Critical Illness Shock

Question 1

Patients with suspected infection can be predicted to have poor outcomes typical of sepsis if they have at least two of the following clinical criteria:_____

Answer 1

respiratory rate ≥22 breaths/min

altered mental status

systolic blood pressure ≤100 mmHg.

Question 2

Shock clinical indicators

Answer 2

Reduced mean arterial pressure (MAP)
Tachycardia, tachypnea
Cool skin and extremities
Acute altered mental status
Oliguria

Question 3

MAP = ___

Answer 3

Cardiac Output (CO) × Systemic Vascular Resistance (SVR)

Question 4

Diminished CO

Answer 4

Narrow pulse pressure (systolic BP – diastolic BP)

Cool extremities, delayed capillary refill

Check proximal extremities for relative “coolness.”

Question 5

Increased CO

Answer 5

Widened pulse pressure (low diastolic pressure)

Warm extremities,

bounding pulses
Rapid capillary refill

Question 6

Patient has increased JVP with noted crackles on PE. Patient has possible _____ shock and should be evaluated for _____

Answer 6

cardiogenic shock

MI

Question 7

Patient has decreased JVP with orthostatis. Patient has possible _____ shock and should be initially given _____

Answer 7

hypovolemic shock

IVF

Question 7

Positive-pressure ventilation increases right ventricular afterload, decreasing _____

Answer 7

cardiac output.

Question 8

A 45-year-old female with a history of septic shock presents with warm, bounding extremities and a widened pulse pressure. What is the next best step in management?

A) Administer intravenous fluids
B) Initiate inotropes
C) Begin antibiotics and aggressive resuscitation
D) Perform an echocardiogram

Answer 8

B

Question 9

A patient with shock presents with cold extremities, hypotension, and a history of significant blood loss. Physical examination reveals orthostasis and decreased JVP. What is the most appropriate intervention?

A) Inotropes and afterload reduction
B) Intravenous fluid resuscitation
C) Vasopressor administration
D) Perform echocardiogram

Answer 9

B

Question 10

A 60-year-old female presents with refractory hypotension despite volume resuscitation. She has cold extremities and a “flat” inferior vena cava on ultrasound. She fails to improve with fluid therapy. What is the next diagnostic consideration?

A) Evaluate for adrenal crisis
B) Perform an echocardiogram for heart failure
C) Initiate vasopressors
D) Administer broad-spectrum antibiotics

Answer 10

A