critical care Flashcards
hypovolemic shock.. PCWP, CO and SVR?
PCWP down (problem), decreased CO, Increased SVR (compensation)
Cardiogenic shock.. PCWP, CO and SVR?
PCWP increased, CO decreased (problem), SVR increased (compensation)
patients have cool extremities
Distributive shock… PCWP, CO and SVR?
PCWP unaffected, decreased SVR (problem), increased CO (compensation)
patients have warm extremities
two main types of hypovolemic shock
hemmorrhagic (trauma, GI, retroperitoneal) and fluid depletion (external fluid loss and interstitial fluid redistribution)
two main types/causes of cardiogenic shock
pump failure (myopathy, drug induced-chemo, mechanical, arrhythmia)
obstructive (impaired filling, direct venous obstruction, decreased compliance, increased vent after load)
to diagnose sepsis (most common type of distributive shock), you must have which diagnostic criteria?
you must have SIRS (systemic inflame response syndrome) + source of infection
SIRS criteria (must have 2 or more)
- temp >38 or 20
- WBC>12,000 or<4000
What should be the clinical approach to sepsis?
early goal directed therapy!
- broad spectrum antibiotics within first hour of recognition
- stabilize (intubate, fluid resuscitation, vasopressors)
steroids if patient doesn’t responsd to fluids or vasopressors
anion gap metabolic acidosis ddx. Also what is delta AG?
delta AG is used to look for hidden additional disorders. =(AG-12) / (24-HCO3)
MUDPILES (methanol, uremia, diabetic ketoacidosis, paraldehyde, iron, lactic acidosis, ethylene glycol, salicyates)
Non gap met acidosis ddx
HARD UP
hyperchloremia, acetazolamide, renal tubular acidosis, diarrhea, ureteral diversion, pancreatic drainage
3 main causes of metabolic alkalosis
GI H+ loss through vomiting, renal H loss, contraction alkalosis
what are the indications for invasive positive pressure ventilation?
- hypoxemic resp failure
- hypercapnic reap failure
- unstable airway
