Edema and Shock --> includes Starling Forces (5 star!!!)

Question 1

what is Pc?

Answer 1

pulmonary capillary pressure–> pushes fluid out of capillary

Question 2

what is Pi?

Answer 2

interstitial fluid pressure⇒ pushes fluid into capillary

Question 3

What is πc?

Answer 3

plasma colloid osmotic pressure (in capillary) ⇒ pulls fluid into capillary

Question 4

what is πi?

Answer 4

interstitial fluid colloid osmotic pressure ⇒ pulls fluid out of capillary

Question 5

what is Kf?

Answer 5

filtration constant ➡ reflects capillary permeability

Question 6

what four things can cause ↑ Kf?

Answer 6

1. infections
2. septic shock
3. toxins
4. burns

Question 7

where does most filtration take place in the capillary

Answer 7

at the arterial side ⇒ higher Pc and πi pull fluid out; by the venous end, fluid has left the capillary and a higher relative πc serves to keep fluid in the capillary

Question 8

what are three conditions ↑ Pc might be seen in

Answer 8

1. CHF (congestion in capillaries)
2. Venous thrombosis
3. Compression of veins

Question 9

4 conditions ↓ πc might be seen

Answer 9

1. Nephrotic syndrome
2. Liver Dz
3. Protein malnutrition
4. Protein losing enteropathy

Question 10

what can cause ↑ πi

Answer 10

Lymphatic occlusion ⇒ (can be due to tumor, surgery, infection or radiation)

Question 11

what happens to SVR and CO in hypvolemic shock

Answer 11

↓ CO w/ compens. ↑ SVR

Question 12

Tx for hypovolemic shock

Answer 12

IV fluids/ transfusion

Question 13

SVR and CO in cardiogenic shock?

Answer 13

↓ CO w/ compens. ↑ SVR

Question 14

SVR and CO in sepsis/ anaphylaxis

Answer 14

↓ SVR w/ compens. ↑ CO (increased HR, sypathetic d.c fro drop in BP)

Question 15

earliest sign of septic shock?

Answer 15

Tachycardia –> can be complicated by multiorgan failure; ischemia may lead to lactic acidosis

Question 16

SVR and CO in neurogenic shock? causes?

Answer 16

both ↓; due to brain or spinal cord injury

Question 17

Tx for cardiogenic shock? (1)

Answer 17

Dobutamine ⇒ inotropic agent (β1 agonist)

Question 18

tx for septic shock (3)

Answer 18

1. ABx
2. IV fluids
3. NE!

*remember, NE is the best vasopressor for spetic shock shock; Epi is for anaphylactic shock

Question 19

what tx is needed for spinal cord injury other than IV fluids to maintain CO

Answer 19

high dose steroids

Question 20

MCC of hypovolemic shock? what is another big cause

Answer 20

1. MCC = blood loss

2. Burns - also cause massive fluid loss

Question 21

7 causes of cardiogenic shock

Answer 21

1. MI
2. pulmonary embolism (PE)
3. CHF
4. tension pneumothorax
5. cardiac tamponade
6. cardiac contusion
7. Arrhythmia ( v-tach or v-fib)

Question 22

central line placement with highest risk of pneumothorax

Answer 22

subclavian

Question 23

why do you not place a internal jugular central line in the left IJ

Answer 23

greater risk of perforating the left SC vein due to the angle at which the left IF and left SC meet

*risk of puncturing the carotid with these too

Question 24

placement for Swan-Getz catheter

Answer 24

right IJ or left SC

Question 25

what is a way to tell from physical exam if a pt is in cardiogenic or septic shock

Answer 25

Cardiogenic –> skin will be cold, clammy, cyanotic

Septic–> skin will be warm and red (due to increased vascular permeability/ vasodilation)

Question 26

pitting edema is what kind of fluid

Answer 26

transudate (no colloid) ⇒ due to ↑Pc or ↓πc

Question 27

non-pitting edema is what kind of fluid

Answer 27

exudate–> doesnt pit b/c protein rich ⇒ due to ↑Kf = infections, septic shock, toxins, burns

Question 28

what is a potential issue with femoral central lines, although the easiest to place and least risk of complication

Answer 28

can only stay in for 5-7 days due to risk of infection