Circulatory Shock

Question 1

What are the components of Tissue Perfusion?

Answer 1

Cardiac Function: preload, afterload, contactility, HR, venous return
Arterial Pressure
Vascular Function: Dist of Cardiac Output
Cellular Function: O2 delivery

Question 2

What are the 3 types of Circulartory Shock?

Answer 2

Cardiogenic: AMI
Hypovolemic: Loss of Circulating BV, Hemmorhage, severe burns
Distributive: Abnormal Shunting of blood: SEPSIS, OD, Anaphylaxis, neurogenic

Question 3

What is the Presentation of Shock?

Answer 3

Low systolic BP
Tachycardia
Oliguria
Mental Obtunation
Cool, Mottled Extremities

Question 4

What tells you the prognosis of Cardiogenic Shock?

Etiologies?

Answer 4

LV FUNCTION

Acute MI
Dilated Cardiomyopathy
Valvular
Arrhythmia

Question 5

What is the most common cause of Distributive shock?

Answer 5

Sepsis

Question 6

What are the consequences of Shock?

Answer 6

Acidemia
Myocardial Dysfunction
Pulmonary
Renal
Gastrointestional
-Hepatic Injury(Shock Liver)
-Intestinal Ischemia
CNS (stupor to death spectrum)

Question 7

What is Therapy for Pts in Shock?

Answer 7

ICU:
Cardiac Rhythm Monitoring
IV meds/Fluids, volume Expansion
Vent support

O2 supplementation
Pulse Ox
ABGs 
Vasopressors 
Inotropics 
Abtx

Question 8

What are labs you would draw for Shock?

Answer 8

Arterial Blood Gas
Serum Electrolytes
Hgb/Hct
Monitor Rhythm
12 Lead ECG
ID Shock Syndrome
Bacterial Culture 
Serum markers of MI (troponin, CK-MB)

Question 9

What drug can be used to increase HR in acute Shock?

Answer 9

Atropine

Question 10

Other medical Tx of Acute Shock from AMI

Answer 10

IV Thrombolysis
Beta Blocker(metoprolol)(will deacrease oxygen demand; used after acute phase)
Pressor agent(doapamine) (increase Contractility, also O2 demand)

Question 11

What tells you that thrombolysis has been sucessful?

Answer 11

ST elevation goes away

Serum markers shoot up