Exam 1 - States of Shock

Question 1

What is the classic definition for shock? (2)

Answer 1

hypotension as either an SBP <90 mmHg or a decrease in 40 mmHg from baseline

Question 2

What is the formula for mean arterial pressure?

Answer 2

MAP = 1/3 SBP + 2/3 DBP

Question 3

List factors affecting MAP? (2)

Answer 3

cardiac output, vascular resistance

Question 4

List factors affecting cardiac output? (2)

Answer 4

heart rate, stroke volume

Question 5

List factors affecting stroke volume? (3)

Answer 5

preload, afterload, contractility

Question 6

What is the goal MAP? HR? Lactate?

Answer 6

MAP >65 mmHg; HR = <100 bpm; lactate <2 mmol/L

Question 7

What is the goal venous blood gas for pulmonary artery catheters? Central venous catheters?

Answer 7

PA = >60%; CVC = >65%

Question 8

List the shock states? (4)

Answer 8

hypovolemic, distributive, cardiogenic, obstructive

Question 9

Define hypovolemic shock and list its causes?

Answer 9

inappropriately low and sudden loss of intravascular volume; hemorrhage, GI losses, severe dehydration, third spacing, burns

Question 10

Match the clinical parameters associated with physical variables? (4)

Answer 10

preload = PCWP, pump function = CO, afterload = SVR, tissue perfusion = mixed venous oxygen saturation (SVO2)

Question 11

Explain the changes during hypovolemic shock? (4)

Answer 11

decreased preload, decreased pump function, increased afterload, decreased tissue perfusion

Question 12

What are treatments for hypovolemic shock? (3)

Answer 12

surgical hemostasis, replace blood (PRBCs, anticoagulation reversal), fluids (IV crystalloids, albumin)

Question 13

Define cardiogenic shock and list its causes?

Answer 13

failure of left ventricle to deliver blood due to impaired stroke volume or heart rate; MI, arrhythmias, HF, valve diseases, dilated cardiomyopathy

Question 14

Explain the changes during cardiogenic shock? (4)

Answer 14

increased preload, decreased pump function, increased afterload, decreased tissue perfusion

Question 15

What are treatments for cardiogenic shock? (3)

Answer 15

revascularization for MI (CABG), correct arrhythmias, left ventricular assist devices (LVADs) and ECMO

Question 16

Define distributive shock and list its causes?

Answer 16

characterized by pronounced vasodilation (vasodilatory shock); sepsis, anaphylaxis, neurogenic, myxedema coma, adrenal/hepatic insufficiency

Question 17

Explain the changes during distributive shock? (4)

Answer 17

decreased preload, variable pump function, decreased afterload, variable tissue perfusion

Question 18

Define obstructive shock and list its causes?

Answer 18

results from critical decrease in LV stroke volume or increase in LV outflow obstruction; PE, severe pulmonary HTN, tension pneumothorax, pericardial tamponade

Question 19

What are treatments for obstructive shock? (2)

Answer 19

needle decompression, fluid drainage

Question 20

Explain the changes during obstructive shock? (4)

Answer 20

increased preload, decreased pump function, increased afterload, decreased tissue perfusion

Question 21

What is the treatment for fluid therapy in shock therapy?

Answer 21

IV crystalloids 30 mL/kg over 15-30 min, then by 10 mL/kg boluses (if cardiogenic 100-200 mL boluses)

Question 22

What is the MOA of norepinephrine?

Answer 22

alpha adrenergic agonist (increases MAP via peripheral vasoconstriction)

Question 23

What is the MOA of epinephrine?

Answer 23

alpha and beta adrenergic agonist

Question 24

What are other important points regarding epinephrine? (2)

Answer 24

may increase aerobic lactate production, useful for anaphylactic shock

Question 25

What are AEs of epinephrine?

Answer 25

tachycardia, arrhythmias, cardiac ischemia, peripheral vasoconstriction, reduced renal blood flow, hyperglycemia, and hypokalemia

Question 26

Explain dopamine’s dose-dependent pharmacologic properties?

Answer 26

<5 mcg/kg/min = vasodilatory, 5-10 = beta-1 adrenergic effects (increased HR), >10 = alpha-1 adrenergic effects (vasoconstriction)

Question 27

What are AEs of dopamine?

Answer 27

tachycardia, arrhythmogenesis, peripheral vasoconstriction (high doses)

Question 28

What types of patients is dopamine most effective in?

Answer 28

those with hypotension and depressed cardiac function

Question 29

What is the MOA of phenylephrine?

Answer 29

alpha-1 adrenergic agonist

Question 30

Which types of patients is phenylephrine most effective in?

Answer 30

those with high cardiac output and low blood pressure

Question 31

What are AEs of phenylephrine?

Answer 31

vasoconstriction, bradycardia, myocardial ischemia

Question 32

Which types of patients is dobutamine most effective in?

Answer 32

those with cardiac output or SVO2/SCVO2 goals that have not been achieved with previous vasopressor therapy

Question 33

Which types of patients is vasopressin most effective in?

Answer 33

those with septic shock

Question 34

Which types of patients is angiotensin II (Giapreza) most effective in?

Answer 34

those with septic shock (or other distributive shocks)

Question 35

What is an AE of angiotensin II (Giapreza)?

Answer 35

thromboembolism