Hypotention and Shock

Question 1

Defined as inadequate tissue perfusion from decreased CO

Answer 1

Shock

Question 2

What is the formula for MAP?

Answer 2

MAP = HR x SV x SVR

Question 3

what stage of shock is associated with compensation, Tachy, and increased SVR?

Answer 3

pre-shock

Question 4

what stage of shock is associated with uncompensated organ damage, tachy, dysnpea, metabolic acidosis, oligouria, and cool extremitites?

Answer 4

Shock

Question 5

what stage of shock is associated with end-organ damage from shock?

Answer 5

End organ dysfunction

Question 6

what lines can you use to resuscitate a patient?

Answer 6

Arterial lines, Central lines, PICC, and Swan-Ganz Catheter (Pulm)

Question 7

Can you give meds and monitor ABGs with Arterial lines?

Answer 7

No meds, Yes ABGs

Question 8

What are 2 central lines

Answer 8

Swan-ganz, PICC

Question 9

What line can enter the Brachia-cephalic vein and ends at the SVC-RA junction

Answer 9

PICC

Question 10

What is normal CVP?

Answer 10

5-15 mmHg

Question 11

What does the Swan Ganz catheter measure

Answer 11

Pulmonary pressure (5-15 mmHg)

Question 12

What does all Shock types include?

Answer 12

Hypotension, Oligouria, Metabolic acidosis, Cool extremeties, End-organ failure

Question 13

Pathophys of hypovolemic shock
HR_
CVP_
PCWP_
CO_
SVR_

Answer 13

HR_Increase
CVP_decrease
PCWP_decrease
CO_decrease
SVR_Increase

Question 14

Pathophys of Cardiogenic shock
HR_
CVP_
PCWP_
CO_
SVR_

Answer 14

HR_ increase
CVP_Increase
PCWP_increased
CO_decrease
SVR_increase

Question 15

Pathophys of Early Sepsis shock
HR_
CVP_
PCWP_
CO_
SVR_

Answer 15

HR_increase
CVP_decrease
PCWP_increase
CO_increase
SVR_decrease

Question 16

Pathophys of Late Sepsis shock
HR_
CVP_
PCWP_
CO_
SVR_

Answer 16

HR_ Increase
CVP_decrease
PCWP_increase
CO_decrease
SVR_increase

Question 17

Pathophys of Neurogenic shock
HR_
CVP_
PCWP_
CO_
SVR_

Answer 17

HR_ decrease
CVP_decrease
PCWP_decrease
CO_decrease
SVR_decrease

Question 18

which shock presents with hematemesis, hematochezia, melena, N/V/D, abdominal pain, trauma, post-op?

Answer 18

hemorrhagic shock

Question 19

What would a CMP show for shock patients?

Answer 19

elevated lactate - anaerobic respiration

Question 20

why do you give a patient crystalloid, colloid, and FFP?

Answer 20

Crystalloid = saline
Colloid = albumin
FFP = frozen fresh blood

Question 21

What 3 things do you monitor in shock patients?

Answer 21

Urine output
peripheral perfusion
Mentation

Question 22

When can you give patients Vasopressors

Answer 22

SBP<70 mmHg

Question 23

what is the number 1 cause of cardiogenic shocK?

Answer 23

Obstructive cardiogenic shock due to Aortic Stenosis, but can also be due to PE, tamponade, or pneumothroax

Question 24

What happens to SVR to compensate for a low CO

Answer 24

SVR increases (renal salt and water retention also)

Question 25

PE of cardiogenic shock

Answer 25

JVD, edema, tachy, tachypnea, crackles

Question 26

``` How do you manage patients with each issue 1 MI 2 V-tach/fib 3 Tension pnemothorax 4 tamponade ```

Answer 26

1 Cath lab 2 ACLS (ken) 3 decompress 4 pericardiocentisis

Question 27

what is a first line Inotrophic drug for shock management?

Answer 27

Dobutamine

Question 28

whats beta blocker and antiarrythmic called that we need to know?

Answer 28

Sotalol and Amioderone

Question 29

What is last line of tx for shock patients

Answer 29

LVAD, RVAD, ECMO, Transplant

Question 30

Etiology of Distributive Shock (think Sepsis Salad)

Answer 30

SALAD | Sepsis, adrenal disease, liver disease, anaphylaxis, Drugs

Question 31

What shock is charaterized with an increase in 02 demand to combat an infection?

Answer 31

Sepsic shock

Question 32

what kind of infection can lead to septic shock

Answer 32

Any (UTI, pneumonia, bacteremia, ect)

Question 33

What stage of septic shock has a decreased SVR, increased CO, and increased Contractility

Answer 33

Early septic

Question 34

when can early septic shock become late septic shock

Answer 34

when pro-inflammatory cells> anti- inflammatory cells = vasodilation

Question 35

What stage of septic shock is charaterized with and increase HR, SVR, and hypovolemia, with decreased CO

Answer 35

Late sepsic shock

Question 36

what populations get septic shock in general

Answer 36

elderly and immuncompromised

Question 37

in septic shock, do order a Pan-culture before or after antibiotics are administered?

Answer 37

Pan-cultures before antibiotics, but you can tx empirically using coverage based on likely infectious agent.

Question 38

If you are going to give a vasopressor, what the firs line?

Answer 38

Norepi along with ventilator support

Question 39

What causes neurogenic shock

Answer 39

pt took a blow to the head that severed the SNS of the thoracocolumnar section of the spine (para/quad)

Question 40

Why are all (HR, CO, SVR) decreased in neurogenic shock?

Answer 40

suppressed/eliminated SNS response.

Question 41

how do the DTRs respond with neurogenic shock

Answer 41

absent or hyperreflexia