Cardiac Clinical Medicine Part 5: Shock

Question 1

What are the major physiologic determinants of tissue perfusion (BP)?

Answer 1

BP = CO X SVR

Question 2

What does CO equal?

Answer 2

CO = HR X SV

Question 3

Stroke volume is determined by?

Answer 3

1) Preload
2) Myocardial contractility
3) Afterload

Question 4

What is shock?

Answer 4

Inadequate tissue perfusion to meet metabolic demand and tissue oxygenation

Question 5

What stage of shock is characterized by reflex compensatory mechanisms are activated and perfusion (BP) to vital organs is maintained?

Answer 5

Compensated

Question 6

What occurs during compensated stage of shock?

Answer 6

1) Sympathetic vascular tone increased
2) Catecholamines are released
3) Renin-angiotensin system activated

Question 7

What stage of shock is characterized by tissue hypoperfusion and onset of worsening circulatory and metabolic derangement?

Answer 7

Decompensated

Question 8

What does decompensated stage of shock lead to?

Answer 8

Hypotension and metabolic lactic acidosis

Question 9

What stage of shock is characterized by organ and tissue injury is so severe that even if the hemodynamic defects are corrected, survival is not possible?

Answer 9

Irreversible

Question 10

What shock category according to physiological etiology is caused by poor pumps?

Answer 10

Cardiogenic

Question 11

What are examples of the cardiogenic category of shock?

Answer 11

1) Cardiomyopathy (AMI, Myocarditis, drugs/toxins)
2) Arrhythmias
3) Mechanical (VSD, valve stenosis)

Question 12

What shock category according to physiological etiology is caused by decreased intravascular volume?

Answer 12

Hypovolemic

Question 13

What are examples of the hypovolemic category of shock?

Answer 13

1) Hemorrhage

2) Dehydration

Question 14

What shock category according to physiological etiology is caused by dilated peripheral vasculature (decreased SVR)?

Answer 14

Distributive

Question 15

What are examples of the distributive category of shock?

Answer 15

1) Sepsis

2) Anaphylaxis

Question 16

What shock category according to physiological etiology is caused by mechanical blockage of circulatory system?

Answer 16

Obstructive

Question 17

What are examples of the obstructive category of shock?

Answer 17

1) PE

2) Tension pneumothorax

Question 18

Cardiogenic shock has what effect on cardiac output?

On systemic vascular resistance?

On pulmonary capillary wedge pressure or central venous pressure?

Answer 18

1) Decrease
2) Increase
3) Increase

Question 19

Hypovolemic shock has what effect on cardiac output?

On systemic vascular resistance?

On pulmonary capillary wedge pressure or central venous pressure?

Answer 19

1) Decrease
2) Increase
3) Decrease

Question 20

Distributive shock has what effect on cardiac output?

On systemic vascular resistance?

On pulmonary capillary wedge pressure or central venous pressure?

Answer 20

1) Increase
2) Decrease
3) Decrease

Question 21

Obstructive shock has what effect on cardiac output?

On systemic vascular resistance?

On pulmonary capillary wedge pressure or central venous pressure?

Answer 21

1) Decrease
2) Increase
3) Variable

Question 22

What are signs of shock?

Answer 22

1) Hypotension
2) Tachycardia
3) Tachypnea
4) Abnormal mental status
5) Cool clammy skin
6) Metabolic acidosis
7) Elevated serum lactate

Question 23

What part of the ABC mnemonic is vital when stabilizing a shock patient?

Answer 23

Circulation

Question 24

How is shock treated?

Answer 24

1) IV fluids
2) Vasopressors
3) US evaluation
4) Broad spectrum antibiotics if infection (sepsis) is cause