Crit Care 3: Pages 76- 82

Question 1

Common causes of distributive shock

Answer 1

Anaphylaxis
Drugs (peripheral vasodilators, nitrates)
Sepsis
Spinal injury (usually above T4 level)

Question 2

Common causes of hypovolemic shock

Answer 2

Acute blood loss
Crush injury, rhabdomyolysis
Cutaneous losses (burns, toxic epidermal necrolysis, erythroderma, excessive sweating)
Drugs (diuretics, laxatives)
GI losses (vomiting/diarrhea)
Kidney losses (diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome, adrenal insufficiency, post-ATN osmotic diuresis)

Question 3

Common causes of cariogenic shock

Answer 3

Arrhythmia (tachycardia, bradycardia)
Heart failure
Pulmonary hypertension
Myocardial infarction
Valvular heart disease (critical stenosis, severe insufficiency, valve perforation, papillary muscle or chordae rupture)
Ventricular septal rupture

Question 4

Common causes of obstructive shock

Answer 4

Abdominal compartment syndrome
Atrial myxoma
Constrictive pericarditis
Pericardial tamponade
Pulmonary embolism
Severe dynamic hyperinflation (e.g., excessive PEEP)
Tension pneumothorax

Question 5

The most common cause of cardiogenic shock is ______

Answer 5

myocardial infarction

Question 6

The Third International Definitions for Sepsis and Septic Shock (Sepsis-3) define sepsis as:

Answer 6

life-threatening organ dysfunction caused by a dysregulated host response to infection

Question 7

Organ systems in SOFA score

Answer 7

respiratory, coagulation, hepatic, cardiovascular, central nervous, and renal

Question 8

qsofa components

Answer 8

elevated respiration rate, altered mentation, and hypotension

Question 9

Predicted Mortality with qSOFA Score ≥2

Answer 9

≥10%

Question 10

criteria for diagnosing septic shock

Answer 10

hypotension requiring vasopressors to maintain a mean arterial pressure of greater than 65 mm Hg and serum lactate level of greater than 2 mEq/L (2 mmol/L) despite adequate fluid resuscitation. Patients who meet these criteria have a 40% or greater risk for in-hospital mortality.

Question 11

A patient who is septic has a mortality rate 1. ____ times greater than for the same underlying condition and comorbidities without sepsis. Mortality increases by roughly 2.___for each sepsis-related organ system failure.

Answer 11

1. 4

2. 15%

Question 12

How much for sepsis bolus

Answer 12

30 mL/kg of crystalloid fluid given within the first 3 hours of resuscitation.

Question 13

First line vasopressor sepsis

Answer 13

norepi

Question 14

Why do you need to exercise caution when using phenylephrine in sepsis

Answer 14

it can lead to decreased stroke volumes despite improvement in mean arterial pressure.

-The Surviving Sepsis Campaign guidelines recommend it be used only as a salvage therapy or in cases where tachyarrhythmia prevents use of alternative vasopressor agents

Question 15

abx recs from surviving sepsis

Answer 15

a carbapenem or extended-range penicillin or β-lactamase inhibitor may be a safe starting point in most septic patients.

Question 16

Antibiotic therapy should usually be continued for ___ to ___ days, depending on the clinical situation.

Answer 16

7-10

Question 17

In patients with neutropenia, guidelines recommend that antibiotics be continued until either (2 things)

Answer 17

the full planned course of therapy concludes or the neutropenic state resolves (neutrophils higher than 500/μL [0.5 × 109/L]), whichever is later.

Question 18

In cases of septic shock, combination therapy with at least ___ antibiotics from different classes should be employed against the most likely bacterial pathogen.

Answer 18

2

Question 19

Although there is not a clear mortality benefit, recent trials have showed that ____ are associated with a faster time to shock recovery and fewer days with organ failure or requirement for mechanical ventilation.

Answer 19

glucocorticoids

Question 20

Do you ever use steroids in sepsis without shock

Answer 20

no

Question 21

how much hydrocortisone for septic shock per day

Answer 21

The Society of Critical Care Medicine and the European Society of Intensive Care Medicine in 2017 recommended a maximum dose of 400 mg hydrocortisone daily, whereas the 2016 Surviving Sepsis Campaign guidelines recommend hydrocortisone to 200 mg daily for refractory shock. An adrenocorticotropic hormone stimulation test is not recommended.

Question 22

Patients with sepsis or septic shock should receive early oral feeding when possible and should be considered at risk for malnutrition when in the ICU for more than ____

Answer 22

48 hours

Question 23

The Surviving Sepsis Campaign Guidelines recommend targeting an upper glucose limit lower than ____ in patients with sepsis and septic shock.

Answer 23

180 mg/dL

Question 24

Heat stroke definition

Answer 24

a core body temperature above 40 °C (104 °F), along with encephalopathy

Question 25

Are antipyretic effective at reducing mortality in heat stroke

Answer 25

no

Question 26

Treatment for non exertional heat stroke

Answer 26

evaporative cooling (water mist and fans) with or without ice packs can be used to lower the core temperature to a safe target level, usually 38.5 °C (101.0 °F)

Question 27

Treatment for exertional heat stroke

Answer 27

evaporative cooling may be effective, but patients who remain severely symptomatic despite evaporative cooling efforts sometimes require immersion in ice water to bring the core temperature down rapidly

Question 28

Malignant hyperthermia tx

Answer 28

Stop inciting drug

Dantrolene

Question 29

Neuroleptic malignant syndrome tx

Answer 29

Stop inciting drug
Dantrolene
Bromocriptine

Question 30

Severe serotonin syndrome tx

Answer 30

Stop inciting drug
Benzodiazepines
Cyproheptadine