Multisystem 14%

Question 1

Cardiovascular Response to Sepsis

Answer 1

Increased Cardiac Output (first response)
Increased contractility
Increased heart rate
Decreased preload and afterload (due to massive vasodilation)

Question 2

Renin-angiotensin-aldosterone system is maladaptive in which type of shock?

Answer 2

Cardiogenic
Renin-angiotensin-aldosterone system causes vasoconstriction (increasing afterload) and retention of sodium and water (increasing preload).
This worsens the heart failure in cardiogenic shock.
Angiotensin-converting enzyme inhibitors are prescribed to block this maladaptive compensatory response to hypoperfusion in cardiogenic shock.

Question 3

What causes AKI in patients with MODS?

Answer 3

Renal hypoperfusion
MAP < 60 for at least 40 min can result in acute tubular necrosis and AKI.
Prolonged hypoperfusion is most likely cause of acute tubular necrosis with MODS.

Question 4

Anaphylaxis

Answer 4

First drug choice is Epinephrine

Symptoms occur within 5 to 20 minutes

Question 5

Epinephrine

Answer 5

Counteracts effects of histamine

Vasoconstrictor

Question 6

Colloids

Answer 6

Increase intravascular colloidal oncotic pressure.
Pull fluid from the interstitial space into the intravascular space.
Either large molecule proteins (albumin) or starches (hetastarch or dextran)

Question 7

Which Crystalloid is Preferred in Hypovolemic Shock?

Answer 7

Normal Saline

Question 8

Sepsis Triad

Answer 8

Exaggerated inflammation Excessive coagulation Impaired fibrinolysis

Question 9

Neurogenic Shock

Answer 9

Clinical findings related to loss of sympathetic nervous system innervation.
No a(alpha) and no b(beta) causing loss of vascular tone and decrease in systemic vascular resistance
Lack of b(beta) causes decrease in heart rate, contractility, and conductivity.

Question 10

Angioedema

Answer 10

Laryngeal edema

Can cause asphyxiation if severe enough and if anaphylaxis is not treated promptly.

Question 11

Class III hemorrhagic shock

Answer 11

Loss of 1500 to 2000 ml

Hypotension, Tachycardia greater than 120 beats/min, Respiratory rate 30 to 40 breathes/min

Question 12

Systemic Inflammatory Response Syndrome (SIRS)

Answer 12

Hyperthermia/hypothermia
Leukocytosis/leucopenia
Tachycardia
Tachypnea
Sensorium changes

Question 13

Which Organ System Results in Highest Mortality

Answer 13

Neurologic

Brain ischemia or hemorrhage

Question 14

Pulse & Associated Blood Pressure

Answer 14

Palpable radial pulse = systolic at least 80 mmHg
Palpable brachial pulse = systolic at least 70 mmHg
Palpable carotid pulse = systolic at least 60 mmHg