Hemodynamics/Sepsis: Shock States

Question 1

Shock states

Answer 1

Hypovolemia, cardiogenic, distributive, obstructive

Question 2

Hypovolemic shock: definition

Answer 2

inappropriately low and sudden loss of intravascular volume

Question 3

Hypovolemic shock: causes

Answer 3

hemorrhage, GI losses, severe dehydration, third spacing, burns

Question 4

Hypovolemic shock: patho

Answer 4

decreased volume or preload → decreased CO → compensatory increase in SVR

Question 5

Hypovolemic shock: what decreases?

Answer 5

PCWP, CO, Scvo2

Question 6

Hypovolemic shock: what increases?

Answer 6

SVR

Question 7

Hypovolemic shock: management

Answer 7

Identify the source of loss
Hemorrhagic: replace blood with PRBCs, FFS, and platelets
GI losses, burns, third spacing: crystalloid fluids, occasionally albumin

Question 8

Cardiogenic shock: definition

Answer 8

failure of LV to deliver blood due to impaired stroke volume or HR; “pump failure”

Question 9

Cardiogenic shock: causes

Answer 9

acute MI, arrhythmias (heart block, afib, ventricular tachycardia), end-stage HF, valve failure or disease, dilated cardiomyopathy, etc.

Question 10

Cardiogenic shock: patho

Answer 10

failure of emptying left ventricle → decreased CO → increased blood volume backs up in pump → increased preload → compensatory increase in SVR

Question 11

Cardiogenic shock: what increases?

Answer 11

PCWP, SVR

Question 12

Cardiogenic shock: what decreases?

Answer 12

CO, Scvo2

Question 13

Cardiogenic shock: management

Answer 13

MI: revascularization- cardiac catheterization or CABG
Arrhythmias: try to achieve sinus rhythm, heart dependent on perfusion goals
Advance methods: LVADs (intraaortic balloon pump, impella, HeartMate, Tandem Heart), ECMO

Question 14

Distributive shock: definition

Answer 14

Pronounced vasodilation

Question 15

Distributive: causes

Answer 15

SEPTIC SHOCK IS CLASSIC, anaphylaxis, neurogenic, myxedema coma (thyroid insufficiency), adrenal insufficiency, hepatic insufficiency

Question 16

Distributive: patho

Answer 16

vasodilation → reduced SVR (volume returning to heart is reduced) → decreased preload → compensation is to increase the HR to maintain CO → will eventually decrease

Question 17

Distributive: what increases?

Answer 17

CO, Scvo2 (at first to compensate)

Question 18

Distributive: what decreases?

Answer 18

PCWP, SVR, CO (after), Svo2 (after)

Question 19

Obstructive shock: definition

Answer 19

critical decrease in LV stroke volume or increase in LV outflow obstructions

Question 20

Obstructive: etiologies

Answer 20

PE (thrombolytic therapy), severe pulmonary HTN, tension pneumothorax, pericardial tamponade

Question 21

Obstructive: patho

Answer 21

decrease in LV stroke volume → decreased CO and tissue perfusion, but preload measurement will appear elevated due to “obstruction” → increased afterload in attempt to compensate

Question 22

Obstructive: what increases?

Answer 22

PCWP, SVR

Question 23

Obstructive: what decreases?

Answer 23

CO, Scvo2