shock?

Answer 43

Obstructive shock

Question 44

List samples of obstructive shock

Answer 44

PE Cardiac Tamponade Tension pneumo Valvular obstruction

Question 45

Tx for obstructive shock

Answer 45

Fluid Remove obstruction (needle thoracostomy, pericardial tap)

Question 46

Low Contractility is what type of shock?

Answer 46

Cardiogenic

Question 47

Dilated=

Answer 47

Distributive

Question 48

Low CO/CI=

Answer 48

Cardiogenic

Question 49

Low CVP and PCWP indicate what?

Answer 49

Hypovolemia

Question 50

Everything is low except SVR?

Answer 50

Hypovolemic

Question 51

Low SVO2 occurs in what conditions?

Answer 51

Low contractility/decreased CO, anemia, increased o2 demand (shivering fever, increased work of breathing)

Question 52

High SVO2 occurs in what conditions?

Answer 52

dead bowel, crush injuries, sepsis indicates decreased tissue extraction of O2

Question 53

Negative inotropes

Answer 53

beta-blockers, calcium channel blockers, and antiarrhythmic medicines

Question 54

Positive inotropes

Answer 54

Digoxin

Question 55

What is the preferred vasoactive agent to treat cardiogenic shock with low output and increased afterload?

Answer 55

Dobutamine

Question 56

first-choice vasopressors to correct hypotension in septic shock?

Answer 56

norepinephrine (levophed) and dopamine

Question 57

2 step tx for neurogenic shock?

Answer 57

IVF Vasopressors

Question 58

Tx for anaphylactic shock?

Answer 58

IVF Hives= benadryl Respiratory distress/stridor=epi Intubate first, then epi!!!!!

Question 59

What happens to the CVP, PCWP, and SVO2 in the end stages of septic shock

Answer 59

The numbers get high after initially being low due to pump failure