management of shock states

Question 1

CVP definition

Answer 1

pressure exerted by fluid in R atrium indicates R heart funciton- Normal is 0-6mmhg

Question 2

CVP is elevated (0-6mmhg) by

Answer 2

fluid overload or cardiogenic shock

Question 3

CVP is decreased (0-6mmhg) by

Answer 3

low fluid in R atrium, dehydration or distributive shock

Question 4

MAP = SBP + 2(DBP/3) def

Answer 4

average driving force in the arterial system,

Question 5

PAP measure of systolic and diastolic pressures in the pulmonary artery

Answer 5

15-25sys /dia 5-15

Question 6

PAP is elevated sys >25, Dys >15 by

Answer 6

increased fluid in the pulm artery, or decreased elasticity of pulm arteryy

Question 7

PAP is decreased SYS <15 or Dias <5 by

Answer 7

hypovolemia

Question 8

PCWP or PAOP, Lft ventricualr end diastolic pressure 6-12 is normal

Answer 8

true

Question 9

PCWP/PAOP is >12 by

Answer 9

omcreased end diastolic pressrue in L ventricl, increased fluid or decreasd elasticity of the LV

Question 10

PCWP/PAOP is <6 by

Answer 10

hypovolemia

Question 11

PCWP is a reflection of the tendency to develop

Answer 11

pulmonary edema, it should e kept at the lowest point possible to maintain adequate cardic function

Question 12

Cardiac output - HRxSV normal is

Answer 12

4-8Lpm

Question 13

CO is >8LPM when

Answer 13

inotropic agents, excess fluid

Question 14

CO is <4LPM when

Answer 14

drugs to decrease contractility or low volume

Question 15

Cardiac Index

Answer 15

CO/BSA more accurate than CO alone because it takes into account BSA, Normal is 2.5-4Lpm

Question 16

SVR def

Answer 16

resistane provided by the systemic circulation, againt which the Left ventricle myst pump blood. It is calculated by MAP- mean CVP x80/CO normal is 800-1200dynes per sec

Question 17

Mixed venous SV02

Answer 17

normal is 60-80% assess 02 delivery

Question 18

SVO2 <60 implies increased tissue extraction of 02,

Answer 18

the patiet has tappe the venous reserve of 02, decreased 02 supply or ppoor CO, anemia, increased 02 demand

Question 19

SV02 >80 implies

Answer 19

decreased tissue extraction of 02, high return of C02, and is an early indicator of status change, causes could be hypothermai, sepis, oxyhemoglobin curve shift L

Question 20

Shock def

Answer 20

clinical syndrome of systemic hypotension, acedemia and imparment of vital organ function from hypoperfusion.

Question 21

Hypovloemic shock think bleed

Answer 21

CO/CI- 
CVP
PCWP
SVR - all are low except for svr 
SVO2

Question 22

Cardiogenic shock -usually MI or other cause acute pump failure

Answer 22

CO/CI- 
CVP high 
PCWP high 
SVR high 
SVO2

Question 23

distributive shock (septic)

Answer 23

CO/CI- high then low 
CVP low then high
PCWP low then high
SVR low 
SVO2 low then High

Question 24

distributive shock anaphylactic

Answer 24

CO/CI- all low 
CVP
PCWP
SVR
SVO2

Question 25

hypovolemic shock mainstay of theapy-

Answer 25

fluids

Question 26

distributive shock neurogenic

Answer 26

CO/CI- all low 
CVP
PCWP
SVR
SVO2

Question 27

Obstructive shock blood backs up into RA and cant get out think PE

Answer 27

CO/CI- low 
CVP high
PCWP normal Low 
SVR HIgh 
SVO2 High

Question 28

cardiogenic shock first therapy -

Answer 28

IV fluids, careful with flooding followed by vasopressors

Question 29

obstructive shock teatment

Answer 29

fluids bt fix the underlying problem

Question 30

Hypovolemic shock def

Answer 30

loss of 20% of the circulating blood volume

Question 31

neurogenic shock tx

Answer 31

fluids then vasopressors

Question 32

anaphylactic shock tx

Answer 32

fluids then benedryl, is first not epi, (epi is indicated for respiratory distress or stridor)

Question 33

distributive shock def

Answer 33

three forms of shock characterized by vasodilation, deceased intravascualr volume, reduced peripheral resistance, and loss of capillary integrity, (septic, anaphylactic, and neurogenic)

Question 34

anaphylactic shock is mediated by

Answer 34

IgE,

Question 35

sepsis abx

Answer 35

within one hour

Question 36

UTI organism

Answer 36

ecoli women

proteus men