management of shock

Question 1

supportive measures for all shock

Answer 1

Establishment of adequate ventilation and oxygenation
Restoration of optimum intravascular volume
Maintenance of adequate CO
Provision of an ideal internal metabolic environment

Question 2

when preload is low..

Answer 2

administer fluids

patient positioning
- HOB flat
- lower extremities elevated
- modified trendelenburg

Question 3

when are blood products administered

Answer 3

May be given when Hgb 7.0 – 9.0 g/dL

FFP for bleeding or planned invasive procedures (If PT/INR elevated)

Platelets if < 5000, or 30,000 with significant bleeding risk, or < 50,000 for invasive procedures or bleeding

Question 4

T or F

a patient in hypovolemic shock will have low preload

Answer 4

true

Question 5

in which types of shock will the patient have a low preload?

Answer 5

hypovolemic

distributive shocks

Question 6

when preload is high…

Answer 6

Administer diuretics
Administer nitroglycerine
Reduce fluid intake
Patient positioning
- Elevate head of the bed
- Low/mid/high Fowlers position

these are specific to cardiogenic shock

Question 7

in which type of shock would treatment include agents to decrease preload?

Cardiogenic
Hypovolemic
Septic
Anaphylactic

Answer 7

cardiogenic

Question 8

when afterload or BP is low…

Answer 8

First step: FLUID ADMINISTRATION

If fluid administration fails, may use drugs to constrict resistance vessels (alpha receptor stimulation):
- Norepinephrine (Levophed)
- High dose Dopamine (Intropin)
- Epinephrine (Adrenalin)
- Phenylephrine (Neosynephrine)
- Vasopressin (Pitressin)

Question 9

in which type of shock is afterload low?

cardiogenic
hypovolemic
distributive

Answer 9

distributive

Question 10

when afterload is high…

Answer 10

May administer drugs to cause resistance vessels to dilate:
- Nitroprusside (Nipride)
- ACE Inhibitors
- Calcium Channel Blockers
- Angiotensin Receptor Blockers

only if the pts BP can tolerate it

Question 11

for which type of shock may meds to lower afterload be used?

Cardiogenic
Hypovolemic
Septic
Anaphylactic

Answer 11

cardiogenic

after + intoropes

Question 12

when contractility is impaired…

Answer 12

Administer positive inotropic agents
- Mid-dose Dopamine (Beta 1)
- Dobutamine (Dobutrex) (Beta 1)
- Milrinone (Primacor)
- Digoxin (Lanoxin)

Question 13

which type of shock is caused by impaired contractility?

Answer 13

cardiogenic

Question 14

which med may be given to treat hypotension?

Nitroprusside
Norepinephrine
Lisinopril
Amiodarone

Answer 14

norepinephrine

Question 15

which of the following meds will decrease heart rate?

Norepinephrine
Nitroglycerin
Lisinopril
Metoprolol

Answer 15

metoprolol

Question 16

Which of the following medications is given for symptomatic bradycardia?

Atropine
Epinephrine
Amiodarone
Adenosine

Answer 16

atropine

Question 17

descrieb the use of corticosteroids for septic shock

Answer 17

Used for patients who still require vasopressors despite fluid replacement (*IV – hydrocortisone. Solu-Cortef)

Patient may have relative adrenal insufficiency

Studies have shown a decrease in mortality r/t septic shock with low-dose corticosteroid use