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Emergency Medicine > ID & Shock > Flashcards

ID & Shock Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

life-threatening condition of circulatory failure that causes end-organ damage, which leads to S&S

A

shock

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2
Q

what causes shock? (2)

A

reduced oxygen
increased oxygen demand

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3
Q

type of shock that occurs d/t not enough blood

A

hypovolemic shock

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4
Q

type of shock that occurs d/t an intracardiac pump failure that leads to reduced cardiac output

A

cardiogenic shock

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5
Q

type of shock that occurs d/t an extracardiac cause of cardiac pump failure

A

obstructive shock

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6
Q

type of shock that occurs d/t severe peripheral vasodilation that reduces the effective circulating volume

A

distributive shock

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7
Q

what is the treatment for a healthy adult with hypovolemic shock?

A

1-2 liters of fluid

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8
Q

what is the treatment for a pediatric with hypovolemic shock? (2 options)

A

20 ml/kg
OR 4-2-1 method

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9
Q

what is the 4-2-1 method?

A

(4 ml/kg for first 10kg)
+
(2ml/kg for kg 11-20)
+
(1ml/kg for every kg above 20)

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10
Q

what is the normal urine output in adults?

A

at least 0.5 ml/kg/hr

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11
Q

what is the normal urine output in pediatrics that weight less than 30kg?

A

at least 0.5 - 1 ml/kg/hr

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12
Q

what is the treatment for cardiogenic shock caused by an MI? (4)

A

ABCs
anti-coagulate
norepinephrine (vasopressor)
+/- IV fluids

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13
Q

what is the treatment for dysrhythmic cardiogenic shock? (2)

A

ABCs
ACLS

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14
Q

what is the treatment for valvular cardiogenic shock? (3)

A

ABCs
decrease pre/after load
surgery

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15
Q

what is obstructive shock most commonly associated with?

A

right heart outflow obstruction

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16
Q

what is the treatment for obstructive shock caused by a PE? (2)

A

ABCs
thrombolytics

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17
Q

what is the treatment for obstructive shock caused by an air embolism? (2)

A

left lateral decubitus / Trendelenburg
vasopressor

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18
Q

what is the treatment for obstructive shock caused by a tension pneumothorax? (2)

A

needle chest decompression

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19
Q

what is the cause of distributive shock?

A

severe peripheral dilation

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20
Q

what are the 3 etiologies of distributive shock?

A

neurogenic shock
anaphylactic shock
septic shock

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21
Q

severe traumatic brain injury and spinal cord injury that results in vascular resistance and altered vagal tone

A

neurogenic shock

22
Q

a patient presents with a discrete demarcation distal of CNS innervation which is erythematous and warm to touch d/t spinal cord injury. Dx?

A

neurogenic shock

23
Q

what is the treatment for neurogenic shock? (2)

A

IV fluids
IV norepinephrine drip (vasopressor)

24
Q

severe, immunoglobulin-E (Ig-E) mediated, allergic reaction to insect stings, envenomation, food, or drugs.

A

anaphylactic shock

25
Q

how does a patient with anaphylactic shock usually present?

A

with at least 2 organ systems affected

26
Q

what is the treatment for anaphylactic shock? (6)

A

remove inciting agent

ABCs

emergent IM epinephrine into mid-lateral thigh q 5-15 mins

supplemental oxygen

albuterol nebulizer (wheezing)

IV fluid

27
Q

what is a slower onset treatment for anaphylactic shock?

A

diphenhydramine

28
Q

what is a slower onset treatment for anaphylactic shock that is used to prevent refractory anaphylaxis?

A

methylprednisolone

29
Q

what does massive vasodilation from bacterial toxins that causes a drop in blood pressure and cardiac output lead to?

A

septic shock

30
Q

what are the 5 Ws of fever?

A

Wind (atelectasis / lung infection)
Water (UTI)
Wound (wound / skin infection)
Walking (venous embolism)
Wonder drug (medication-induced)

31
Q

who should receive a core temperature to assess for fever? (4)

A

babies < 3 months

< 2 yrs c/o fever + normal temp by other means

immune compromised

severely ill

32
Q

any fever in a neutropenic patient is suspicious for infection, and should have what 2 things done before initiating antibiotics?

A

blood culture
urine culture

33
Q

why should a patient with a neutropenic fever never receive a rectal exam?

A

d/t potential bacterial seeding

34
Q

what is the treatment for neutropenic fever?

A

cefepime 2g q 8hrs (pseudomonas)

35
Q

a fever > 100.9 for > 3 weeks with no obvious source despite investigation

A

fever of unknown origin (FUO)

36
Q

what are the 3 most common causes of FUO?

A

infection
malignancy
vascular disease

37
Q

how to define a febrile infant?

A

rectal/core temp that is 100.4 or more

38
Q

what is the treatment for a febrile infant that is 28 days or younger? (2)

A

antibiotics
admit

39
Q

which patients need a UA and urine culture via catheterization to diagnose as febrile infant? (3)

A

females < 24 mo
uncircumsized males < 12 mo
circumcized males < 6 mo

40
Q

what lab finding indicates we should get an xray for a febrile infant?

A

if WBCs > 20K

41
Q

what lab finding indicates we should start empiric antibiotics for a febrile infant?

A

if WBCs > 15K

42
Q

what is the difference between bacteremia and sepsis?

A

sepsis is the presence of bacteria in blood w/ clinical symptoms

43
Q

what is the Systemic Inflammatory Response Syndrome (SIRS) criteria?

A

source of infection

+

at least 2:

fever / hypothermia

HR > 90 bpm

RR > 20 / PaO2 < 32

leukocytosis > 12,000

44
Q

sepsis with lactate > 2 OR organ dysfunction

A

severe sepsis

45
Q

sepsis with hypoperfusion despite adequate IV resuscitation OR lactate > 4

A

severe septic shock

46
Q

what are the management guidelines for severe sepsis < 3 hrs of presentation? (3)

A

measure lactate
blood culture
antibiotics (cefepime, ceftriaxone)

47
Q

what should be done in severe sepsis within 6 hours?

A

repeat lactate if initial is > 2

48
Q

what are the management guidelines for septic shock < 3 hrs of presentation? (4)

A

measure lactate
blood culture
antibiotics (cefepime, ceftriaxone)
crystalloid

49
Q

what should be done in septic shock within 6 hours?

A

repeat volume + perfusion assessment

+/- vasopressor

50
Q

for any case of sepsis, when should antibiotics be administered to obtain the best outcome?

A

within the first hour

Emergency Medicine (12 decks)

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