Medicine - Adams

Question 1

What is the first thing you should do for a patient in shock?

Answer 1

GIVE FLUIDS!

Then vasopressor agents (NE or epi, dompaine, or dobutamine)

Question 2

What are the 4 types of shock?

Answer 2

Cardiogenic
Hypovolemic
Extracardiac (outflow obstruction)
Distributive/Dissociative (increased area for blood to disperse to)

Question 3

Describe Cardiogenic Shock

Answer 3

Causes of decreased CO due to pathology of heart

Problem with delivery

SUCH AS:
Acute MI
Arrhythmia (too fast or too slow)
Out flow obstruction= aortic stenosis, hypertrophic cardiomyopathy)
Mitral regurgitation, VSD

Question 4

Describe Extracradiac Shock

Answer 4

Outflow obstruction= caused of decreased CO are due to external pathology

Problem with delivery

Pulmonary Emboli
Pericardial Tamponade
Constrictive pericarditis
Pulmonary hypertension

Question 5

Describe Hypovolemic Shock

Answer 5

Lack of fluid = decreased CO due to decreased preload

Problem with delivery

Diarrhea, vomiting, diuretics, sweating
Hemorrhage
Burns
Ascities

Question 6

Describe Distributive/Dissociate shock

Answer 6

Increased area for blood to disperse too

Increased CONSUMPTION/DEMAND
High output shock

Initially CO is increased then it fails
Decreased SVR or mal-distribution
Septic Shock
Spinal Cord injury
Anaphylaxis
Cyanide
Carbon monoxide

Question 7

What is the shock index?

Answer 7

heart rate/ systolic pressure
Normal index = .5-.7

Greater than 1 is ABNORMAL! (increased mortality)

Question 8

What is a good marker for monitoring the course of shock?

Answer 8

Lactic Acid

Also:
Level of alertness
Urine Output

Question 9

What should you think in a shock patient that has flushed with warm skin?

Answer 9

Distributive/Dissociative shock

Increased consumption!

Spinal cord injury, septic shock, anaphylactic shock

Question 10

What type of shock is common post operatively?

Answer 10

Extracardiac - PE!

Question 11

What should you suspect is there are many other neurologic symptoms? (numbness in limbs, etc)

Answer 11

Distributive/Dissociative

Spinal cord injury

Question 12

“Distant heart sounds” is a give away for what?

Answer 12

Cardiac tamponade!

Extracardiac (outflow obstruction) Shock

Question 13

What are some typical lab findings in shock?

Answer 13

HYPERkalemia (high K)
HYPOnatremia (Low Na)
Metabolic acidosis
HYPERglycemia
Lactic Acidosis

Question 14

What are classifications of systemic inflammatory response syndrome?

Answer 14

REQUIRES at least TWO:
Temp 38
Pulse > 90
Respiration > 20
PCO2  12000

Question 15

What is shock?

Answer 15

hypoperfusion of vital organs

Question 16

What does a Swan Ganz catheter measure?

Answer 16

Left ventricular pressure

Question 17

Father & mother w/ CAD at what age increases your risk factor?

Answer 17

Father

Question 18

What distinguishes Angina from MI?

Answer 18

Angina symptoms last LESS than 30 mins

Question 19

What symptoms would indicated unstable angina?

Answer 19

Increased duration, frequency, or intensity

New associated symptoms

Occurring with increasingly less activity or at rest

Question 20

What is the ST elevation criteria?

Answer 20

ST elevation > one box in all leads but greater than 2 boxes in leads V2 and V3

New LBBB

Question 21

Treatment for STEMI (Acute coronary syndrome)?

Answer 21

Fibrinoyltics (TPA, reteplase)
PCl with dilation and stinting
CABG = coronary artery bipass grafts
Medications-
Nitro
Morphine- for pain unresponsive to nitro