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Year 2 CV > Exam 3, Shock > Flashcards

Exam 3, Shock Flashcards

1
Q

what is body position for shock

A

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

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2
Q

what is general definition of shock

A

arterial blood flow is inadequate to meet needs for O2

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3
Q

Tissue perfusion depends on what

A

CO and SVR

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4
Q

What are types of shock

A

hypovolemic
cardiogenic
distributive

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5
Q

what is hypovolemic shock caused by

A

hemorrhage
fluid loss
poor intake

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6
Q

how are CO and SVR affected in hypovolemic shock

A

decreased CO and increased SVR

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7
Q

What are causes of cardiogenic shock

A

cardiomyopathies, arrhythmias
mechanical
extracardiac/obstruction

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8
Q

how are CO and SVR affected in cardiogenic shock

A

decreased CO and increased SVR

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9
Q

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

A

increased

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10
Q

what can cause distributive shock

A

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

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11
Q

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

A

resdistribution of flow to skin

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12
Q

how is CO and SVR and PCWP affected in distributive shock

A

increased CO
decreased SVR
decreased PCWP

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13
Q

what are markers of clinical shock

A

SBP 1.0 mmol/L

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14
Q

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?

A

hypovolemic

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15
Q

how is CVP levels in hypovolemic shock

A

decreased

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16
Q

What is Tx for hypovolemic shock

A

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

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17
Q

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?

A

cardiogenic

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18
Q

describe CO, PWCP, afterload levels in cardiogenic shock

A

low CO, increased PWCP and increased afterload

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19
Q

what is normal Cardiac index

A

<2.2L/min/meters squared

20
Q

What is Tx for cardiogenic shock

A

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

21
Q

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

A

pericardial tamponade

22
Q

What is Becks triad and what does it suggest

A

distended neck veins
distant heart sounds
distressed BP

cardiac tamponade

23
Q

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

A

obstructive

24
Q

what are causes of obstructive cough

A

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

25
Q

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

A

SIRS

systemic immune response syndrome

26
Q

what is SIRS

A

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

27
Q

What are the labs in SIRS, sepsis or distributive shock

A 
CMP, ABGs
type and crossmatch
coagulation parameters
lactate
blood cultures
28
Q

what is usual acid base imbalance in SIRS

A

respiratory alkalosis

29
Q

What process is related to PAMPs

A

septic shock

30
Q

what is general criteria for sepsis/SIRS

A

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

31
Q

what are the inflammatory variables of sepsis

A

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

32
Q

what are the hemodynamic variables of sepsis

A

SBP <60-65

33
Q

what are the organ dysfunction variables of sepsis

A 
PaO2/FiO22 mg/dL
INR or PTT changes
Ileus
platelets <100,000
bilirubin
hyperprolactinemia
decreased capillary refill
34
Q

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

A

1

35
Q

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

A

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

36
Q

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

A

fluid resuscitation

37
Q

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

A

distributive shock, septic shock

anyphlyaxis and adrenal insufficiency?

38
Q

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

A 
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
39
Q

What CVP do you wnat to maintain in septic shock

A

8-12 mm

40
Q

how much fluids do you give early on in shcok

A

5 L in first 6 hours

41
Q

What cardiac index needs to be maintained during septic shock

A

2-4 L/minsquared

42
Q

What vasopressor is originall used in septic shock

A

norepi

43
Q

what vasopressor is used for warm shock

A

phenylephrine

44
Q

what vasopressor is used for anaphlyactic shock

A

epinephrine

45
Q

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

A

> 70%

46
Q

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

A

PRBCs

if still <70% then dobutamine

47
Q

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

A

hydrocortisone 50 mg q 6 hours

Year 2 CV (31 decks)

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