Hemodynamics/Sepsis: Presentation, Signs/Symptoms

Question 1

Shock definition

Answer 1

potentially fatal physiologic reaction resulting from various conditions including infection, injury, hemorrhage, dehydration, heart failure

Question 2

Classic definition of shock

Answer 2

Classic definition: hypotension (<90 SBP) or decrease by 40mmHg from baseline

Question 3

Shock is characterized by what?

Answer 3

Cellular dysoxia: diminished blood circulation, inadequate O2 delivery

Question 4

Shock outcomes

Answer 4

MOSF, death

Question 5

End organ dysfunction in shock: CNS

Answer 5

encephalopathy, cortical necrosis

Question 6

End organ dysfunction in shock: Cardiac

Answer 6

tachy/bradycardia, ventricular ectopy, myocardial ischemia/depression

Question 7

End organ dysfunction in shock: pulmonary

Answer 7

acute respiratory failure, ARDS

Question 8

End organ dysfunction in shock: renal

Answer 8

AKI, ATN, prerenal insults

Question 9

End organ dysfunction in shock: GI

Answer 9

erosive gastritis, ileus, pancreatitis

Question 10

End organ dysfunction in shock: hepatic

Answer 10

ischemic hepatitis, cholestasis, “shock” liver

Question 11

End organ dysfunction in shock: hematologic

Answer 11

DIC, dilutioonal thrombocytopenia

Question 12

End organ dysfunction in shock: metabolic

Answer 12

hyper/hypoglycemia, glycogenolysis, gluconeogenesis, hypertriglyceredemia

Question 13

End organ dysfunction in shock: immune system

Answer 13

gut barrier function, cellular and humoral immunity depression

Question 14

Clinical presentation of shock: cardiovascular organ compromise

Answer 14

cardiac index <2.2 L/min/m2, SBP <90 or MAP <65mmHg

Question 15

Clinical presentation of shock: tissue hypoperfusion

Answer 15

cold, clammy, mottled skin
lactate >2mmol.K
Scvo2 <65%
Svo2 <60%

Question 16

Clinical presentation of shock: organ dysfunction

Answer 16

encephalopathy, lethargy, confusion, urine output <0.5ml/kg/hr, liver dysfunction

Question 17

Parameters: BP formula

Answer 17

CO*SVR

Question 18

Paramters: CO formula

Answer 18

HR*SV

Question 19

Parameters: stroke volume

Answer 19

preload, intrinsic contractility, afterload

Question 20

Parameters: SVR

Answer 20

increase with constriction (cold skin), decreases with vasodilation (warm skin)

Question 21

Invasive monitoring: CVC

Answer 21

measures central venous oxygen saturation from venous blood gas (pH)

Used to administer fluids, pressers, ABX, TPN

Question 22

Invasive monitoring: PAC

Answer 22

measures pulmonary capillary wedge pressure (preload LV volume), CO/cardiac index, mixed venous O2 saturation (Svo2), SVR

Question 23

Optimizing preload

Answer 23

Fluid responsive patient= increased CO
Increase the preload, increase the CO

Question 24

Invasive monitoring: arterial line

Answer 24

measures MAP, SBP, DBP, ABG