Lecture on Shock

Question 1

Definition of Shock

Answer 1

State of Inadequate tissue perfusion leading to hypoxia and death

Question 2

SIRS

Answer 2

Systemic inflammatory response to infection

Question 3

Vital signs for SIRS

Answer 3

Temp > 38
RR > 20
HR > 90
WBC > 12

Question 4

Criteria for Sepsis

Answer 4

Sepsis is the systemic response to infection manifested by two or more of the following conditions as a result of infection:

• Temperature greater than 38C or less than 36 C (this is not a mistake. Super weird)
• HR greater than 90
• RR greater than 20
• PaCO2 less than 32
• WBC greater than 12000 or less than 4000 or with more than 10% immature band forms

Question 5

What is severe sepsis?

Answer 5

Sepsis associated with organ dysfunction, hypoperfusion or hypotension. Hypoperfusion and perfusion abnormalities may include, but are not limited to, lactic acidosis, oliguria, or an acute alteration in mental status

Question 6

What is septic shock?

Answer 6

Sepsis-induced hypotension despite adequate fluid resuscitation along with the presence of perfusion abnormalities

Question 7

Sepsis-induced hypotension

Answer 7

Systolic less than 90 or a reduction of greater than or equal to 40 from baseline in the absence of other causes for hypotension

Question 8

Who gets septic shock?

Answer 8

Anyone! Tends to be more in the following categories though:

• Immunocompromised: DM, Medicated (transplant or RA, the heavy stuff), IV drug abuser, hospitalized, asplenic, ESRD, etc.
• Extremes of age

Question 9

Basic Stepwise Algorithm for treating hemorrhagic shock

Answer 9

1. Find bleeding
2. Stop the bleeding
3. Reverse coagulopathies (ASA, Warfarin)
4. Replace blood and support patients
5. Hypotensive Resuscitation for traumas

Question 10

What are the three most common causes of anaphylaxis?

Answer 10

• Antibiotics
• Insects
• Food

Question 11

Dosages of Epinephrine for Anaphylaxis

Answer 11

0.1 mg IV or 0.3 - 0.5 mg IM

Question 12

What is the underlying event for neurogenic shock?

Answer 12

Disruption of sympathetic outflow, usually secondary to a blunt trauma to the c-spine.

Presents with bradycardia and hypotension

Question 13

What is cardiogenic Shock?

Answer 13

Decreased cardiac output despite adequate volume-tissue hypoperfusion

Question 14

In summary, what fluids do we use depending on the shock?

Answer 14

Septic - Crystalloid
Hemorhagic - Blood
Anaphylaxis - Crystalloid
Neurogenic - Crystalloid
Cardiogenic - None

Question 15

How will the extremities feel based on the shock type?

Answer 15

Septic - Warm
Hemorrhagic - Cool
Anaphylaxis - Warm
Neurogenic - Warm
Cardiogenic - Cool

Question 16

What Beta pressors do we use and for what do we use them?

Answer 16

Dobutamine - Cardiogenic Shock

Dopamine - Multiple shock types

Question 17

What alpha pressors do we use and for what do we use them?

Answer 17

Phenylephrine - 2nd line shock therapy

Norepinephrine - Sepsis