Exam 3, Shock

Question 1

what is body position for shock

Answer 1

keep warm and comfortalbe
turn victim head on one side if neck injury not suspected.
put on back with legs raised

Question 2

what is general definition of shock

Answer 2

arterial blood flow is inadequate to meet needs for O2

Question 3

Tissue perfusion depends on what

Answer 3

CO and SVR

Question 4

What are types of shock

Answer 4

hypovolemic
cardiogenic
distributive

Question 5

what is hypovolemic shock caused by

Answer 5

hemorrhage
fluid loss
poor intake

Question 6

how are CO and SVR affected in hypovolemic shock

Answer 6

decreased CO and increased SVR

Question 7

What are causes of cardiogenic shock

Answer 7

cardiomyopathies, arrhythmias
mechanical
extracardiac/obstruction

Question 8

how are CO and SVR affected in cardiogenic shock

Answer 8

decreased CO and increased SVR

Question 9

how is pulmonary capillary wedge pressure affected in hypovolemic and cardiogenic shock

Answer 9

increased

Question 10

what can cause distributive shock

Answer 10

sepsis, TSS, anaphylaxis, toxin reactions, spinal cord injury, myxedema or adrenal crisis

Question 11

how come individuals with distributive shock have a normal or high central venous O2 sat level

Answer 11

resdistribution of flow to skin

Question 12

how is CO and SVR and PCWP affected in distributive shock

Answer 12

increased CO
decreased SVR
decreased PCWP

Question 13

what are markers of clinical shock

Answer 13

SBP 1.0 mmol/L

Question 14

alcoholic patient with cirrhosis and ascites presents with vomiting, dry mucous membranes, clammy skin, oliguria, mental status change, BP 70/50
what type of shock?

Answer 14

hypovolemic

Question 15

how is CVP levels in hypovolemic shock

Answer 15

decreased

Question 16

What is Tx for hypovolemic shock

Answer 16

fluid replacement
0.9% saline, 1-2 L wide open
PRBCs
goal is to obtain CVP 8-12 mmHg

Question 17

diabetic patient with dyspnea and BP 65/50
Hx + for MI
patient on loop diuretic, aldosterone antagonist, ACEI and beta blocker
HR 140
cool clammy skin
patient resltess
b/l basilar crackles and neck veins are distended
type of shock?

Answer 17

cardiogenic

Question 18

describe CO, PWCP, afterload levels in cardiogenic shock

Answer 18

low CO, increased PWCP and increased afterload

Question 19

what is normal Cardiac index

Answer 19

<2.2L/min/meters squared

Question 20

What is Tx for cardiogenic shock

Answer 20

upright O2, NIPPV
low BP- dobutamine
normal or high BP- IV NTG or nitroprusside with IV loop diuretic
AF- esmolol or cardioversion
Post MI- antiplatelets, norepi or dopamine
IABP, CABG, PCI

Question 21

distant heart sounds with clear lungs, neck veins distended, BP 60/40
EKG shows electrical alterans
most likely?

Answer 21

pericardial tamponade

Question 22

What is Becks triad and what does it suggest

Answer 22

distended neck veins
distant heart sounds
distressed BP

cardiac tamponade

Question 23

TEE shows free space anterior and posterior to ventricular wall,
represents what type of shock?

Answer 23

obstructive

Question 24

what are causes of obstructive cough

Answer 24

tension pneumothorax, pericardial disease, disease of pulmonary circulation, cardiac tumor, left atrial mural thrombus, obstructive valvular disease

Question 25

HIV patient with cough, fever, HR 98, RespR 26, WBC 9,000 with 15% bands. glucose 145 patient most likely has?

Answer 25

SIRS | systemic immune response syndrome

Question 26

what is SIRS

Answer 26

dysregulated inflammation related to autoimmune disorders, pancreatitis, vasculitis, VTE, burns, surgery

Question 27

What are the labs in SIRS, sepsis or distributive shock

Answer 27

``` CMP, ABGs type and crossmatch coagulation parameters lactate blood cultures ```

Question 28

what is usual acid base imbalance in SIRS

Answer 28

respiratory alkalosis

Question 29

What process is related to PAMPs

Answer 29

septic shock

Question 30

what is general criteria for sepsis/SIRS

Answer 30

infection plus TPR changes like high or low temp, HR>90 RR>20 Glucose >140 altered mentation edema >20

Question 31

what are the inflammatory variables of sepsis

Answer 31

WBC>12,000 with bandemia >10% WBC<4,000 Increased CRP and procalcitonin (increased CD 64)

Question 32

what are the hemodynamic variables of sepsis

Answer 32

SBP <60-65

Question 33

what are the organ dysfunction variables of sepsis

Answer 33

``` PaO2/FiO22 mg/dL INR or PTT changes Ileus platelets <100,000 bilirubin hyperprolactinemia decreased capillary refill ```

Question 34

severe sepsis can be diagnosed with significatn dysfunction in how many organs?

Answer 34

1

Question 35

What are the most common lab results that are evident of severeorgan dysfunction

Answer 35

ARDS ARF, DIC or serum lactate >4mmol/L

Question 36

septic shock can be diagnosed whtn unable to maintain MAP >60mmHg after what?

Answer 36

fluid resuscitation

Question 37

What types of shock and syndrome are characterized by a SVR<800 dynes.s/cm

Answer 37

distributive shock, septic shock | anyphlyaxis and adrenal insufficiency?

Question 38

what are the 9 steps to done within 2 hours for patients with infection, SIRS and dysfunction of one organ

Answer 38

``` serum lactate two sets of blood cultures two 18 gauge lines start antibiotics give 2 L NS CBC and BMP O2 sat>90% norepi is shock is present transfer for lactate >4mmol/L, Systolic BP <60 after 2 L NS ```

Question 39

What CVP do you wnat to maintain in septic shock

Answer 39

8-12 mm

Question 40

how much fluids do you give early on in shcok

Answer 40

5 L in first 6 hours

Question 41

What cardiac index needs to be maintained during septic shock

Answer 41

2-4 L/minsquared

Question 42

What vasopressor is originall used in septic shock

Answer 42

norepi

Question 43

what vasopressor is used for warm shock

Answer 43

phenylephrine

Question 44

what vasopressor is used for anaphlyactic shock

Answer 44

epinephrine

Question 45

what central venous O2 sat is maintained early on in septic shock

Answer 45

>70%

Question 46

If central venous O2 in septic shock is <70% what do you give

Answer 46

PRBCs | if still <70% then dobutamine

Question 47

if septic shock is due to adrenal insufficiency what might you use to Tx

Answer 47

hydrocortisone 50 mg q 6 hours