Clinical Perspective - Shock Flashcards
What are the diagnosis criteria for sepsis?
Any two of the listed symtoms.
What is a Swan catheter?
Catheter inserted into the R heart that can be used to measure venous oxygen saturation and calculate cardiac output
What is the neurologic status of a patient in Class II shock?
Anxious appearing, but not yet confused
What are the various types of distributive shock?
Sepsis, neurogenic, anaphylactic
What is the equation for shock index?
SI = HR/SBP
What is the equation to calculate mean arterial pressure?
MAP = (2*diastolic pressure + systolic pressure)/3
What blood test can be used to assess cellular hypoxia and shock severity?
Lactate levels - higher levels indicate more severe shock
What is the pathophysiologic cause of distributive shock?
Severe peripheral dilation
In hypovolemic shock, CO and central venous pressure decrease. What is the effect on systemic peripheral resistance?
Increases to ensure perfusion of vital organs
A person with this type of shock will appear warm and dry as opposed to cold and clammy.
Distributive shock
Distributive shock causes a significant decrease in peripheral resistance and venous pressure. Why is this?
Systemic vasodilation
What findings are associated with cardiogenic shock.
Narrow pulse pressure, pulmonary edema, cold extremities, decreased CO
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?
Class III
How is venous pressure, peripheral resistance, and cardiac output affected by cardiogenic shock?
Venous pressure and resistance increase due to a significant drop in cardiac output
A higher shock index is associated with worse outcomes. What score is considered normal?
Normal SI < 0.7
Neurogenic shock is caused by injury to the spinal cord. What is the pathophysiology?
Injury above T6 causes loss of sympathetic tone controlled by the ANS leading to hypotension, bradycardia, and hypovolemia
What is the pathophysiology of septic shock?
Unregulated, widespread release of inflammatory mediators and cytokines leading to significant vasodilation and shock
A patient presents with septic shock. What is one of the most important first steps in clinical management.
Diagnosis and treatment of the causative agent (antibiotics, removal of mechanical device, debridement of wound, etc.)
What are the three categories of shock?
Distributive, cardiogenic, hypoveolemic
What is the most common type of shock?
Septic shock - most common in elderly patients
Hemorrhagic shock is divided into four classes. How can classes 2 and 3 be differentiated?
Reduced systolic blood pressure with absent radial pulse
