Fever and shock

Question 1

Causes of post-op fever

Answer 1

The F Ws:
Wind: atelectasis
Water: UTI
Wounds: wound infection or abscess
Walking: DVT
Wonder drugs: Drug reaction
Womb: Endometriosis

Question 2

Hypovolemic shock:

• CO, PCWP, PVR
• tx

Answer 2

CO: decreased
PCWP: decreased
PVR: increased
Replete with IVF and PRBC in 3:1 ratio

Question 3

Cardiogenic shock

-CO, PCWP, PVR

Answer 3

CO: decreased
PCWP: increased
PVR: increased

Question 4

What pressors to use in cardiogenic shock?

Answer 4

If hypotensive: dopamine

If not hypotensive: dobutamine

Question 5

Septic shock

• CO, PCWP, PVR
• Tx

Answer 5

CO: increased
PCWP: decreased
PVR: decreased
this is maximally dilated vasculature
Tx: IV antibiotics. give fluids until CVP = 8

Question 6

Anaphylactic shock

-CO, PCWP, PVR

Answer 6

CO: increased
PCWP: decreased
PVR: decreased

Question 7

Neurogenic shock:

-what is it, what causes it, how to treat it

Answer 7

Spinal shock leading to autonomic dysfunction: vasodilation and bradycardia

Tx: atropine, IVF (raise MAP to 85 and stop giving IVF to prevent cord swelling)

Question 8

What changes first in hemorrhagic shock?

Answer 8

Heart rate

Question 9

J wave

Answer 9

Classic EKG sign in hypothermia

-positive deflections between QRS and T

Question 10

Tx of hyperthermia

Answer 10

Benzodiazepine to prevent shivering
Cold water, wet blankets, ice
Rule out NMS and malignant hyperthermia -> both these conditions are treated with dantrolene (muscle relaxant)

Question 11

Normal cath pressures:

-CVP, RVP, Pulm artery pressure, PCWP, LVP

Answer 11

CVP: 3-8
RVP: 15-30/3-8
Pulm artery: 15-30/4-12
PCWP: 2-15
LVP: 100-140/3/12