Critical Care

Question 0

What is 3rd spacing? What can cause this condition?

Answer 0

Leakage of intra vascular fluid into the interstium due to pressure unbalancing (burns, bowel obstruction, pancreatitis)

Question 1

What are the 3 types of shock? Give examples of each.

Answer 1

1. Hypovolemic (hemorrhage, vomiting/diarrhea, or 3rd spacing) 2. Cardiogenic 3. Distributive (septic, anaphylactic, neurogenic)

Question 2

Shock with bradycardia?

Answer 2

Neurogenic until proven otherwise

Question 3

Shock after injury or post operative

Answer 3

Hypovolemia until proven otherwise

Question 4

What are the signs and symptoms of hypovolemic shock? Which lab value should be followed?

Answer 4

Tachycardia, hypotension (orthostatic if mild), cold extremities; urine output

Question 5

Which organ sustains damage first during a hypovolemic state? Why?

Answer 5

The kidneys; constriction if the renal arteries due to increased RAA system

Question 6

What are the 4 classes of hypovolemic shock?

Answer 6

Class I: <40% blood loss (life threatening)

Question 7

What is the best treatment for hypovolemic shock? Why?

Answer 7

Fluid resuscitation with lactated ringers; colloid is expensive and not anymore effective and saline can cause hyperchloremic metabolic acidosis

Question 8

How much fluid should be given during resuscitation of a patient with hypovolemic shock?

Answer 8

3-4 mL for every 1 mL lost

Question 9

What history items are pertinent in a patient suspected of blood loss but is not tachycardic?

Answer 9

Beta blockers? Athlete? Neurological problems (autonomic NS damage)?

Question 10

What are the S/Sx’s of distributive shock?

Answer 10

Warm extremities with declining organ function that is refractory to fluid resuscitation

Question 11

What is the minimum amount of urine production required to be considered adequate?

Answer 11

AT LEAST 0.5 mL/Kg/hr.

Question 12

What is the continuum of symptoms seen in septic shock?

Answer 12

Always: fever and tachycardia
Early: warm extremities, good pulses, good urine
Late: cold extremities, decreased pulses, low urine

Question 13

What is the continuum of systemic infection?

Answer 13

SIRS, sepsis (known infection), severe sepsis (end organ damage), septic shock (add hypotension)

Question 14

What is the criteria for SIRS?

Answer 14

2 of the following:
A. Temp. 36 < or > 38
B. HR > 100
C. RR > 20
D. Elevated WBC

however this method has largely fallen out of favor for a more individual presentation