Clinical Perspective - Shock

Question 1

What are the diagnosis criteria for sepsis?

Answer 1

Any two of the listed symtoms.

Question 2

What is a Swan catheter?

Answer 2

Catheter inserted into the R heart that can be used to measure venous oxygen saturation and calculate cardiac output

Question 3

What is the neurologic status of a patient in Class II shock?

Answer 3

Anxious appearing, but not yet confused

Question 4

What are the various types of distributive shock?

Answer 4

Sepsis, neurogenic, anaphylactic

Question 5

What is the equation for shock index?

Answer 5

SI = HR/SBP

Question 6

What is the equation to calculate mean arterial pressure?

Answer 6

MAP = (2*diastolic pressure + systolic pressure)/3

Question 7

What blood test can be used to assess cellular hypoxia and shock severity?

Answer 7

Lactate levels - higher levels indicate more severe shock

Question 8

What is the pathophysiologic cause of distributive shock?

Answer 8

Severe peripheral dilation

Question 9

In hypovolemic shock, CO and central venous pressure decrease. What is the effect on systemic peripheral resistance?

Answer 9

Increases to ensure perfusion of vital organs

Question 10

A person with this type of shock will appear warm and dry as opposed to cold and clammy.

Answer 10

Distributive shock

Question 11

Distributive shock causes a significant decrease in peripheral resistance and venous pressure. Why is this?

Answer 11

Systemic vasodilation

Question 12

What findings are associated with cardiogenic shock.

Answer 12

Narrow pulse pressure, pulmonary edema, cold extremities, decreased CO

Question 13

A confused patient is brought to the ED. Their BP is reduced, HR is 130bpm, and you cannot feed a radial pulse. They are determined to be in shock. In what class of shock is the patient?

Answer 13

Class III

Question 14

How is venous pressure, peripheral resistance, and cardiac output affected by cardiogenic shock?

Answer 14

Venous pressure and resistance increase due to a significant drop in cardiac output

Question 15

A higher shock index is associated with worse outcomes. What score is considered normal?

Answer 15

Normal SI < 0.7

Question 16

Neurogenic shock is caused by injury to the spinal cord. What is the pathophysiology?

Answer 16

Injury above T6 causes loss of sympathetic tone controlled by the ANS leading to hypotension, bradycardia, and hypovolemia

Question 17

What is the pathophysiology of septic shock?

Answer 17

Unregulated, widespread release of inflammatory mediators and cytokines leading to significant vasodilation and shock

Question 18

A patient presents with septic shock. What is one of the most important first steps in clinical management.

Answer 18

Diagnosis and treatment of the causative agent (antibiotics, removal of mechanical device, debridement of wound, etc.)

Question 19

What are the three categories of shock?

Answer 19

Distributive, cardiogenic, hypoveolemic

Question 20

What is the most common type of shock?

Answer 20

Septic shock - most common in elderly patients

Question 21

Hemorrhagic shock is divided into four classes. How can classes 2 and 3 be differentiated?

Answer 21

Reduced systolic blood pressure with absent radial pulse