Chapter 7: Diagnosis and Management of Shock

Question 1

Primary endpoints of shock

Answer 1

correcting tissue oxygenation and correction of hypo-perfusion

Question 2

4 types of shock

Answer 2

Hypovolemic cariogenic distributive obstructive

Question 3

Hemodynamic profiles of shock

Answer 3

***

Question 4

3 types of distributive shock

Answer 4

septic neurogenic anaphylactic

Question 5

___ tonic fluids should be used for fluid resuscitation

Answer 5

iso

Question 6

Vasoactive agents alpha and beta receptor profiles Dopamine phenylephrine norepinephrine dobutamine milrinone

Question 7

What is first line med for septic shock

Answer 7

norepinephrine

Question 8

starting norepinephrine rate

Answer 8

0.05 ug/kg/min

Question 9

why might CO decrease with norepinephrine

Answer 9

increase in after load as BP increases

Question 10

starting dose dopamine low rate septic shock

Answer 10

1-5 ug/kg/min

Question 11

does dopamine have inotropic, chronotropic effects or both?

Answer 11

both

Question 12

Potential adverse effects of dopamine

Answer 12

arrhythmia, and tachycardia

Question 13

Epi has inotropic and chronotropic effects. what is starting dose shock

Answer 13

0.05 ug/kg.min

Question 14

adverse effects if epi

Answer 14

increased myocardial oxygen consumption-bad for heart failure, aerobic lactate production increased.

Question 15

starting infusion rate phenylephrine

Answer 15

25 ug/kg/min

Question 16

what is phenylephrine used for

Answer 16

neurogenic shock, hypotension causes by epidural anesthetic (states with arterial dilation without cardiac depression)

Question 17

Dobutamine primary increases ___

Answer 17

stroke volume

Question 18

Milrinone class

Answer 18

phosphodiesterase inhibitor

Question 19

Milrinone draw back

Answer 19

can cause significant hypotension

Question 20

3 goals when treating hypovolemic shock

Answer 20

restore normal BP,HR, and organ perfusion

Question 21

for hypotension what is best 2 fluids

Answer 21

crystalloid (LR or NS)

Question 22

What patients have greater risk if dying in septic shock

Answer 22

hypotenuse and lactate >4

Question 23

when should corticosteroids be considered for septic shock

Answer 23

when adequate fluids and other vasoactive medications fail to restore hemodynamic stability

Question 24

classes of meds to avoid in obstructive shock

Answer 24

Diuretics and venodialtors

Question 25

Oliguria is defined as urine out put of

Answer 25

<0.5 ml/kg/hr

Question 26

Persitance of oliguria for ____ hours is one criteria for AKI

Answer 26

6